Comprehensive Textbook of Sexual Medicine Nilamadhab Kar, Gopal Chandra Kar
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1Comprehensive Textbook of SEXUAL MEDICINE
A
Quality of Life
Research and Development Foundation
initiative
2
3Comprehensive Textbook of SEXUAL MEDICINE
Nilamadhab Kar DPM MD DNB MRCPsych Consultant Psychiatrist Wolverhampton City Primary Care NHS Trust Wolverhampton United Kingdom Gopal Chandra Kar MD LLB Former Director of Medical Education and Training Orissa, Bhubaneswar Former Principal SCB Medical College and Professor of Psychiatry Mental Health Institute, Cuttack India
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Comprehensive Textbook of Sexual Medicine
© 2005, Nilamadhab Kar, Gopal Chandra Kar
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition : 2005
9788180614057
Typeset at JPBMP typesetting unit
Printed at Replika Press Pvt Ltd., 310 EPIP, HSIDC, Kundli, Sonepat (Haryana)
5Dedication
Who taught us the most and prompted
for this endeavour—the patients
6
7Contributors 13Preface
Human sexuality and its expression are intensely varied and are constantly changing, which makes an interesting study. The last few decades have seen sexual revolutions; initially, making communication of information on sex easier, with more open discussions on sexual behaviors, which occurred in 1960s; and later, expressing a willingness to engage in a variety of sexual practices, some of which may once have been deemed deviant or at least unacceptable to one's social status, and a regeneration of sexual interest and behavior among the postmature population, which is occurring in the last decade. The changes are of course affecting societies differentially depending upon various factors. These developments are reflected in the clinical practice where it has become common to find person with sexual concerns.
The subject of sex has always remained a sensitive topic, and it is still a taboo in many cultures. The sexual behavior and problems of a person are usually kept secret, even when it is the reason for distress. Pitiably, many clinicians also shy away from evaluating, identifying or managing the sexual disorders and distresses of their patients. Current curriculum in primary medical education has not given enough importance to this matter, to equip the student with adequate skill to deal with the sexual problems.
There are many books dealing on this subject especially sexual relationships and acts; and there are lot of books on ‘sex’ available to general public from various sources, including those laden with lot of misinformation. There is no dearth of research and clinical material in this field, especially on specific aspects of sexual problems and their management. However there is a need for a clinical textbook compiling the available information to provide clinical guidance on management of sexual disorders, to discuss various related issues and ideally to demystify sexuality for the students, providing them with the holistic picture of the subject.
Comprehensive Textbook on Sexual Medicine intends to bridge the gap. In this book it has been tried to cover almost all areas relevant in the study of sex and required for practice of sexual medicine. Besides the core sexual disorders, extensive attention has been given to various related fields. The developmental aspects, which form the basis of many sexual attitudes and behaviors, and anatomical and physiological aspects essential for refreshing and keeping in touch with basic sciences have been covered. Cultural, psychological, social and legal issues those are extremely important for a sound clinical practice have also been dealt with. Related urosurgical, gynecological, and dermatological information, which will help liaison in this field of practice for a better patient management, are given in different chapters. Experts who deal with persons with concerns in these areas and understand the need of such patients and the treating clinicians have contributed the chapters. The relevance and practical clinical utility of the chapters and their content to the practicing clinicians was kept in mind during preparation of the book and may be re-emphasized here. Though 14the information base of the book does contain advanced research findings in many areas to improve the current understanding, it is primarily expected to fulfil the requirements of clinicians for managing persons with sexual concerns. It is hoped that this will be beneficial not only for the practitioners of sexual medicine, the psychiatrists, clinical psychologists, social workers and the students of these fields; but also, for the students and practitioners of allied medical, surgical fields who during their practice come in contact with persons with concerns with their sexuality; and in general for the students of sexology.
Nilamadhab Kar
Gopal Chandra Kar
15Acknowledgements
Preparation and completion of this book is the result of outstanding help from many individuals. We are indebted to them and wish to extend our thanks. In the initial days many practitioners supported the idea that there is a need for such a book and gave us enthusiasm to take up this project. In the initial phase, during the preparation of the composition of the book Jagadisha, MD, Seema Mehrotra PhD, of National Institute of Mental Health and Neurosciences, Bangalore; KB Kumar, PhD, N Dinesh, Clinical Psychologists, of Kasturba Medical College, Manipal, and N. Murali, DPM, DNB, Consultant Psychiatrist, Australia, actively researched and contributed.
We have enlisted the help of K Haridas, MD, DCH, Kottresh S, MD; Gunasagari Rao, PhD; Dilip K Murthy PhD, Kavitha Murthy, PhD; Malathi K. Murthy, PhD; KS Latha, PhD; Hema Tharoor, DPM; Arti Dogra, MD; KB Kumar, PhD; Aswini Kumar Mohapatra, MD; Susan Benjamin MD, Deepak Ranjan Nayak, MS, Monoj Mohanty, MD, PSVN Sharma, MD, DPM, Joseph Thomas, MS, MCh, for detailed comments and suggestions on various chapters, which have been immensely helpful. We are indebted for their efforts in integrating various areas. Soumitra Shankar Datta and Prathap Tharyan, of CMC, Vellore have expressed their gratefulness to Thomas John, for valuable comments on the chapter ‘contemporary media and human sexuality’. Prabha Chandra, MD, AN Chowdhury, MD, BN Misra, MD, DPM, Mrugesh Vaisnav, MD, Soudamini Dhal, MD, TSS Rao, MD, Nirmal Kumar Nayak MD gave us hope and enthusiasm at various points in the preparation of the book and we are deeply appreciative of their help.
‘Sexuality in The Kama Sutra of Vatsyayana’, by O Somasundaram was published in Indian Journal of Psychiatry, 1986, 28, 2, 103–108. It is republished here for its immense relevance, with the kind permission of Utpal Goswami, MD, the Editor of The Indian Journal of Psychiatry.
Nagaraj TM, artist of Anatomy Department of KMC Manipal has drawn pictures for the Anatomy and Genetics chapters. We thank him for his excellent contribution. We wish to thank Tushar Kanti Das MD for presenting a book on Kama Sutra long back even before editing of this book started as if opening a door for a long-winded journey. Ramananda Satapathy MD provided information on various indigenous texts on sexology, especially Kama Sutra and deserves a special mention. Partha Pratim Kundu, DPM, Vivek Pattan, MD, Ashutosh Chouhan, MD, Nitin Shukla, MD, collected many references on sexology, Indian studies on sexual problems, and histories on sexual medicine and helped to make the texts much richer. Rajaballav Kar, MA of Sofomor Academy, Bhubaneswar, Rathi Nair of Manipal Institue of Communication, and Usha Rajagopalan, deserve special mention for selecting and providing relevant references of and quotes from Indian Poets for the chapters. Meera BS, Reshma V Mallya, Alison James and Sam Alexander need mention for their typological and secretarial help. Manjula, nurse in psychiatry department of Kasturba Hospital patiently managed patient engagements during this phase of editing in an extremely cooperative way. 16Mr Tarun Duneja (General Manager Publishing), Jaypee Brothers Medical Publishers (P) Ltd. has been very helpful, in bringing out this book, with professional advice and guidance.
Quality of Life Research and Development Foundation, Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education and Wolverhampton City Primary Care NHS Trust have provided basic facilities for preparation and deserve to share the honour.
Sasmita and Shreyan have also helped being considerate and understanding to the extra time and pressure that was demanded by the book.
This book has been possible by the support and cooperation of all the contributors of various chapters in the book, who worked with enthusiasm and great interest. We express our deep appreciation to all of them and remain indebted for their help.