“Fed up... can’t tolerate any more. It wasn’t like anything I’d ever imagine, six years and four months...I’m a man with flesh and blood, emotions....NO SEX!” John boiled with anger and frustration while Julie blushed, gazing down with guilt and shame. Referred from the family court, both of them were in front of the doctor.
John had filed a divorce suit against his wife alleging unconsummation of marriage due to her fear and non-cooperation. After the hearing and family counselling sessions, the court felt a professional evaluation is warranted and ordered the couple to undergo the same at Dr Promodu’s Institute of Sexual and Marital Health. The hospital submitted a comprehensive report to the court within a week stating that Julie was suffering from vaginismus, a psychological problem treatable and curable. Armed with the expert opinion, the court had no hesitation in ordering for treatment and dismissed the divorce petition. Despite fear of pain and bleeding while attempting coitus, she recovered fully within just three weeks of sex therapy. They are now living abroad happily with two children
By Sumithra Sathyan
Marital adjustment problems and divorces are steadily on the rise in our society as is evident from the divorce petitions piling up each day in the family courts. Sexual problems are one of the major causes. The nucleus family structure, demands of job, parenting and other factors weigh heavily on finding enough time for love and sex. Physical and mental exhaustion at the end of the day is another reason for avoiding sexual activities. Other challenges to one’s sexual life are personality factors, attitudinal problems, unhappy family circumstances, emotional baggage, lack of interest, physical illness etc. The good news is that most of these problems hampering healthy sexual life are treatable. All research reports published on this subject have unanimously concluded that a healthy and satisfying sexual life is essential for mental and physical wellbeing.
In an interview, Dr K Promodu, well-known Sexologist and Clinical Psychologist and Chairman & Managing Director of Dr Promodu’s Institute of Sexual and Marital Health, tells Future Medicine that for a healthy new generation, we need a healthy and stable family atmosphere. Dr Promodu’s Institute of Sexual and Marital Health, Kochi, Kerala, is a pioneer in this field and the only hospital in the country exclusively devoted for the treatment of sexual and marital problems.
What is your opinion about the role of sex in a successful married life?
The role of sex is multifarious such as reproductive, recreational and relational. If God decides to ban sex, what will be the fate of humanity? Certainly that will be the end of the human race on Earth. So there is a reproductive need. Recreation is an activity which gives pleasure. Sex is one of the most popular and inexpensive recreation within married life. Here the goal is to strengthen emotional bondage and intimacy through deriving pleasure or orgasm for both partners. When these goals are achieved without causing distress to the partners, it is a healthy and happy sexual act. Sex is the glue that holds a marriage together. Healthy sexual act evolves from equality, mutual ,respect , genuineness , unconditional love , mutual understanding and effective communication , in a nutshell good relationship between the partners.
While for many other species, sexual behaviour is biological, controlled and limited to the purpose of reproduction, for the humans it is not physical alone but psychological or emotional also. Any risk of failure in sex, rejection, humiliation, exploitation etc is a major concern and often culminates in sexual dysfunction and related problems. Love and sex in marriage go hand in hand to make a successful, stable relationship.
What are the major physical conditions that can hinder or affect a healthy sexual life?
Various physical diseases like diabetes mellitus, hypercholesterolemia, hypertension, arthritis, mental illness, systemic illness such as cardiovascular conditions, neurological disorders, side-effects of medicines etc. can ruin the sexual life. Diabetes is one of the commonest causes which can impair sexual functioning and it is more predominant among men. Diabetes leads to damage of corpora cavernosa(Spongy tissues inside the penis) by producing impairments in nerve, blood vessels and smooth muscle. It is estimated that majority of men with diabetes are prone to develop erectile dysfunction. Another common cause, yet often neglected is elevated cholesterol. The low density lipoprotein (LDL) popularly known as the bad cholesterol slowly builds up in artery walls causing a thick plaque leading to narrowing of arteries, thereby restricting the blood flow to the penis and resultant erectile dysfunction. The very same pathogenesis is responsible for heart attack also.
Doctors often tell some patients that “Your ED is psychogenic”. Is it true?If so, what are the psychological factors affecting sexual health?
Well it is a good question. Last month, a couple came to me with history of an unconsummated marriage of three years and seven months. He couldn’t maintain erection despite taking high dose of Viagra. Our investigations proved that the cause of his ED was psychological. On further enquiry, very reluctantly he revealed that at the age of 19, he attempted sexual intercourse with a married woman and he lost erection during the act on hearing some noise outside. He tried repeatedly to regain erection but in vain. He became anxious and worried in the bedroom as these memories continued to haunt him. This anticipatory anxiety was the culprit leading to non-consummation of marriage for many years which could be resolved easily with psycho sexual therapy.
Erectile dysfunction denotes an inability or difficulty to develop and or maintain an erection sufficient for satisfactory intercourse. Psychological and somatic processes are usually involved in the causation of erectile dysfunction. Starting from the relationship issues to core medical problems, many factors can impair a man’s erection. The common non-medical issues are relationship between the couple and with their in-laws, faulty communication, broken family atmosphere, occupational stress, interpersonal and intrapersonal conflicts, pasttraumatic experiences, performance anxiety etc.
What are the common sexual dysfunctions you come across?
Human sexual response is a psycho physiological experience with four phases- desire, excitement, orgasm and resolution. Problems occurring in any particular phase of this cycle can lead to sexual dysfunction. Sexual dysfunction refers to any problem during any stage of the sexual response cycle that prevents the individual from engaging in a sexual relationship as he or she would wish. It can be broadly categorised into desire disorders, arousal disorders, orgasm disorders and pain disorders. Sexual desire disorder is lack or loss of desire to have sex; sexual aversion disorder is a sense of dislike, hate or aversion to sexual activities; loss of erection in men and lack or loss of lubrication in women are arousal disorders; orgasmic disorder is an inability to achieve an orgasm, or it is delayed markedly, premature ejaculation is an early orgasmic response; dyspareunia (Pain during intercourse) and vaginsmus are pain disorders.
Out of 12,718 cases seen at our hospital from 2006 to 2012, more than 80 per cent patients comprising of 9,605 men and 1,372 women had sexual problems. Most of the men had erectile dysfunction (59%) and premature ejaculation (29%) and while women had vaginismus (58%), desire disorder (13%) and orgasmic dysfunction (12%).
How do you evaluate these cases at your hospital?
We do have a set of evaluation programmes for different group of patients. Each patient is first seen by a general duty medical officer who plans the primary level investigations , Then, all male patients are examined by our andrologist who advises level 2 investigations , where required. Female patients are examined and evaluated by our gynaecologist who advises second level investigations if necessary. All these patients are also seen by the sexologist. Based on the clinical evaluation, investigations, examination findings and post evaluation discussions among different specialists , we arrive at the final diagnosis and plan the treatment .
What are the treatment methods for common sexual dysfunctions?
Broadly treatment methods include medication, psychological methods such as sexuality education, sexuality counselling, individual sex therapy, couple sex therapy, marital therapy, cognitive behaviour therapy, operations like penile prosthesis implant surgery, venous ligation, microscopic microsurgical varicocelectomy, vasovasostomy, cosmetic circumcision and other surgeries.Treatment is planned based on the diagnosis, prognostic factors, patient compliance and affordability and carried out by our team of specialists. Wherever indicated , patient is referred to marital therapist, diabetologist, cardiologist or any other relevant specialists as per the need of the patient. Whatever may be the problems, scientific and effective treatments are available today .
Tell us about sex therapy?
Sex therapy is one of the most common treatments for sexual problems.It is also known as psycho sexual therapy. Sex therapy is a form of treatment of sexual problems by modifying and incorporating sexual experiences with the help of psychological methods. In sex therapy, specialised clinical skills are used for helping men and women as individuals and/or couples to solve or modify their sexual problems. During the individual and conjoint sessions, the sex therapist will assess their knowledge about sex and sexuality, may give sexuality education and counselling to remove their myths and misconceptions. Certain homework assignments may be prescribed depending on the type and nature of problems. This includes reading books, exercises, activity schedules, prescription of a particular behaviour pattern, communication skills etc. These are exclusively designed at each session based on the nature and problems of the individual or couple to suit their needs to desensitise or modify specific symptoms and to enhance the performance. Sex therapy is not directly teaching sex or asking the patients to perform sex in front of the therapist as is the popular misconception. It is the most effective tool for the treatment of sexual problems of psychologenic origin. For cases with organic or mixed etiology, a combination of medicines and sex therapy gives better results than trying one of these methods alone .
What is penile prosthesis implant surgery?
Penile prosthesis implant surgery is usually done for those patients whose erectile dysfunction cannot be effectively managed with other methods of treatment such as medicine or sex therapy. Prostheses are medical devices made of silicone material. The simplest type of prosthesis consists of a pair of malleable or bendable rods which are surgically implanted within the corpora cavernosa of the penis through two small incisions made on the body. Inflatable devices are also available. Some of the implants contain a stainless steel wire inside which is wrapped in a silicon fabric so as to make it stronger and easily flexible. It is a life long permanent remedy for erectile problems. Advantages of this treatment are: a) after the implant surgery, patient need not take any erectogenic medicine to induce erection,b). it is a lifelong remedy for erectile dysfunction,c). sexual contact can be continued without any loss of rigidity even after ejaculation.
How is your experience with penile prosthesis implant surgery? What is the level of patient’s satisfaction?
We have done the highest number of penile prosthesis implant operations in South India and the experience is extremely good in terms of operation procedures, absence of complications and highest level of patient satisfaction. We have also used all types of implants such as malleable, non-malleable and inflatable devices. All our patients who underwent implant surgery are extremely happy and able to perform very well. One of our patients, a 67 years old man whom we operated in 2006, visited us with his wife in March 2013. He told us that “we began to enjoy actual, good sex only after the implant operation”.
What inspired you to start a hospital for sexual medicine when even talking about sex is considered as a taboo?
As I mentioned earlier, sex is one of the basic needs of human being. Everyone experiences sexual problems and concerns at some point of time in their lives, but silently suffer as they are ignorant of whom to be consulted for a solution. No wonder quacks fish in troubled waters and exploit their ignorance for fiscal gain. Most of the qualified medical professionals shy away due to the social stigma; a few others ignore it as a minor problem. This persuaded me to think differently and venture into this unexplored area to provide relief to the suffering fellow human beings.
(Dr K Promodu is the Founder and Managing Director of Dr Promodu’s Institute of Sexual & Marital Health.He is a Clinical Psychologist, Sex Therapist and Researcher practising in the field of sexual medicine for the past 23 years. He received the Psycho National Award in 2013 from IACP at the national conference held in All India Institute of Medical Sciences, New Delhi. He is an active member of International Society for Sexual Medicine and World Association for Sexual Health.www.drpromodusinstitute.in)