The discourse around sexual health is often centered around disease and the presence or absence thereof. It is also limited to persons who are deemed to be in their sexual prime. We must reimagine sexual health to encompass a positive, respectful and proactive approach to sexuality, sexual expression, relationships, communication and safety - across various life stages. In addition to this, people must have the right to pleasurable and safe sexual experiences.
In the past, most women's health initiatives have been focused on reproductive health and have failed to effectively address their sexual health. There is now a pressing need for patient education endeavours so as to bolster healthy outcomes not just for individuals, but also their families and communities.
Taboo surrounding women’s sexual health
We cannot address what we do not talk about. Sex and sexuality are still very taboo topics in India. For instance, Sexually Transmitted Infections (STIs) testing is not a very common practice in India. A lack of awareness about safer sexual practices and more importantly about the need for regular STI screening means a lot of sexually active women in India may not get tested. They are also not aware that all STIs are treatable and there’s also the added fear and stigma associated with a positive result. The consequences of undiagnosed and untreated STIs can be quite serious. For example, untreated chlamydia and gonorrhoea are big contributors to infertility in women. These are two infections that can be cured with a simple dose of antibiotics if detected early.
Intersections with other health issues
Sexual health is intrinsic to a person’s physical, emotional and overall well-being. Further, physical and mental health conditions can also impact a woman's sexual health and her relationship with her body and sexuality. For instance, Polycystic Ovary Syndrome (PCOS), which is a very common lifestyle disorder in women, can bring with it a myriad of mental health symptoms such as mood swings, lowered levels of self-esteem, and body image issues. In addition to this, the stress of having to cope with a chronic condition can impact one’s sex drive. Some physical symptoms of PCOS are weight fluctuations, excess facial and body hair, hair loss, acne and issues with fertility. This may make intimacy challenging and also negatively impact a woman’s sexual health.
Accessibility of care
It is impossible to talk about sexual health, especially in the context of women without a conversation around aspects of accessibility, consent, shame, stigma, violence and discrimination. Achieving a healthy sexual life for women requires them to be able to access discreet and liberal healthcare services, which are few and far in-between. Healthcare providers must actively enable self-reflection and candid communication as women may hide or downplay their symptoms owing to the fear of being judged. In addition to this, sexual health issues often require multiple touchpoints with professionals across various specialisations. This then has women running from pillar to post to access holistic care. In an attempt to bridge this gap, a few digital health companies are offering full-stack services ranging from teleconsultations with an array of specialists to diagnostics to long-term support programs.
Creating safe spaces for women to talk about their sexual health
We need to create safe spaces for women to talk openly about their sexual health. One such lesser-known issue is a condition called 'Vaginismus', which is defined as the inability to allow vaginal penetration of a penis, finger, tampon or menstrual cup due to a severe involuntary spasm of the vaginal muscles, despite the person’s definite wish to do so. This is an issue that is seldom spoken about and women endure painful sexual encounters and experience self-blame and feelings of inadequacy. This is where carefully designed support programs can help women overcome such chronic conditions. Dr Taru Jindal, a leading expert in the field in association with Proactive For Her designed a 6-week support program not just to enable women to heal from vaginismus but to also explore themes of pleasure and relationship harmony. The program has interventions by gynaecologists, trauma-informed mental health professionals, relaxation and pelvic floor therapists and intimacy coaches.
The way forward
We need to contextualise sexual healthcare in a woman’s identity location, spanning over her personal sexual preferences, relationships and cultural upbringing. Capacity-building around sexual communication with partners also forms a core part of care provision. I believe that there is a need for an equal partnership from patients when it comes to their healthcare decisions and we must actively combat concerns around medical fat phobia and mental health stigmatization. Through collaborative care, we need to change conversations to be more inclusive of different sexual health goals and we believe that achieving this will help us build communities that enable women to thrive and live their best lives.
The author is Achitha Jacob, CEO and founder of Proactive For Her. The views expressed are personal.
(Edited by : Jomy Jos Pullokaran)