In the Indian society people have some major expectations from a marriage. The married couple is expected to have sexual intercourse (marriage being the only legalised outlet for sexual release), beget children and raise a family as soon as possible.

We all take for granted that every married couple will be able to have sexual intercourse without any difficulty. We think that there is no need to educate the bridal couple and that they will manage to have sex automatically if they are sent into the bedroom on the nuptial night. But in reality, it is not easy. While it is true that the sexual urge or drive is instinctual and spontaneous, the sexual behaviour (including the sexual act) is not instinctual but learned. Couples may experience difficulty in performing the sexual act on the first day or night after the marriage. Some face problems later in life, even after a period of non-problematic sex life.

Sexual problems, irrespective of the causative factors, frequently cause serious psychological problems such as hostility between the marital partners and even complete breakdown of the marriage itself.

The Masters-Johnson Study

Till recently the management of sexual problems was very difficult and unsatisfactory. This was mainly due to the fact that the causative factors were not known to healthcare professionals. Hence qualified medical doctors were reluctant to prescribe remedies to these problems. This resulted in the public seeking help from unqualified people (quacks).

Thanks to Drs. Masters and Johnson, these lacunae have, to a great extent, been overcome. Masters and Johnson’s pioneering study clearly explained the sexual physiology (normal functioning) of the human sexual act, which was studied in a laboratory setting. Their studies were objective about the human sexual response. This research stimulated many health care professionals to take up the management of sexual problems on a full time basis. Thus sexual medicine emerged as a new discipline in modern medicine.

Common Sexual Problems

In Men

• Lack of or reduced sexual drive or interest.
• Impotence or erection dysfunction- problem in obtaining or maintaining a penile erection.
• Problems in ejaculation - premature ejaculations, inability to ejaculate during intercourse, retarded ejaculation
• Lack of pleasure in intercourse.
• Pain during or after intercourse or both.

In Women

• Lack of or reduced sexual interest.
• Inability to get aroused (Dry Vagina).
• Orgasmic dysfunction- inability to obtain an orgasm (climax) during intercourse.
• Vaginismus- unconscious or subconscious tightening of the vaginal muscles, preventing intercourse.
• Pain during or after intercourse or both.

Problems that both sexes may face

• Sexual orientation problems like homosexuality, lesbianism, bisexuality and transexualism.
• Body image concerns - under developed breasts, genitals, secondary sex characters etc.
• Faulty sex techniques leading to infertility.
• Paraphilias - abnormal sexual behaviour etc

It is a well-established fact that sexual functioning does not depend only on physical factors. The psyche or mind plays an equal role in sexual functioning. Moreover, sexual behaviour is not purely instinctual, but mostly learnt. Hence, it is very important to understand that, besides body organs, several other, (including socio-cultural) factors are involved during the sexual act.

Diagnostic Tools

Sexual medicine adopts a comprehensive evaluatory procedure in diagnosing sexual problems. The consultant obtains a detailed sexual history (preferably from partners, in case of couples who are married) and performs a thorough physical examination. After this, the necessary laboratory investigations are performed depending upon the contingency.

State-of-the-art diagnostic tools are available nowadays to identify the causative factors. Some of these are:

• Biochemical Tests
• Hormone Assays
• Penile Haemodynamic Studies
• Nerve Conduction Studies
• Ultrasound Scans
• Doppler Studies
• Rigiscan
• Psychological Assessment Tests

Once the causative factor is identified, the appropriate treatment strategy is offered to the patients.

Treatment Strategies

The treatment strategies include:

• Sex Therapy
• Sex Counselling
• Medication (treatment with medicines).
• Surgical(Corrective) Therapy
• Hormone Replacement Therapy
• Vacuum Suction Devices
• Penile (Intracavernous) Injections
• Penile Implant Surgery
• Behaviour Modification Therapy
• Supportive Psychotherapy
• Marital Therapy