(Tread gently. This article has some potentially disturbing content)

If the first words that come to your mind when someone says ‘sex’ are syphilis, rape and unsafe abortions, then one can safely say that you are not exactly in a sex-positive frame of mind.

As a young medical student in the late 1980s, accurate information on sex was extremely scarce. There was no Internet. There was no sex education in schools. No Dr. Watsa’s column[1]. There was less than zero possibility of parents giving one ‘the talk’. Then we enter medical college and dissect a penis or a vulva within the first few weeks of joining. Talk about a steep learning curve! Except of course these organs are on a body that has been in the formalin tank for a week or more, so it isn’t exactly the most attractive introduction to the parts.

We study physiology for a year and a half. Nervous system, digestive system, endocrine system, circulatory system. We hear the famous joke of a Professor asking a medical student what a five- letter word that starts with P and dilates up to five times on excitement is. She blushes and says she couldn’t possibly say the word and he tells her dryly that her imagination is stronger than her medical knowledge. The answer is apparently ‘pupil’.

But that joke is probably the only thing that alluded to the physiology of sex. We have no clue who Masters and Johnson or Kinsey are. There is no more scientific information available on foreplay, orgasms or masturbation than the popular pornographic material of the day can offer.

The next we hear about sex is in the lectures on medico-legal concerns that involve the definition of virginity (why is it even a medical concern?!), rape (with the notorious ‘two-finger test’ which has now been taken out of the guidelines), and ‘unnatural sex’ which includes lesbian and gay sex as well as bestiality and necrophilia.

Quite a range to suddenly be acquainted with. The bestiality lecture leads to much alarm and giggling, with much hilarity during the oral exams when baffled students answer ‘parrot’ and ‘horse’ to questions about potential animal partners.

The next time we learn about anything related to sex is during the third year when the ObGyn lectures explain about painful sex (dyspareunia), the husband stitch (to be used to tighten the vagina post-delivery so that the husband, poor man, should not forgo his pleasure due to a ‘lax’ vagina), screening for sexually transmitted infections for pregnant women, and, of course, once again, sex in the context of rape and unwanted pregnancies.

(The ObGyn emergency room is where the children who had been sexually abused used to be brought in. The youngest we had while I was a resident was a 3 year old.)

We learn some more about sex during the Venereal Diseases term where we sit and watch slide after slide of ulcers, pus-filled organs, rashes, scars, both on real organs and under the microscope.

One more red card for sex.

In Psychiatry we learn about the use of electro-conversion therapy (ECT) as a treatment for homosexuality. We learn it in the same way as we learn everything else. Word perfect and ready to write up in an exam. Who cares what it means? As if in the 1980s we knew any ‘homosexuals’! None of us were –  that was for sure, right?

In Preventive and Social Medicine sex is mentioned indirectly  – through the great and critical need for contraception due to the ‘population explosion’ in India.

This is it.

This is what a young medical student is taught. Even in the government programs that we implement through the public sector hospitals the focus is always on reproductive health, and there is almost no mention of sexual health.

We were not monks nor were we isolated from the outside world, so we picked up the same prejudices and stigma around sex that everyone else in society did. We learnt to look down upon unmarried girls who sat in our antenatal wards for months on end because they had come in too late for an abortion and needed to deliver and give up the baby for adoption before they could go back to their families and society. That was caused by sex.

We saw small girls with vaginas torn from being raped. That was caused by sex.

We treated patients day after day, who waited for their test results outside the pathology lab, with syphilis, chlamydia, gonorrhoea – all men, oddly enough.  We routinely asked them, “Bahar gaya tha?” meaning “Did you have sex with a sex worker?” We knew that was ‘bad sex’.

Year after year, for 5 to 8 years this is what we were taught, and this is what we did, and we saw only the pathological consequences of sex or learnt about potential ‘bad sex’ which had legal consequences. Why would one imagine that moral consequences were not intricately tangled up too?

It is not a coincidence that the women healers who were branded as witches were believed to be flying off on a broom at night and having sex with the devil. It is no coincidence that ‘modern’ medicine that emerged with men as leading lights after having burnt or drowned all the witches, is never going to be women-centred. It is no coincidence that the term ‘hysteria’ was coined as a catch-all term for the women who showed signs of emotional or sexual frustration and the treatment offered was to remove the uterus, the hysteros.

If anyone expects that after this ‘indoctrination’ your doctor will emerge as a sex-positive, gender-sensitive and rights-affirming practitioner, just stop and ask yourself: How? Why? In what reality would that ever be possible?

There is never a single conversation about sex, the role of sex for power and pleasure, the evolution of sex, the sex act, sexuality (even as a term, let alone as a spectrum), gender, misogyny, patriarchy, circles of respectability, legality, and justice in the medical curriculum.

So if we expect our healthcare providers, whether a doctor or a nurse, to have a healthy attitude towards sex and sexuality, we need a huge reform of the way medicine is taught in medical and nursing colleges. We need to bring in all these issues to them when they are 18 and starting to learn, and not expect them to stumble upon it only after they are qualified and grown-up, or else they will never find the language and right attitude and remain a prejudiced, moralistic doctor or nurse with a negative attitude towards sex, believing that nothing good can ever come of it.

[1] Dr. Watsa is India’s best-known ‘sexpert’ who writes regular newspaper columns answering people’s questions.

Cover Image: Pixabay