|Year : 2017 | Volume
| Issue : 6 | Page : 542-547
Epidemiology of patients attending a special clinic on sexual dysfunction from Eastern India: A retrospective data review
Arghya Pal, Nitu Mallik, Rudraprasad Acharya, Dilip Kumar Mondal
Department of Psychiatry, Medical College and Hospital, Kolkata, West Bengal, India
|Date of Submission||26-Mar-2017|
|Date of Acceptance||20-Jun-2017|
|Date of Web Publication||17-Jan-2018|
37, Raja Peary Mohun Road, Uttarpara, Hooghly - 712 258, West Bengal
Source of Support: None, Conflict of Interest: None
Background: Sexual dysfunctions (SD) are among the most common psychiatric disorders leading to significant impairment in the quality of life. However, in spite of that, little data exist regarding the prevalence of these disorders, especially from Eastern India. Methodology: This study was a retrospective analysis of the data from patients attending a special clinic conducted in the Outpatient Department in a General Hospital Psychiatry Unit from an urban center in Eastern India over the calendar year of 2016, adhering the Prins criteria. Results: Of the 237 patients attending the clinic, 235 (99.2%) were male and rest were female. The most common disorders reported included premature ejaculation (PME), erectile dysfunction (ED), comorbid ED and PME, lack of sexual desire, and dhat syndrome (DS). Comparison of the sociodemographic and clinical profile of patients of each disorder showed that patients with DS had a younger age and significantly lower history of nicotine use disorder. Conclusion: There is dearth of data regarding the prevalence of SD in clinical population from Eastern India. There is a high gender disparity among the patients attending the special clinic. The prevalence of the disorder in this clinic-based was similar to community studies conducted in India, but differed from studies conducted in Western countries. The major limitation was the cross-sectional design and limited generalizability of results.
Keywords: Epidemiology, India, outpatient department, sexual dysfunction
|How to cite this article:|
Pal A, Mallik N, Acharya R, Mondal DK. Epidemiology of patients attending a special clinic on sexual dysfunction from Eastern India: A retrospective data review. Med J DY Patil Univ 2017;10:542-7
|How to cite this URL:|
Pal A, Mallik N, Acharya R, Mondal DK. Epidemiology of patients attending a special clinic on sexual dysfunction from Eastern India: A retrospective data review. Med J DY Patil Univ [serial online] 2017 [cited 2019 May 19];10:542-7. Available from: http://www.mjdrdypu.org/text.asp?2017/10/6/542/223371
| Introduction|| |
Sexual dysfunctions (SD) are one of the most common disorders that are characterized by changes in the pathophysiology of the sexual response cycle or in sexual desire that deters the individual or couple from deriving satisfaction from sexual activity. SD have deleterious effects on the interpersonal relationships or quality of life of the individuals. However, in spite of it, the issue of SD remains an enigma considering the fair amount of taboo, embarrassment, and concealment that is associated with it. It also falls in the watershed of psychiatric disorders and other medical disorders which makes it challenging to the treating clinician.
The current knowledge of epidemiology in SD can be classified as descriptive or analytical studies. Descriptive studies are those which have been done in the community settings or on special population (e.g., all males in a village, etc.). Analytical studies, on the other hand, generate risk factors and the associations of various SD with risk factors. A review of the epidemiological data on SD raises a lot of heterogeneity in the studies. The causes of such heterogeneity include, difference in respondent age, different percentages of responders, varied time duration of the study, lack of consensus in the definition of SD, and different strategies of collecting data (telephone interviews, mailed questionnaires, in-office questionnaires, face-to-face interviews, single questions versus multiple versus scales. Most commonly the studies probed among SD in males, and common SD encountered were erectile dysfunction (ED), premature ejaculation (PME), decreased desire, and inability to achieve orgasm. The studies have reported the prevalence of ED increases with the increase of age. The rates also were comparable across various study population across the globe. The Asian studies reported the prevalence of ED at 7%–15% rate of ED for ages 40–49 years and 39%–49% for ages 60–70 years. Results from the Australian studies showed the prevalence at 5%–6% for ages 40–49 years and 12%–13% for ages 50–59 years. Grossly, the results from the European, North and Latin American centers revealed comparable results., However, certain studies have concluded higher prevalence of ED in the Asian as compared to the other regions. Finer evaluation of the studies also showed that PME was one of the most commonly elicited conditions with a higher prevalence in the Asian and North American clusters. The females were grossly less represented in most of the studies. Lack of sexual interest was the most often reported problem among the females with a higher rate in the Asian population. The other dysfunctions reported were inability to reach orgasm and dyspareunia. Overall 28% of the males and 39% of the females reported at least one SD. However, it is important to mention here that although there was a fair representation of the Asian population in these reviews, there was no Indian study that was included. Few Indian studies that have been conducted in the community setting showed that SD is prevalent in among 1/5th of the males with the most common disorders reported being ED, PME, and decreased desire., This highlights the need for further studies on the epidemiology of SD in Indian settings.
SD was largely ignored from the purview of the major epidemiological studies even being one of the common mental disorders. The research in this field has been lacking and mostly confined to single-center studies. However, considering that sexuality is dependent on the sociocultural milieu  and center of conduction, the current state of evidence seems limited. Interest in this, however, has been steadily increasing following advancements in the best of our knowledge of sexual functioning and advent of various pharmacological agents for its treatment. This increased interest has resulted in the initiation of special clinics for the treatment of sexual disorders. Data from such clinics are mainly available from the Western countries which cannot be generalized to every setting.
The current study intends to bridge this gap by analyzing data from a special clinic attending to patients with SD from a General Hospital Psychiatry Unit (GHPU). The aim of the current study was first, to describe the sociodemographic and clinical variables of the patients attending the SD clinic in the calendar year of 2016, second, to describe the prevalence of various disorders and third, to compare the sociodemographic and clinical variables of the patients with various disorders.
| Methodology|| |
This study was a retrospective analysis of data from patients attending a special clinic conducted in the Outpatient Department in a GHPU from Kolkata, Eastern India, over the calendar year of 2016. The hospital caters to the states of West Bengal, Sikkim, Bihar, Orissa, and various states of the Northeast India as well as Bangladesh and Nepal. The special clinic is conducted 1 day in a week over 5 h and is attended by designated residents and consultants from the Department of Psychiatry. Patients who presented primarily with sexual complaints without any comorbid psychiatric (except substance use disorder) or known medical disorders at the time of the first presentation were referred to the clinic after being screened with clinical assessment in general outpatient clinic. We decided that screening the patients with the above-mentioned parameters would select the “real-world patients” of SD that is described in the classificatory systems. The clinic runs in a separate room providing privacy to the patients to minimize any bias arising out of underreporting. The patients were allowed to choose the gender of the clinician to minimize underreporting.
Every patient who attended the special clinic was recruited for this study after informed consent. The sociodemographic and clinical parameters of the patients were recorded on their first visit. The information was obtained from the patients and their partners/spouses when available. The patients were encouraged to involve their partners/spouses in the treatment and the information was clarified when partners/spouses were available in the subsequent visits. The patients were also investigated for comorbid medical conditions (which were unknown at presentation) and may play a role in the presentation of the SD. Although most of the data were collected in the first visit itself, the data regarding the presence of medical comorbidity were collected on later visits based on availability of investigation reports and/or documents of lateral consultation. Liaison with corresponding department was established for the comprehensive management of these patients. The diagnosis was made on the basis of the clinical assessment. The International Classification of Diseases 10th Edition was followed for classification of the disorders. No ethical clearance was sought for this study as this study was a retrospective review of the data attending the clinic, which is in accordance with the Institution policy and the National Code on Clinical Trials.
The prevalence studies on SD often follow the Prins criteria, which is a 15-point scale used to establish the validity of such a study, in which our study attained a score of 11 [Table 1].
| Results|| |
The sociodemographic and the clinical profile of the patients attending the clinic are depicted in [Table 2]. It is worth mentioning that the majority of the patients attending the clinic were male (99.2%), married (67.5%), and without any medical comorbidity.
|Table 2: Sociodemographic and clinical profile of the patients attending the sexual dysfunction clinic|
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The sociodemographic and clinical profile of the patients of the five most common diagnoses (i.e. ED, PME, comorbid ED and PME, Dhat syndrome [DS], and lack of sexual desire) are depicted in [Table 3]. It is worth mentioning here that since the diagnosis of medical comorbidity could be established only for the patients who had presented for follow-up with investigation reports and/or documents of lateral consultation available.
|Table 3: Sociodemographic and clinical profile of patients of erectile dysfunction, premature ejaculation, comorbid erectile dysfunction and premature ejaculation, dhat syndrome, and lack of sexual desire|
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Comparison of the clinical and sociodemographic variables among the common diagnoses revealed no significant differences except age of onset of disorder which significantly less for DS as compared to the other disorder [Table 4]. It was also found that number of patients with nicotine dependence was significantly less among patient with DS as compared to other disorders [Table 5].
|Table 4: Group comparison of age at onset between patients of erectile dysfunction, premature ejaculation, comorbid erectile dysfunction and premature ejaculation, dhat syndrome, and lack of sexual desire|
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|Table 5: Comparison of nicotine use disorders between patients of erectile dysfunction, premature ejaculation, comorbid erectile dysfunction and premature ejaculation, dhat syndrome, and lack of sexual desire|
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| Discussion|| |
Our study aimed at describing the sociodemographic and clinical variables of the patients attending the SD clinic and to describe the prevalence of various disorders along with the comparison of the sociodemographic and clinical variables of the patients with various disorders. This is significant because, according to the best of our knowledge, no previous study had attempted to describe the epidemiology of patients attending a special clinic for patients with SD in a GHPU from Eastern India. Our study attained a score of 11 on the Prins criteria which was the cutoff for inclusion of studies in various systematic reviews in the past. This study thus addresses a lacuna in the existing literature with good evidence base.
In our study, 99.2% of the patients were male and only 0.8% were female. This is striking as compared to most other studies conducted on outpatient basis, where there is a more even representation of either gender. This trend is also alarming as studies in the past have found that SD can be more common in females as compared to males. Incidentally, the two female patients who had attended our clinic had expressed their concern whether they should be consulting in the clinic meant for “males.” This highlights the issue of misconception that is associated with SD and the need for sensitivity on the part of clinicians to psychoeducate the general population about the domain of our services.
The results of our study showed that the average age of the patients attending the clinic was 33 years and the most common disorders were PME, ED, DS (ICD 10-F48-other specified neurotic disorders), and loss of sexual desire. There is no data to directly compare our findings. However, the most common disorders reported are very similar to those reported in the past community-based epidemiological studies conducted in Asia, North America, and in the Latin American studies., The findings are also in line with the findings of a community-based study conducted in South India, where the average age and most common diagnosis among the male patients were similar to our findings. However, it should be pointed out that the most common SD in our population was PME, as opposed to ED in other studies. No male patients in our clinic presented with male anorgasmia, postcoital dysphoria, or paraphilias unlike studies conducted in the Western countries. This is also similar to the findings in previous studies conducted in India ,, and reiterates the assumption that probably these disorders are rare in Indian population.
Our clinic was designed for special care of patients with SD and patients recruited underwent thorough screening in the general outpatient clinic. However, in spite of that we were surprised to receive a considerable number of patients with diagnosis which are outside the traditional realm of SD. Around 20% of our patients were diagnosed with other psychiatric diagnosis (DS and body dysmorphophobia) and about 2% of the patients were diagnosed with nonpsychiatric diagnosis (retrograde ejaculation). We decided to continue the consultations of most of these patients in our clinic because we felt that the management of these patients could be more effective in our clinic.
The comparison of clinical characteristics of the individual disorders showed that the patients with DS were more likely to be of a lower age and unmarried. This is also supported by the existing literature  where patients have been younger and unmarried or recently married. It is worth mentioning here that many of the patients with DS had presented months before getting married seeking emergency consultations. The reason behind this differential presentation, in our opinion, could be that married people are more concerned with sexual performance since they are currently sexually active and therefore more anxious about disorders related to performance such as PME or ED. Whereas, unmarried Indian males are more concerned about possibility of poor performance postmarriage, which according to the popular belief could be due to passage of dhat.
The most common substance use in our sample was nicotine use disorder. Intra-group comparison revealed that it was significantly less in patients with DS and significantly high in patients with comorbid PME and ED. This further supports the fact that nicotine dependence is a known risk factor associated with SD.
The strength of our study was the use of screening procedure followed by detailed assessment, conduction of the study at a GHPU with large catchment area, and having relatively broad inclusion criteria to allow selection of “real-world patients.” Our study was also adherent to the Prins criteria which establish the validity of the study. The major limitation of our study was the cross-sectional design which did not allows us to determine the long-term retention rates and acceptability of the treatment to the patients. This study was conducted on patients who voluntarily opted to seek treatment. This limits the generalizability of the results. Furthermore, this study fails to address a sizable population who did not seek treatment due to various reasons. This study also did not includes patients with known psychiatric or medical comorbidity. This also limits the generalizability of the data considering SD is a common presentation in various psychiatric or medical illnesses.
The recommendations for the future practice include generation of epidemiological data from other centers, considering that SD is highly prevalent in all genders and across all age groups. It is also important to state that it is necessary to examine the variations of the prevalence of SD across various sociocultural clusters. The future attempts should also be made to extract data from patients who choose not to seek treatment owing to the embarrassment and taboo associated with the disorders. Further studies should be conducted in the community settings, and use of proper technique to extract information (e.g. - Snowballing, Key informant technique) is advisable. Use of analytical epidemiological studies aiming to finding out reasons behind the differential presentation of SD across various countries is also the need of the hour.
| Conclusion|| |
Our study wishes to imply that there is dearth of data regarding the prevalence of SD in clinical population from Eastern India. There is a high gender disparity among the patients attending the special clinic with services that are on offer being mostly used by males. Finally, the prevalence of SD is comparable to the results from the community-based studies from India, but differences were observed with the Western studies.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]