Roadmap for sexual medicine: Agenda for Indian Psychiatric Society

Byline: T. Sathyanarayana Rao, Ajit. Avasthi For life to be born and perpetuate, union of the female and male is quintessential across species. For thousands of years, sexual pleasure has been depicted in various hues; darker and lighter, enraging and soothing. Sex has been revered, worshipped, followed and yet tabooed, looked down upon, considered a vice to protect oneself from. No single thing about life is so variedly thought of as is sexual union. Artists have symbolized sex in various forms expressing through words, paintings, and sculptures. Nonetheless, sex continues to be talked about in hushed tones, not to be discussed beyond closed doors. In such a scenario, the good and ills about carnal union remain undisclosed and many a suffering unknown. Men and women undergo great distress from sexual problems but help -seeking is vehemently avoided. When any help is sought, it is from friends, local healers and self proclaimed doctors who promise guaranteed cure within 24 h. With local media flashing such attractive advertisements, the sufferers easily fall prey. To say the least, most of the people suffering from sexual problems never reach the 'doctor' to seek medical advice. This is especially true for our country. Against this background, the initiative taken by the Indian Psychiatric Society to provide a special platform for sexual medicine is rather commendable. The Continuing Medical Education (CME) session that was held in Ahmedabad in the year 2008 amassed expert opinions and brilliant suggestions. This effort has paved the way further and strengthened the foundation for the science of sexual medicine in India. On the clinical front, the Indian Psychiatric Society (IPS) has already taken an extremely crucial step, i.e. the IPS has generated the clinical practice guidelines[sup] [1] for sexual disorders. These clinical practice guidelines provide a comprehensive review of Indian research and moreover, include management algorithms for various sexual disorders. This effort is definitely bound to make a significant impact on the clinical practice in this field. Research and management guidelines are still conspicuously absent for paraphilias and gender identity disorders. Where does sexual medicine stand in terms of general medicine and psychiatry and behavioral sciences? General health is reflected through various biological functions of the human body such as appetite, sleep and libidinal drive. Sexual health forms an integral part of general health with both physical and mental components to it. Both physical and mental fitness ensure healthy sexual life. Physical illnesses such as diabetes mellitus and hypertension affect various systems including cardiovascular and nervous (including autonomic) systems. With these vital systems playing important role in the execution of sexual functions, it is natural that sexual health is affected adversely. In other words, sexual health is closely intertwined with physical health. So, the integration of sexual medicine with other branches of medicine is absolutely essential, but has not yet occurred in a significant way. The importance of sexual health in psychiatry, to say the least, is immense. Primary sexual problems affect overall mental health of the individual and the reverse holds as much truth. Anxiety disorders and anxious predispositions have enormous bearing on sexual functioning, whereas changes in libido accompany mood disorders. Not just that, these disorders are of relevance but also the psychopharmacological agents cause a myriad of sexual side effects. Let us have a status check on where we stand currently in this field and where we lack. Sexual problems are highly prevalent in men and women, but are highly under-recognized and under-reported. Majority of epidemiological studies of erectile dysfunction and premature ejaculation are conducted on clinical populations. The numbers generated are far from reality. …