Even before Saurabh Arora got his online healthcare platform off the ground, the former Facebook data scientist had an inkling of what Indians might want to ask doctors – especially if they could send questions via a smartphone app and in complete privacy.
The low-hanging fruits, as Arora described them, were mental health, women’s health and questions about the wellbeing of children. But the subject that would probably provoke most curiosity, Arora felt, was sexual health.
Arora’s instincts were not off the mark. Two years after the launch of Lybrate – an online doctor database that connects physicians to patients through a mobile app – user data from the platform shows that an overwhelming number of Indians have many, many questions about sex.
Lyrate allows users to post general health queries, consult doctors in real time, search for doctors nearby and book appointments online. Users can choose to remain anonymous for online interactions. Across cities like Delhi, Chennai, Kolkata and Hyderabad people are using Lybrate for help about sex.
Lybrate, of course, is not entirely representative of India’s patient population. But with an enrolled base of 100,000 doctors who interact with a daily patient load of 200,000 individuals, according to the company’s estimation, the user data still provides a significant insight into what health concerns Indians are asking about.
“I’m sure these discussions are not new,” Arora said, referring to the overwhelming interest in sexual health among Lybrate’s users. “Particularly in metros, the need has been there, and it has been circulating in private groups, one-to-one phone conversations, and things like that.”
Conversations around sex are still largely taboo in India. Sex education is not part of the curriculum in most schools. Few parents will openly talk about the subject and even doctors can be hesitant to ask patients questions about their sexual habits.
On the other hand, the environment that many young, smartphone-wielding Indians grow up in involves a liberal dose of pornography. Indians – and not just the men – are among the most prolific consumers of online porn in the world, with a special liking for smut involving “Indian bhabhi”, “Indian wife” and “Indian aunty.” Obviously, all of this happens behind closed doors with little room elsewhere for serious discussions about sex.
So, in a country where over 40% of the population is under 20 years of age, people seem to be moving the discussion online. And platforms like Lybrate, which allows individuals to consult doctors without necessarily surrendering their privacy, provide a window into that exchange.
Lybrate’s data shows that across tier I, tier II and tier III cities the most common questions are on erectile dysfunction, premature ejaculation, menopause, low libido.
The absence of an open conversation about sex and sexuality in India is an overwhelming concern for sex educators like Anju Kishinchandani, who focuses on educating school-going children in Mumbai. For the lack of better options, children are turning to the internet for answers and pornography is often the first thing they find.
“It’s very, very scary,” said Kishinchandani, “If they (children) are learning about sex and sexuality mostly through porn films, then they’re getting a very, very warped view because what they’re seeing there is not reality.”
The extent of misinformation can be frightening. Kishinchandani, for instance, recalls teenagers aged between the ages of 16 and 18 explaining how porn has shaped their assumptions about contraception.
“I’ve had children of that age group tell me that ‘Why are you saying that we need to use contraception? Because when we watch porn films on our phones, those people don’t use contraception,’” she said.
Silence over sex
Meanwhile, parents are still unwilling or unable to broach the topic with their children. “Parents are still unfortunately clueless,” said Kishinchandani. “I lot of them want to talk to their kids but they don’t know how, so they don’t end up talking to them.”
The taboo is so overwhelming that even doctors sometimes hesitate to ask their patients about their sex lives. “They (doctors) say, ‘how can I ask? They (patients) might find the question irrelevant. They may think that I’m asking too personal a query’,” said Rajan Bhonsle, a sexologist. “This open dialogue between whether it a parent and child, the teacher and student or a doctor and patient has to happen.”
The consequences of the lack of dialogue on sex can be serious.
“I meet people in their 40s and 50s and 60s, when they have avoided getting into relationships or getting married only out of some myths and misconceptions they are carrying about themselves, or about the sexual act,” explained Bhonsle, who is also a professor at the department of sexual medicine at Mumbai’s Seth GS Medical College and KEM Hospital.
Then, there is the possibility of individuals develop fetishes, paraphilias and fixations related to sex, according to Bhonsle, only because they were not informed at the right time in the right manner.
The obvious risk of sexually transmitted diseases, including HIV/AIDS, is also aggracated by the silence around sex.
Stigma and crime
Suppression of an accessible discussion on sex in India may have an even more wide-ranging manifestation – the endless wave of sexual crimes against women.
“This kind of taboo around talking about sex means people don’t understand what sexual relationships are about,” said Paromita Vohra, founder and creative director at Agents of Ishq, an online sex education project. “Because when there is a silence on a subject, then all kind of hierarchies continuously get played out. And all of stigma also attached to things.”
Men in India, she explained, often have no idea of what women’s pleasure is, what women’s consent entails and how to negotiate that consent. So when they are rejected, it sometimes translates into violent reactions, like acid attacks or other acts of aggression.
For women, who usually do not have space to speak about their own sexual desires and comfort, there is also very little awareness. “When you don’t ever talk about what is a healthy sexual relationship or a healthy sexual interaction, how do you learn to recognise it?” Vohra said. “How do you learn to say, ‘No, this is not OK for me?’”
In a country where 95% rape accused are family, friends, co-workers or known to the victim one way or the other, this lack of information about sex – and a stifled discussion on the subject – can evidently be very dangerous.
And that is why the conversation that platforms like Lybrate is provoking is important. It is a fact that Arora recognises, although he is also acutely aware of the limitations.
“Tools like ours are obviously a great help but we understand that we cannot fulfil everything,” he said. “We still believe that to truly solve the problem, more and more people should know (about the subject). But more and more people should get aware at an earlier stage.”