Women's Sexual Health Has Been Ignored for Too Long, and Patients are Paying the Price?

Mohali: The clinical damage in women's sexual health is rarely done by the condition itself. It is done by the delay.

Vaginismus, female sexual arousal disorder, female orgasmic disorder, low sexual desire and pain during intercourse are all treatable. What makes them difficult in Indian practice is that patients typically arrive years after onset, by which point the original problem has acquired several others.

An epidemiological study of an urban population in Mysore found sexual dysfunction in close to 27% of women surveyed, with lack of desire most commonly reported, followed by difficulties with arousal, enjoyment and lubrication. The same study recorded low reporting rates and low treatment rates. The gap between those two figures is where the harm accumulates.

What delay actually does

“A woman who has experienced pain during intercourse for two years is not presenting with the same condition she had at the start,” says Dr. Vanshikha Arora, Founder and Chief Medical Officer of UnTaboo, who holds an MBBS and a Fellowship in Psychosexual Medicine from JSS Medical College and Hospital, Mysore. “There is now an anticipatory response layered on top of it, often muscular guarding, frequently avoidance, and usually a relationship under strain. We are treating three problems instead of one.”

The pattern compounds. Pain leads to anticipation, anticipation leads to tension, tension worsens pain. By the time a woman seeks help, untangling which element came first can itself require assessment.

The delay is rarely a matter of months. In gynaecology practice, the point at which a woman finally presents is often decided by something other than her own discomfort.

“I often see patients of vaginismus who have been in their marriage for many years but show up at the OPD only when there is a huge pressure for child bearing from the family. Many at this stage will not even be receptive to the treatment of the sexual problem,” says Dr. Sanjana K, an obstetrician and gynaecologist with over nine years of experience, who advises unTaboo on women’s sexual health protocols and psychosexual care pathways.

That last observation carries the real clinical weight. A woman who arrives under family pressure has not decided to seek treatment. She has been sent. The consultation begins from a position that makes engagement harder, years after the point at which the same condition would have been straightforward to treat.

Conditions that are treated as personality

Part of what sustains the delay is that these concerns are rarely presented to women as conditions at all. They are experienced as personal failings, as relationship difficulties, or simply as how things are.

They are none of those. Some causes are hormonal. Some follow childbirth, surgery, or a medication a woman is already taking. Some are conditions such as PCOS presenting through a symptom nobody connected back to it. Some are psychological, and many are a combination.

“When a woman reports pain during sex, that is a clinical symptom with causes that can be identified and treated,” Dr. Vanshikha says. “It is not something she is expected to tolerate quietly.”

The framing matters clinically, not just rhetorically. A woman who believes she has a condition seeks treatment. A woman who believes she has a temperament does not.

Why nobody asks

The other half of the delay sits with the healthcare system rather than the patient. Sexual health is rarely raised in routine consultations, including in the specialties best positioned to raise it.

“Sexual history is almost always neglected, even in gynaecology OPDs,” says Dr. Sanjana K. “Common reasons being busy practice, assumed irrelevance, discomfort opening up a sexual discussion, fear of being judged and so on. The total neglect of sexual health in the medical UG and PG teaching curriculum is to be blamed too.”

She makes a further point that reframes what such a question is actually for. “Most practitioners may not be aware that evaluating a sexual health concern surfaces many important areas,” she says. “What the patient comes with is just the tip of the iceberg.”

That is an argument for routine enquiry on clinical grounds rather than compassionate ones. A sexual history is not only a route to treating the presenting complaint. It is a diagnostic window onto conditions a patient has not thought to mention, and onto some she may not know she has.

The cost of asking is a few seconds of a consultation. The cost of not asking is measured in the years of additional problems that accumulate while nobody does.

What changes the timeline

Privacy alters the arithmetic for many patients. For a woman, the barrier is often not the consultation but everything preceding it: being seen entering a clinic, explaining an appointment at home, sitting in a waiting room evidently designed for someone else. A private consultation removes obstacles that have nothing to do with medicine and everything to do with whether the appointment happens at all.

Assessment then needs to be as thorough as it would be for any other complaint, covering physical health, hormonal changes, medications already being taken, psychological wellbeing, stress, lifestyle and relationship factors, with diagnostic tests or psychological input where indicated.

“The biggest obstacle is not treatment,” Dr. Vanshikha says. “It is that most women do not know there is anything to treat. Once they know, the medicine is usually the straightforward part.”

Dr. Sanjana K is a senior advisor at unTaboo, guiding women’s sexual health protocols, clinical standards and psychosexual care pathways. She holds an MBBS and an M.S. in Obstetrics & Gynaecology (Gold Medalist), along with a DNB, MCCG and FRGUHS in Fetomaternal Medicine, and a Fellowship in Psychosexual Medicine. Registration number KMC119400.

Dr. Vanshikha Arora is Founder and Chief Medical Officer of unTaboo. She holds an MBBS and a Fellowship in Psychosexual Medicine from JSS Medical College and Hospital, Mysore.