Next to survival, the most primitive & primal human instinct is SEX. It is inevitable- almost. The universe would have come to a stand-still if there was no sex.

Inevitable or not, sex and sexuality are important for personality development & well-being. They are inherent, inevitable components of one's overall personality.

You can not be a complete self & possess a good personality, without being a congruent sexual self. It is not possible to contribute effectively to self or society if sexually inadequate or frustrated.

An individual's happiness revolves around this healthy sexuality which is developed. Likewise the art & the science of performing sex are developed- though sexual instinct continues to be natural, inherent & spontaneous.

To develop a healthy personality, what is required is grooming of appropriate sexual personality & learning appropriate sexual behavior. This is possible only if one acquires the right perspective of sex whether by experience or with the help of professional counselors or therapsists.

No. Sexual interaction is not only a means for procreation but is also an end in itself for pleasure. Scriptures like Kamasutra, Sushrat Samhita, Charak Samhita; and sculptures like Khajuraho, Konark & many other temples where sex has been depicted on the walls bear testimony to the sanctity attached to sex by our forefathers.

Sex is the most primitive & primal human instinct; second only to survival.

Sex, besides Procreation & Pleasure, is important for Physical & Mental Health.

Its role in strengthening the bonds of intimacy between two steady partners is also well recognised.

On the psychological & emotional fronts too, an active sexual life has plenty to contribute. It is considered to be a stress buster. It releases physical & mental tensions, gives a sense of psychological fulfillment & enhances one's body image.

Some have talked very passionately of role of sex in spirituality wherein it has been equated with salvation ('Nirvana' or 'Moksha'). There are ancient references which say that sex (Kama) is one of the 3 doors (dwars) or paths leading to salvation (Moksha)- the other 2 being riches & duty (Dhan & Dharma).

Even present day contemporaries echo similar views. Dr Deepak Chopra, M.D, a prominent voice of Eastern philosophy & Chairman and co-Founder of the California-based Chopra Center for Wellbeing has this to say 'The peak experiences of sexuality such as orgasm, are characterized by a state of consciousness where there is a sense of timelessness, loss of ego, naturalness, vulnerability, surrender and defenselessness. This is a spiritual state. If we could be like this all the time, we would be enlightened'.

Different trials have shown an irrefutable correlation between the levels of Testosterone- the main male sex hormone on one side; and the mental health (depression), the cognition (risk of memory loss, Alzheimer disease), the muscle mass & the bone density (osteoporosis) on the other side. People, who indulge in regular sex with a steady partner, tend to stay healthier even in old age. Various researches show that a regular sex, with a caring partner:

Burns calories & tunes Muscles.

Improves circulation reducing risk of Cardiac diseases.

Relieves Migraine, reduces Arthritic pain.

Slows down age-related changes like Osteoporosis, Memory impairment (Alzheimer).

In WOMEN, regulates Periods, makes Menopause easier; lessens Miscarriage/Stillbirths; increases Fertility & reduces Menstrual cramps.

Releases physical & mental Tensions.

Enhances Body image & counters depression. It is rejuvenating, leaves an afterglow, makes one look younger. It also gives a sense of fulfillment- Physical, Psychological & Emotional.

Everybody seems keen to know about sex, but few are willing to talk about it openly. This results in acquiring misinformation from unauthentic sources, leading to misconceptions. Also because Sexual/Psycho-Sexual Medicine in our country is not a well established, well defined, scientifically practiced stream of Medicine; the quacks monopolise this practice. The sexual myths & misconceptions thrive because of these quacks, and the quacks thrive because of these myths & misconceptions.

Sexual problems arise either because of Psychological reasons (mind) or Physical reasons (body). However, it is well accepted now that all the sexual problems of even physical origin, ultimately become Psychological because of 'fear to perform' or what is called 'Performance Anxiety'.

To have a healthy sexual life, the 'mind' & the 'body' are required to work in tandem and 'the connect' between the two too, should be efficient.

This is because

Many people feel that sex is natural & that no one, including doctors/counselors, can do anything about sex problems if they occur.

Undue taboo & stigma are attached to sex.

At times, sex is considered sinful & immoral.

A false sense of guilt & shame exists in society about talking/indulging in sex.

Fear of intense humiliation at being labeled as impotent/frigid, lacking masculinity/ femininity.

Misplaced apprehension that partner may look down upon, ridicule, dominate or even break the relationship, if gets to know of the sexual problem. And therefore, ill-founded concern of keeping it a secret.

Has to be accepted as a way of life' attitude, especially as in old age.

A Psycho-Sexologist, preferably with a medical background, has a pivotal role to play in the sexual health of the patients & treatment of sexual disorders. He is the one who assesses whether the disorder is due to a Psychological reason alone needing just psycho-therapy; or is a result of a pathological disease (e.g. Hormonal Imbalance, Diabetes, Heart, kidney problems etc.), needing services of a specialist in addition. Even if the problem is not psychological, the symptoms of sex problem over a period become independent of the physical disease & tend to stay even after the disease has been treated unless specifically addressed by the Psycho-Sexologist. A Psycho-Sexologist's role acquires further significance as it is the 'BRAIN' that is considered to be the biggest sex organ of the body.

Since the leading causes of sex problems like ignorance, myths, misinformation, the negative conditioning (wrong learning), performance anxiety etc., are psychological in nature, they are highly amenable to sex counseling. Thus with age-appropriate education, such dysfunction can be prevented. Adolescent counseling, Pre-marital (before marriage) & Marriage counseling can go a long way to help the cause especially because the targets groups can be identified.

An individual may develop anxiety if unable to perform even once, for as small a reason as physical tiredness, mental fatigue, lack of sleep or even an inconsequential argument.

Anxiety affects performance which in turn reinforces anxiety causing further decline in performance. This sets in a vicious cycle of anxiety -----> declining performance ----->anxiety.

This vicious cycle is the biggest hurdle faced by the therapist & to break this cycle, the biggest challenge.

Sexual urge is between ears (mind) & is innate. But the sexual act is between the thighs and is learnt. One learns to perform sex either with experience (exploration & experimentation) or through sexual counseling. Sex therefore, is a behavior. And like all behaviors, one has to learn its proper technique. If faulty, it has to be unlearnt then re-learnt. Learning the right behavior or the art or the science of sex is a process that goes on all through one’s life. At no point, can an individual claim to know all about this behavior. So even those who have no sexual problems, are benefited by counseling to enhance their sexual pleasure & prevent sex problems to happen.

Sex therapy is the structured science of treating the sex problems with the help of counseling & drugs.

Since sex is an art as well as a science, a good sexual counseling goes a long way to prevent sex problems; and to take care of them if they still occur. The counseling assumes more significance if sex is considered a pleasure & intimacy oriented phenomenon where-in orgasm is more important than ejaculation. Counseling is an effective tool since sex is a learnt behavior that improves with learning & experiencing.

Since sex is one’s very personal world with no reference points available, people often are ignorant whether they are leading a normal or abnormal sexual life. Sexual counseling is needed for those also who perceive their sexual life to be normal.

Sex basically involves 2 major components:

MIND: Brain is considered to be the biggest sex organ in the body. There is no denying that sex is largely in the mind. It depends on sexuality (sexual personality) of an individual which is sum total of Nature & Nurture. Nature means what a person inherits at birth & nurture is what one learns with passing days. After birth, nothing can be done to change the natural inheritance. However nurturing or bringing up can definitely be influenced. Sexual nurturing depends on acquiring the right kind of awareness about sex. Nurturing also depends on one's initial sexual experiences. If one learns the right perspective of sex and if the initial sexual experiences are pleasurable, the pleasurable sex gets reinforced with every episode of sex and thus, one tends to lead a healthy sexual life. Conversely, if initial sexual experiences are frustrating or painful, the indifference or aversion to sex gets reinforced with each subsequent sexual encounter, culminating into sexual problems. The commonest example is Premature Ejaculation in males. If initially, the sex is performed hurriedly under the fear of being caught like in garages, vehicles, corporate lunch breaks etc. one tends to develop Premature Ejaculation in the later part. Another common example is the fear of pain/bleeding in a woman. If first intercourse is without much foreplay leading to pain in a woman, subsequent intercourses too may be painful despite generous foreplay. That is how we say the body is where the mind is. Since sex is a conditioned response or a learnt behavior, mind plays the most significant role in sex.

BODY: It is true that sex is between the ears (mind) but it is equally true that its execution is between the thighs (body). So the Vigor & Vitality (sexual health) of the body is no less important. A healthy body is a pre-requisite for a healthy sex.

Also, sex does not involve a single system of the body. The origin of sex and therefore its problems, is of multidisciplinary nature. The various systems of the body involved in sex are the Psychology, Psychiatry, Uro-genital System, Endocrinology, Vanereology, Gynecology etc.

The peculiarity about sex problems is that even if the problem lies with one partner, both the partners suffer equally, necessitating therapy for both. They are treated as one dyad (each considered half patient) unless individual is single, or the partner is not available or is unwilling; in which case treatment is given to the willing/available partner. If relationship crisis is at the core of the sex problem, then the focus of therapist is on the relationship rather than the individual partners. Various steps involved in treatment are:

Diagnosis & treatment of physical causes like Diabetes; diseases of Heart, Kidney, Thyroid; certain cancers; spinal diseases; some surgeries; tobacco & liquor addiction, substance abuse- the list is too long.

Unlearning the inappropriate behavior/technique/sexual conduct & learning the appropriate one.

Addressing psychological cause (ignorance, myths, misconceptions, stress, anxiety, spectatoring).

Changing the mind-set (Sex is dirty, oral sex is abnormal, good women do not move in bed, we have come off-age, sex is not pleasure oriented, sex is only penetrative & genitalia oriented, simultaneous orgasm is mandatory etc.)

Instituting CBMs (Confidence Building Measures) for building confidence, self esteem, body image.

Building healthy relationship.

Improving sexual as well as non-sexual communication.

Improving perception.

Increasing awareness about the importance of Foreplay & Afterplay.

Understanding orgasm.

Fantasizing & imagery.

Creating awareness about exploring each others' sexual needs.

Sexual pleasure enhancing techniques to counter sexual monotony/boredom & to create novelty.

Practicing 'sensate focus exercises' & 'masters & johnson's technique' especially in premature ejaculation & impotence.

Eros therapy for women.

Kegels exercises.

Providing appropriate perspective of sex (especially in challenged situations like Cancers, Spinal Injuries etc.) i.e. sex is not only between thighs or genitalia oriented or penis-in-vagina or penetrative but is between ears, is intimacy oriented & is participative.

There is no customized, tailor made, quick-fix solution in cases of sex, marriage & relationship problems. Each case is unique needing a different approach....

Sex problems are unique to each individual because each individual is unique. The therapy can ill afford to be restricted to a particular or specific stream or discipline of Medical Science. The approach is required to be eclectic & holistic considering each individual's bringing up, awareness, societal values, customs & traditions, religious & cultural backgrounds etc. The sex therapy revolves around the single fact i.e. whether the cause or origin of sex problem is brain (psychogenic) ALONE or there is an underlying disease (physical) too.

If psychogenic alone, treatment is psychotherapy with or without drugs.

If genesis is physical, person is investigated to find out the underlying disease which then is treated. In this case too, psychotherapy is must because by the time the disease is treated, the symptoms of sex problem become autonomous & tend to stay unless specifically addressed by a Sexologist.

The commonest of all the sex problems in males are Impotence (ED- Erectile Disorder) & Premature Ejaculation. Almost 20% of all males at some stage of their lives, suffer from these. The problems commonest amongst women are the low libido (desire), disparunia (painful intercourse) & Anorgasmia (inability to reach orgasm/climax). There are many other problems too.

Both have their own roles to play which are independent, still interdependent. It is important to understand that coitus is between thighs but the orgasm is between the ears. While the former is taken care of by a Psycho-Sexologist plus others, later is exclusively the purview of Psycho-Sexologist. However ideally speaking, Psycho-Sexologist should be the first point of contact with the patient & the whole treatment should be carried out under his charge.

Advent of Viagra in 1996 brought a revolution in the Science of the treatment of sexual dysfunction. This not only gave teeth to the therapy, but made a perceptible contribution towards diagnosis of such diseases. This, added to the fact that we have such wonderful investigation tools like Penis Doppler, prompted highly qualified doctors to jump into the field of sexology, hitherto, the monopoly of quacks; making sex practice very scientific.

This also led to extensive research widening the spectrum of treatment options.

The time tested techniques like Masters & Johnson's Technique, Sensate focus exercises, Eros Therapy (for women) etc ensure a good outcome. With a wide variety of available drugs & modalities like Testosterone, Sildenafil, Verdanafil, Tadalafil, Yohimbine, SSRIs, Clomipramine, Dopexitine; various sprays; penile injections; vacuum devices; sexual enhancers, surgeries (penile implantation, vascularisation etc), the cure is almost assured in the right hands. Those few diseases which are not curable, are at least treatable or manageable with the altered perspective of sex & modified sexual behavior.

Sex is a very personal world. It acquires a very special place in a man's life as it is considered to be a symbol of his manliness (mardangi). It has come to occupy the same platform for women, as an issueless woman is often socially ostracized & faces the ignominy of being labeled a baanjh- a social stigma. Sex is a very big concern as sexual inadequacies can break a relationship or a marriage. It can also be a ground for divorce & matrimonial alimony/compensation. This gives quacks an easy tool to exploit the sexual inadequacies of patients. Quacks put God's fear in the minds of the gullible patients and squeeze them.