At half past midnight in a busy emergency room in a Delhi government hospital, an unconscious patient in his mid-20s was wheeled on a stretcher. His relatives told us that he tried to end his life by drinking a toilet cleaner. Our team rushed into action and was able to stabilise him thankfully. After he came to his senses, we found out that the young rickshaw puller had tried to kill himself because he was suffering from erectile dysfunction and his wife had left him. He’d spent close to Rs 1 lakh on snake oil treatments, running from one quack to another in desperation. This in a country where a generic Viagra pill costs less than Rs 25. This in the national capital. What happens in the hinterlands is definitely beyond the pale.
This sexual health month, we talk about the silent epidemic of sexual dysfunction in rural India.
Globally, 1 in 4 men suffer from at least some form of sexual dysfunction. The numbers for women aren’t very different either. One of the major reasons these dysfunctions go untreated or mistreated is the taboo around the topic. But, changes in societal attitudes take decades and can’t be rushed through. While government initiatives like the National Health Mission and National AIDS Control Organisation have made substantial inroads in increasing access to treatments related to maternal and infant mortality and sexually transmitted diseases respectively, the more routine sexual disorders have gone unnoticed.
The abysmal doctor-patient ratio in small towns and rural India is just one part of the problem. The fact that most people there live in tightly-knit small communities where more people know each other adds another level of complexity to it. Data from an ongoing study undertaken by us and our colleagues in Bihar suggests that the number of patients that consult a doctor for sexual dysfunction is almost negligible.
This, added to the misinformation around sexual health, creates a vacuum ripe for quacks to fill. The quacks are usually on the move and sit at a place only once or twice a week. Their lack of rootedness in a particular locale allows the patients some level of impersonal touch to the communication that they aren’t able to find with a local doctor. According to the Indian Medical Association, there are at least 10 lakh quacks practising in the country, many of them proclaiming to cure sexual dysfunction. They usually prescribe self-prepared and untested traditional medicines that don’t work and in many cases, prove fatal for the patients. The same is true for most over-the-counter traditional medications available to treat such dysfunction.
A 2022 NITI Aayog study found that the average blood lead level in India is 4.9 μg/dl. The numbers for the Hindi belt go up to 10.4 for Bihar, 8.7 for Uttar Pradesh and 8.3 for Madhya Pradesh. For comparison, these numbers globally average between 0.8 to 3.2 μg/dL and anything above 3.5 μg/dL is flagged as a concern requiring medical intervention by the Centre for Disease Control (CDC) in the United States. Among other reasons, NITI Aayog puts traditional medicines sold over the counter or by quacks as a primary source for such lead poisoning that results in an estimated 2.3 lakh deaths annually in India.
To address this, we recommend an approach based on Rohini Nilekani’s framework of demarcation and continuum among samaaj, sarkar and bazaar (society, state and market). Given the high disease burden of sexual dysfunction, an increased focus on the same is called for in our national and state health programs. This can be done by incorporating it into the National Health Mission via the Primary Healthcare Centres (PHCs). But in order for it to work, the government will need to impart special training to the last-mile healthcare workers. Currently, sexual medicine is not recognised as a separate discipline in India and is scattered among andrology, urology, dermatology and psychiatry. A Medical Council of India recognised 6-month or year-long fellowship in Sexual Medicine after MBBS can help out in regularising the discipline. Various certifications by the International Society for Sexual Medicine provide a template for such a fellowship.
Teleconsultation circumvents the taboo and shame attached to these disorders and provides much-needed confidentiality to the patient. It can prove to be one of the most important tools in enabling access in this context. The government should facilitate private initiatives in this area and should not over-regulate or restrict teleconsultation/e-pharmacies as it can prove to be counter-productive. Once the initiatives around increasing access start showing results, a crackdown on quacks is desirable as they not only benefit from making the topic a taboo but also perpetuate it by offering snake oil treatments that don’t work.
The long-term solution to these is sensitising the population on sexual health and enabling their access to quality information on the same. Introducing elements of sexual health education in schools can help. The samaj (society) element of it comes in the dissemination of information and awareness around sexual health through mass media and popular culture. Movies like OMG 2 show that such a revolution might be in the offing.
Rural India needs a solution to this silent epidemic mired in shame and the time to act is now.
The authors are co-founders of a rural health tech company Raazapp. Views expressed in the above piece are personal and solely that of the author. They do not necessarily reflect News18’s views.
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