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How Does Anal Sex Not Lead To Pregnancy? A Guwahati Gynaec’s Stories Of Sex Ed With Adults

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Ramnath Bhuyan is a 33-year-old gynaecologist in a small town 50 kilometers away from Guwahati. He has been working at a maternity hospital there for three years now — he returned home after stints in cities like Delhi and Bombay (where people hardly visit male gynaecologists, he says), and a mostly rural set up in Sholapur.

The difficulty in Sholapur had been that all his patients wanted to get their uterus removed for the smallest of problems. When he came back home to work in his small town, he faced a set of new challenges — he began to deal largely with infertility cases, which meant he needed to ask his patients about sex.

He tells us about what he has learned about intimate life from his work.

A woman once came to me and said she liked being on top while having sex with her husband. But she was worried. Would being on top make it harder for her to get pregnant? She wasn’t sure if the semen was going inside her or not — you know, because it seemed like more was coming outside than going in. You’d be surprised at how common a question that is; this business of it all coming out. But actually everything that needs to go inside already has.

Working as a gynaecologist in a town about 50 kilometers from Guwahati, is very different from working in the city. I’ve been here, working in my father’s hospital for three years now. I did my medicine in Manipal, then came home to Guwahati and was at the Guwahati Medical College for a year, before moving to Delhi and Mumbai. So I’ve worked in cities a lot, except for a stretch in the middle in Sholapur at a mostly rural set-up.

In cities, women didn’t ask me about the technicalities of sex. A pregnant woman, or a young woman who has a problem with her period isn’t going to tell you about her sex life. Perhaps, they’ve done their homework on that front, because they have easy access to that kind of information. Instead, they asked about specific problems — like infections, STDs, or contraception, sometimes even about putting on weight because of contraceptives.

In our Maternity Hospital, I treat a very broad category of people, mostly between the ages of 18 and 24. And after coming here, I have been dealing quite a bit with infertility cases. I find myself asking rather specific questions about my patients’ sex lives; personal questions that aren’t usually asked.

The kind that never happened to me in the city? Nobody came to me worried they haven’t had children yet, only for us to find on repeated questioning that the couple had not had sex at all.

In our town, most of the time both husband and wife come to talk to me because they think they’re infertile. I say ‘think’ because once we do the examination and tests we need to, we often find that there’s actually nothing wrong. It’s at this point that we have to start asking again and again, politely of course, if they are having a problem with intercourse. Then there are some bad cases, when the wife is just 16 years old, and we have to say that she’s probably too young to have children.

Once, a couple came to me because they hadn’t had children, but the examination showed that neither of them was infertile. So I kept asking about sex, until suddenly it became clear that they had been having only anal sex. Then there was also a time when a couple came to me saying the husband had a decreased libido. But actually, the husband wasn’t particularly interested in having sex with his wife because he preferred porn. What follows in each of these cases is a lot of counselling.

One thing that’s often common in infertility cases in rural and urban India — men flat out refuse to undergo any tests to check if they’re infertile. They say it’s all the woman’s fault. I know a man who was worked up enough to divorce his wife because they hadn’t had kids, but was still refusing to get tested himself. And then in Nalbari, there are women who have infertility, related to poly cystic ovarian syndrome, but their husbands don’t want to spend on treatment, so they start having extramarital affairs instead.

Information or the lack of it is not always the problem. In many cases, I’ve noticed that when couples think they are facing decreased libido or infertility, it’s something else altogether. It’s that they are having mechanical sex without feelings or intimacy. Sometimes, there’s no emotion involved because the couple hardly knows each other. The fact of the matter is that they’re unaware of each other and each other’s bodies. It’s the reason women come in with post-coital tears and bleeding — the women are not wet enough, aroused enough, but the husbands are trying to push their penis inside anyway, especially when they’re newly married.

When we see cases like this we do a lot of counselling. We keep telling the couple that they need to talk to each other. As it is there’s very little conversation between them: the man goes off to work in the morning, and when they go to bed at night, the man complains the woman isn’t interested, when the case is probably that she’s exhausted after a day of cleaning, cooking, looking after the kids, and washing clothes.

Sometimes, when the woman comes on her own, she says her husband isn’t interested when she is. But there is no room for her to tell her husband this.

Actually, when women come alone I hear a lot of other questions (sometimes, even if they do come with their husbands, they wait till they’re alone with me during examination to ask me what they really want to know). The most common complaint from women, something that she can’t say to her husband, is the age-old problem — that he always finishes first. She not might phrase it like that, but what this really means is that she is not reaching orgasm and the husband is not at all interested in making sure she has an orgasm too. This problem as you can imagine, is common in cities too.

And very occasionally, a woman will come alone to the doctor if she is having pre-marital sex. These women come because they need contraception, and they can’t go to a medical store and buy it, because everyone will look at them weirdly. I had one bad case, a woman who had had pre-marital sex came to me with an ectopic pregnancy [where a fertilised egg implants outside the uterus]. We had to tell her parents and get permission to do a surgery even though she was over 18, because that is the norm here.

It hits me every now and then how different things are here. There are almost no conversations about sex — sometimes young women don’t know anything about it until they’re suddenly in bed naked with a man. It’s no wonder then that couples think the problem is a decreased libido or infertility when it isn’t.

Everybody, whether they’re from a village or a city needs to be educated about sex. Once that happens, sex might even become more enjoyable — as it should be.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

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The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

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Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

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Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

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Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

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A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
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Bidisha was selected in’s flagship program ‘She Creates Change’ having run successful online advocacy
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