In a room full of budding doctors and their mentors feasting on every patient walks in, eyes glistening at the sight of a rare sign they spot or a “ whoosh “ of the murmur they just heard. Alas if the unfortunate patient confesses to have a sexual problem; the hush that falls around the room when sexual health comes up, thats when you caught the elephant in a room full of top educated professionals.The truth is sexual dysfunction is not rare, nor is it trivial yet, most of us junior doctors and even many of our teachers would rather talk about kidney stones than premature ejaculation or vaginismus. That has to change, at earliest.
Sexual medicine sits at the core of holistic healthcare. Think about it: someone dealing with erectile dysfunction, low desire, or painful intercourse isn’t just dealing with a “private” issue. These problems ripple out hurting relationships, mental health, confidence, and sometimes, even the motivation to seek any healthcare at all. Meanwhile, the social stigma and lack of open conversation means patients hesitate to seek help, and doctors struggle to give it.
Here’s the thing sexual health education in India is patchy at best. We look up the weekly paper tabloids and binge watch sex education series on netflix in the name of sex education. All medical education curriculum taught us, by showing how flowers pollinate early on and lectures on contraception and STD’s .Everything else? It’s a blur, often skipped over due to embarrassment or “lack of time.” When you do face a real patient with sexual dysfunction as a junior doctor or at a PHC chances are you’re improvising, Googling under the table, or just referring onwards, hoping someone else will handle it better.
Clinical case discussions rarely cover things like erectile dysfunction, female sexual pain disorders, or LGBTQIA+ issues.There’s minimal structured guidance, no clear mentors, no standard clinical protocols for sexual complaints in most hospitals.
Let’s not sugarcoat it. The first time a patient sits across from you and quietly admits, “I can’t perform,” it’s awkward. Both sides are nervous. Impulsively we think its a porn addiction or he’s a pervert or have a small laugh inside our head. Challenges range from not knowing how to respond with empathy to what to ask next, to referral confusion, to the sheer lack of safe spaces for these conversations.
This further has a domino effect on the young budding doctors of feeling helpless, and the guilt of letting someone down after a vague or rushed referral and self doubt.
As its not every day patients or relatives disclose such issues unless they have utmost faith and trust on that doctor.
Then comes the Question : whom to refer ? Patients have a tough time getting shuttled inter departments between urology , gynaecology ,dermatology , finally landing with psychiatrists this also adds on to the financial and mental burden of being shunned from one opd to the other having to repeat the same ordeal to different doctors only to hear “ its not our problem to solve “
That brings us to Why Departments Aren’t Just a “Nice to Have” They’re Fundamental
Structured departments in sexual medicine aren’t about formality they’re about giving patients real care, and doctors real tools. Right now, the buck is being continuously passed. Sexual health needs to be nested within confident, knowledgeable teams that cut across disciplines. Not only do departments train us scientifically, but they signal to patients: your concerns are valid and treatable.
Lack of departmental ownership is a recipe for clinical confusion and unmet needs.
Scientific progress, better research, case audits, systematic data collection only happens when someone is responsible and invested.
Setting up these departments and post-grad programs is not just plugging a gap. It’s creating a culture that collaborates where urology, psychiatry, dermatology, endocrinology, neurology, medicine, and surgery pool their expertise. Only then can we approach the bio-psycho-social reality of sexual dysfunction.
India has the clinical volume, but we need to channel it into robust learning and research.
Interdepartmental collaboration isn’t extra; it’s the bare minimum for meaningful care in sexual medicine.
Clear steps: curriculum reform, dedicated faculty, structured clinics, interdisciplinary grand rounds, and practical mentorships.
Almost every intern or resident has a story including mine , moments of uncertainty, wanting to help but not knowing how. I remember the embarrassment of my early consultations, but also the relief for both me and the patient when genuine, nonjudgmental care broke the ice. These lived realities reinforce structured support and upskilling aren’t optional, they’re vital. With the right mentorship, we build trust not just knowledge, but confidence for ourselves and dignity for our patients.
Keep ignoring this, and nothing changes: patients get subpar care, stigma snowballs, and medical professionals remain awkwardly unprepared for a conversation that should be second nature. But with dedicated sexual medicine departments, post-grad training, and a visible, multidisciplinary approach, we will turn the tide.
Future doctors must be equipped to handle sexual health issues ethically, confidently, and with real clinical skill. By normalizing sexual medicine, we signal respect for the whole person, not just their list of diagnoses.
Time to Lead, Not Follow
India’s medical colleges are at a crossroads. The old way double entendre, referral roulette, bashful teaching isn’t just outdated, it’s a disservice. It’s time for us, as the upcoming generation of doctors, to demand and build sexual medicine into the heart of medical education. Not just someday but now.
Dr. Nikunj Gokani