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ORIGINAL ARTICLE
Year : 2017  |  Volume : 10  |  Issue : 6  |  Page : 536-541  

Prevalence and pattern of misconceptions about semen loss and sexual prowess among male medical interns


1 Department of Psychiatry, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India
2 Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

Date of Submission22-Jan-2017
Date of Acceptance22-May-2017
Date of Web Publication17-Jan-2018

Correspondence Address:
Dr. Ajish G Mangot
Department of Psychiatry, Krishna Institute of Medical Sciences Deemed University, Karad, Satara - 415 110, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJDRDYPU.MJDRDYPU_16_17

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  Abstract 


Introduction: Sexual misconceptions have been around in India for a very long time. Growing liberal attitudes toward sex and sexual permissiveness can be expected to occur in the context of improved sexual knowledge among people. However, sexual myths continue to remain rampant. Therefore, the present study was planned with the aim to assess the level of sexual misconceptions regarding semen loss prevalent among male medical interns. Participants and Methods: This was a cross-sectional study among unmarried male medical students doing an internship. Eighty-one interns were recruited after fulfilling predecided inclusion/exclusion criteria and were asked to complete a specially made questionnaire to assess their sexual beliefs anonymously in complete privacy. Responses were analyzed using frequency distribution. Results: Seventy-nine percent of the participants believed that loss of semen can lead to reduction in the size of the penis, while 44.44% (n = 36) believed that it leads to sexual weakness, 56.8% (n = 46) believed it can lead to physical weakness, and 56.8% (n = 46) believed that excess masturbation can decrease sexual prowess. Discussion: This study helps bring to light the prevalence of sexual misconceptions among medical interns in spite of reaching a stage where they are expected to have sound conceptual, theoretical, and practical knowledge about sexual health and wellbeing. There is a dearth of national and international studies exploring the sociocultural aspects of sexuality specifically among medical students. The findings from this study are expected to stimulate researchers and academicians into further exploring the aspect of sexuality among the young medical fraternity.

Keywords: India, medical, misconceptions, sex, students


How to cite this article:
Mangot AG, Siddiqui F, Murthy VS. Prevalence and pattern of misconceptions about semen loss and sexual prowess among male medical interns. Med J DY Patil Univ 2017;10:536-41

How to cite this URL:
Mangot AG, Siddiqui F, Murthy VS. Prevalence and pattern of misconceptions about semen loss and sexual prowess among male medical interns. Med J DY Patil Univ [serial online] 2017 [cited 2018 Aug 14];10:536-41. Available from: http://www.mjdrdypu.org/text.asp?2017/10/6/536/223358




  Introduction Top


Culture has a significant influence on human knowledge and behavior. We are social beings living in groups, and hence transfer of knowledge occurs constantly, often without conscious awareness. This cannot be highlighted more emphatically than when sexual behavior and knowledge are evaluated in populations with different cultural backgrounds.

India is a country where discussing sex makes people extremely uncomfortable, and hence gets brushed under the carpet. Sex education was not a part of routine education for a long time, and ever since it has been introduced, there is little, if any, improvement in scientific knowledge of sex among the youth.[1] The first formal exposure to concrete information regarding the workings of the human body happens at school. However, students may find it difficult to have an open discussion regarding reproductive and sexual functions with their teachers resulting in failure to achieve the desired goal. The next potential source of practical information regarding sex is family members, especially parents. However, even they have not been found to be adequate and reliable.[2] In this scenario, siblings, friends, print and audio-visual media are the most popular sources of information on sexual matters.[2] However, they tend to be inconsistent, inadequate, and often unscientific resulting in the propagation of wrongful beliefs among the youth.

Several misconceptions with respect to semen, masturbation, menstruation, and sexual acts persist in the Indian society.[3],[4] Such misconceptions about human sexuality have been around in India for a very long time.[3] It is these misconceptions that also form the basis for Dhat syndrome or semen-loss anxiety, a culture-bound syndrome found commonly among north Indian population.[4]

One would imagine that growing liberal attitudes toward sex and sexual permissiveness would result in improved knowledge among the people. However, sexual myths continue to remain rampant. For young people in India, social prudishness does not allow smooth transfer of scientific sexual health information. Consequently, they remain ignorant of basic knowledge required for safe sexual behavior and develop deep-rooted myths about sexuality. Poor knowledge of sex and related matters is an important problem, in addition to risky sexual behaviors, associated with mortality, morbidity, and social problems in adolescents.[5]

Family and educational institutions exercise great control over the sexual behavior of unmarried youth in India compared to the west. Sex education, if delivered adequately in school, can serve to prevent the development of sexual misconceptions. The school environment is one designed for learning of established, proven, and scientific facts. Therefore, it is safe to say that information obtained during schooling, would be more influential than that received from other sources. When faced with sexual problems, people tend to approach their family physician, gynecologist, dermatologist, or psychiatrist for help. Therefore, it becomes crucial that the doctors themselves are well-informed and knowledgeable of normal and abnormal sexuality so as to correct the erroneous foundations on which many sexual problems are erected. There are very few studies which have tried to evaluate sexual misconceptions among medical professionals. The internship is a period of practical training which readies a doctor for general practice. A postgraduation in relevant specialty will most likely eradicate any unscientific beliefs that he/she may have regarding sex and sexuality. However, several medical professionals choose to practice immediately on graduation. Therefore, the present study was planned with the aim to assess the level of sexual misconceptions prevalent among male medical interns who in a short period would be qualified to practice on their own.


  Participants and Methods Top


Selection criteria

This was a cross-sectional study among unmarried male medical students doing internship from a medical college attached to a private deemed university in Central India. Institutional Ethics Committee approval was obtained before recruiting the participants. The concerned batch had a total of 149 students including males and females. The total sample size for the study was 98 male students. All students were independently evaluated by a qualified psychiatrist. Students who were unmarried and consented to participate were included in the study provided they were free of any medical/surgical/psychiatric illness. None of the students were alcohol/substance dependent. Along with socio-cultural-religious influence, sexual knowledge, and resultant concepts also depend on sound theoretical background and clinical exposure provided in medical colleges. Hence, students doing externship (interns who completed their final year of MBBS from a different university) were excluded from the study to minimize this potential confounding factor.

Instrument for assessment

All eligible participants were asked to complete a questionnaire to assess sexual misconceptions anonymously in complete privacy. This questionnaire was adapted from Comprehensive Questionnaire for Assessment of Dhat Syndrome.[6] First author of the above scale gracefully shared a copy for personal use. The questionnaire was translated into English, and only relevant questions were included after applying it to a pilot batch of 10 students by two qualified psychiatrists. Data from these ten participants were not included in the final analysis. This modified questionnaire evaluated general information about masturbation practices, physical or psychological consequences of loss of semen and various factors affecting sexual prowess/power/ability.

Analysis of data

Data were analyzed using frequency distribution tables in Microsoft Excel 2013 for Windows operating system.


  Results Top


The responses for the questionnaire to assess their sexual misconceptions have been summarized in [Table 1], [Table 2], [Table 3]. On evaluating the beliefs about the apparent consequences of loss of semen, 79% (n = 64) were found to have a belief that it can lead to reduction in the size of the penis, while 44.44% (n = 36) surely believed that it leads to sexual weakness and 56.8% (n = 46) believed it can lead to physical weakness [Table 1] and [Table 2].
Table 1: General beliefs about the apparent consequences of loss of semen

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Table 2: Beliefs about specific physical/psychological issues apparently caused by loss of semen

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Table 3: Beliefs about factors which may apparently negatively affect the sexual prowess

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On evaluating the beliefs about various factors which may negatively affect their sexual prowess, a vast majority answered in the negative. Yet 56.8% (n = 46) believed that excess masturbation can decrease sexual prowess [Table 3].


  Discussion Top


Although none of the medical interns recruited in this study had a diagnosis of Dhat syndrome, the sexual beliefs and misconceptions that they harbor are strikingly similar to the ones responsible for Dhat syndrome.[3],[4] There are many potential sources of such misinformation as outlined in the introduction.[2] In the Indian set-up, the major source of sexual information for youngsters is friends.[7] Parental education, occupation and family type also appear to impact the children's knowledge.[7] At the core of prevention is timely sex education. When this is integrated into health education among adolescents, propagation of myths regarding the human physiology can be effectively curbed. However, it has its own share of controversies.[1]

It was found that a significant number of interns believed masturbation to be unnatural and 75.3% of the participants felt guilty after masturbating. However, masturbation is a safe activity and even has a role in healthy sexual development.[8] It was also found that a large percentage of participants believed that loss of semen has adverse consequences such as bending of the penis, physical, and sexual weakness. This is despite the fact that reproductive anatomy, physiology, and clinical pathology are major parts of the undergraduate medical syllabus. The contradictory coexistence of apparently “adequate” sexual knowledge and wrong/unscientific beliefs, leads us to understand that many youngsters have been unable to form a sound foundation of sexual/reproductive health concepts.

Many Indian and international researchers have tried to assess the sexual knowledge, attitude, and misconceptions among medical and nonmedical students over the last more than two decades. A survey done in Belgaum, Karnataka among nonmedical undergraduate students found that more than 88% of their participants harbored sexual misconceptions about masturbation and semen loss similar to this study. The survey also did not find any difference among urban and rural population and hence the authors opine that education may not alter firmly held misconceptions as is evident in our study too.[9] On the other hand, more recent study found science students had relatively adequate information about sexual health as compared to their counterparts in arts and commerce stream. Further, the authors suggest that imparting knowledge about sexual health through educational programs may help in achieving a desirable change among these students.[7] They also found that parental education had a significant impact on their child's sexual health and knowledge. Students whose parents were unskilled and semiskilled by occupation had “inadequate” knowledge about sexual health when compared with students whose parents were skilled by occupation.[7] Another study conducted in the western Indian state of Rajasthan found that medical students harbored sexual myths about masturbation, semen, size of penis, etc., albeit lesser than their nonmedical counterparts.[10] However, the sexual myths covered in this study were primarily restricted to male reproductive system while the aforementioned study had included both males and females. This could have been a factor for the relatively lower myths observed among medical students. Our study did not have that confounding factor as it involved only male students. Further, the authors in the above-mentioned study do not offer any explanation or resolution for sexual myths observed among medical students. One of the earlier Indian studies to study knowledge, sexual practice, and attitudes of medical students in relation to HIV/AIDS among 1st year medical students found that even though majority of the students had heard of the disease, many harbored misconceptions about transmission of HIV.[11] A study done more recently also found similar results.[12] Considering these studies recruited only 1st year students, the above finding could be explained by the fact they were yet to receive full medical knowledge about the disease and hence harbored misconceptions. Further, these studies did not investigate other sexual concepts. Another study involving medical students from Delhi found satisfactory knowledge regarding sexual intercourse, masturbation, contraception, and sexually transmitted diseases but also found that the common source of knowledge about sex were friends (74.5%), pornographic films (56.2%), and books and magazines (55.1%).[13] Although this study did not tackle sexual misconceptions, it is very likely that the recruited students may have harbored several misconceptions considering their predominant source of knowledge being nonmedical. A large-scale study involving 27 medical colleges and recruiting 1996 medical students in the Indian state of Maharashtra found that despite mostly positive attitudes toward modern contraceptives, sex education and family planning counseling, the participants had misconceptions about modern methods of contraception.[14] A recent study involving 381 young school girls found that they had substantial doubts about menstruation and were influenced by societal myths and taboos in relation to menstrual practices.[15]

With respect to international research on sexual misconceptions among students, a Chinese study [16] done three decades back mirror findings of this study as well as other recent Indian research findings described above.[9],[10] The author had evaluated 97 undergraduate medical students for their sexual knowledge and attitudes and found that their responses showed significant gaps in sexual knowledge. The students were harboring misconceptions traceable to traditional Chinese beliefs on the association between health and semen.[16] It is indeed quite surprising that this study found similar results even though the participants were born a generation later to their Chinese counterparts. A Turkish study involving 598 senior university students found that they held sexual myths irrespective of their branch of study.[17] A British study involving medical students also found that most of the students had inaccurate factual knowledge about certain important sexual health issues.[18] A more recent study involving Malaysian public university postgraduate students also found unsatisfactory level of knowledge on sexual and reproductive health.[19]

These findings suggest that inadequate sexual knowledge and associated sexual myths and misconceptions among students are universal phenomena, irrespective of their field of education, i.e., medical or nonmedical. They also demonstrate that culturally transmitted information is quite resistant to eradication by scientific learning. Such socio-culturally held beliefs and myths about sex and sexuality thus remain long-standing. Such findings can be explained by two factors: (1) inadequate school level sex and family education, and (2) inadequate medical school education.

As described earlier, parents may not be an ideal source of information with regards to sexual matters.[8] Hence, the onus of providing scientific information to children and adolescents falls on the shoulders of school and college teachers. However, attempts to introduce sex education to the younger minds have often been met with intense opposition in India. Indian Ministry of Human Resource Development and National AIDS Control Organization tried to promote adolescent education program in the school curriculum which led to a major controversy in 2007 and subsequent banning of the program in many Indian states whose regional governments found the recommendations unacceptable. Tripathi and Sekher [1] found that an overwhelming majority of young Indian men and women are in favor of introducing sex education in their school curriculum and further found that there exists a wide gap between the proportion of them who perceive sex education is important and those who actually received it. However, the present ground reality may be gradually changing for the better with the introduction of “Adolescent Friendly Health Clinics” through “Rashtriya Kishor Swasthya Karyakram” of National Health Mission, Ministry of Health and Family Welfare, Government of India.[20]

The other potential factor which needs to be considered, especially with respect to this study, is the possibility of inadequate or nonexistent tackling of sexual myths and misconceptions in the medical school curriculum. The common criticisms against the present medical curriculum are that it fails to inculcate appropriate skills and competence among learners. The National Knowledge Commission (NKC) working group, established by the Government of India, observed that the medical education in the country was mostly directionless, unregulated and nonstandardized (NKC Report, 2007).[21] The NKC report strongly recommended amendments of Indian Medical Council Act to make Medical Council of India (MCI) a “truly autonomous statutory body and not simply as a recommending body to the Central Government as is the present MCI.” MCI had recently focused to augment the undergraduate curriculum for psychiatry under the aegis of Indian Psychiatric Society.[22] This movement is quite encouraging and will definitely increase mental health awareness among medical professionals and thereby help in reducing the sexual misconceptions.


  Conclusion Top


This study helps bring to light the high prevalence of sexual misconceptions among medical interns, who are, for all practical purposes, fit to practice the science of medicine in the community and hence can be presumed to be knowledgeable with respect to normal and abnormal human bodily functioning. This is a one-of-a-kind study exploring the misconceptions and cultural beliefs pertaining to semen loss among budding doctors where an attempt has been made to offer an explanation and potential solutions to this issue. The inherent limitations in this study include the lack of assessment of biological knowledge of the interns and the exclusion of females.

Anatomy, physiology, pathology, gynecology, surgery and psychiatry, the participants which may be considered as the closest to deal with sex-related topics are covered throughout the period of medical school. This ideally must reinforce scientific knowledge regarding the human reproductive system by the time students reach graduation. However, the findings from this study do not appear to support this. In this case, a large number of the interns were harboring one or many misconceptions regarding masturbation and related semen loss. A concerted effort on the part of the teachers and students from the 1st year of medical school itself can build a solid foundation of knowledge.

From the authors' experience, attendance in both psychiatry theory lectures and clinical postings is abysmal. In fact, the general level of understanding regarding mental health and illness, as a whole, is poor among Indian medical graduates.[23] Keeping these points in perspective, the authors suggest the inclusion of a separate topic on sexual misconceptions in the psychiatry theory lecture series. Exposure to patients with sexual problems and Dhat (and other similar) syndromes during clinical posting will help in providing a practical point of view regarding the significant distress leading to mental illness while harboring such beliefs. These students are our future specialists and super-specialists. Most individuals fall back on their family doctors and other specialists to clear their sexual doubts.[2] It would be a matter of concern to the medical community if they happen to harbor the same misconceptions as held by laymen.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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