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Sexuality as a subject is forbidden and there appear to be very few avenues or spaces, for people to talk about matters connected to sexual well being. We know that each person has a unique 'sexual narrative' influenced by factors such as culture, gender, personal experiences, country contexts, ability/disability etc. Various laws and policies in one's country could also influence one's sexual expression or relationships to a great extent. Besides, there are everyday problems such as worries related to work or pressures of juggling between one's family and job etc which might play a role in affecting one's sexuality. Sexual concerns may occur anytime in an individual's life. They could occur very early in one's life or much later.

A discussion on sexual concerns has to be positioned in the larger framework of sexuality and unless we are able to talk about sexuality freely and openly in our society, it becomes even more difficult to talk about a 'sexual concern'. Consequently, sexual concerns get labeled as ‘sexual problems' and are then claimed by the medical fraternity as something, which requires their attention. However, we know that sexual concerns differ from person to person and from one context to the other. Also how one may decide to deal with them also differs widely.

In some cultures the demand for an hour-glass figure for women and therefore the aspiration of women to achieve such a figure could become a sexual concern; in some other culture or country, it could be just the opposite. For men, it could be the constant anxiety about penile size or sexual performance. We know that sexualities and genders are not limited to binary concepts. How are sexual concerns manifested across various genders and sexualities? How do they play out in different cultures and contexts?

In this E-Discussion, participants were invited to offer their views around four lines of enquiry:

(i) Sexual Concerns – Talking About Them?

What do we mean by sexual concerns/problems? What is the general perception? Do we think it is important to talk about 'sexual concerns' as a subject? Do they find a place in the hierarchy of concerns that need to be looked at and dealt with? If so, where do we place them in this hierarchy? Or do we end up shelving them for later? What are the sexual concerns that people have? What is one's perception of a 'sexual concern'? Is it to do with sexual dysfunctions and disorders only? Is it about the 'right' way to have sex or the 'right' number of times to do so? When does a 'concern' become a problem? Is it the individual or the people involved themselves who decides there is a problem? Or is it the medical professionals and service providers who do so? What goes into the construction of a 'sexual problem'?

(ii) Sexual Concerns – Varieties and Manifestations across Cultures

How do sexual concerns manifest in different cultures and across variables such as gender, age disability etc? What are the myths and misconceptions related to sexuality in various cultures and contexts? What stereotypes and assumptions go into myth making? What would be the sexual concerns specific to a group of people like people with disabilities? The differing nature of disabilities may well be a variable in itself and may accordingly evoke a variety of concerns.

(iii) Sexual Concerns – Approaches and Management

What are the ways and means people adopt to address their sexual concerns? Are sexual concerns adequately addressed? If not, what are the remedies? Do we know of services that we think have been successful in dealing with these concerns? As individuals, which of these services are we comfortable with approaching and why? Which of these services do we have easy access to? Do we choose to call up a helpline or pose our questions to newspaper or magazine columns or to websites? Or do we feel more comfortable approaching traditional healers and taking herbal pills and potions? Do people’s life circumstances also reflect their choice of these services? Would a transsexual person or a person with a disability feel equally comfortable to access these services? Do we feel that there should be different sets of services for the varying needs of individuals?

(iv) Sexual Concerns – What do rights have to do with them?

Do we feel that sexual rights are significant enough to be claimed as a set of entitlements? Why is it that there is so much silence when it comes to sexuality? What are the rights that we can associate with sexual concerns? Can we claim spaces to talk about issues of sexuality without feeling embarrassed and guilty? Can we claim services that could help us address these sexual concerns without them being exaggerated or pathologised as 'disorders'?

A summary of all that was discussed follows. Not everything that was discussed was directly in response to, or completely in keeping with the mentioned lines of enquiry.

Much of what we say about sexual concerns has to be placed in the broader context of sexuality. As one of the participants pointed out, sexual concerns are what affect us individually and that ‘whatever concerns me in my sexual or asexual life is a concern’. She added that, the world of sexual concerns is very large, including anything and everything from erection to depression to emotional and inter-relationship problems. Another participant shared that ‘at an individual/personal level it could range from seeking information on sexuality to building proper communication channels around oneself regarding sexuality whereas at an inter-personal level, the complexity of communication is more visibly felt’.

In addition to the complexities of interpersonal relationships, there is also the socio-cultural and religious contexts in which people live. Religion and culture offer definite guidelines and codes of belief about sexuality. Marriage as a social institution is also important in that society often treats sexuality as something, which exists only within marriage and many interventions are based on this assumption, even though people have sexual concerns both within and outside of marriage.

The range of sexual concerns differs from person to person with respect to different contexts and life circumstances. There are wide differences in the levels of sexual interest and desire among people. As one of the participants points out, ‘different people attribute different meanings to sexual thoughts, feelings and behaviours and what we consider ‘normal’ then varies significantly’.

When does an issue cease to be a sexual concern and become a ‘ sexual problem’ causing anxiety or discomfort? Sexual problems are in turn medicalised, fitted into various disease-oriented models and consequently need to be treated or cured. In the words of another participant, ‘I guess when a concern has led to considerable dysfunctioning of the organism it could be considered as a problem. That is if it creates severe emotional or physical discomfort, conflict in relationships, or problems in other aspects of their lives, it could be considered as a ‘problem’. One of the participants has expressed that a lot of research is needed in this direction. However, would research be the only way in which we get to talk about these specific concerns? Are there avenues where we could share and discuss them freely?

A few of the participants who have responded to the forum hold that sexuality cannot be talked about without putting an equal emphasis on defining gender roles that individuals play in their lifetimes vis-ŕ-vis the changing society. Only when we are able to understand these contexts will we be able to define what sexuality means to each individual and the specific sexual concerns that individuals face. If we even talk about gender roles, we know that the range of sexual concerns differs largely between that of different genders right from body image to performance concerns.

Though sexual concerns are definitely governed by binary gender stereotypes and roles, such as men playing the role of the ‘enactor’/‘initiator’ of the performance and women playing a ‘submissive’ role. We also know that there is an overlap in the kind of concerns shared by both men and women. Talking about sexuality does not come easily to either men or women. Although, as one of the participants points out, it may seem more acceptable to find men talking about sexuality as they may have the societal license to do so often in the form of jokes and humour. We therefore find that spaces such as this - to talk about sexuality - do exist. What remains absent, however, are spaces where we can talk about how sexuality affects each of us in very many ways individually or within relationships, physically or emotionally.

There were extensive discussions during this subtopic on what sexual concerns means to each of us individually. One of the female participants from Paris helped in listing out common sexual concerns among people and brought out inter-linkages between how sexual attitudes and sexual needs, whether they are individual or come from the society that one lives in, contribute to what are known as sexual concerns. Another female participant said that the concerns of most women also have a lot to do with marriage and the corresponding social status accorded to them. Therefore widows or women who are separated/divorced or women who have sex outside of marriage all carry different levels of stigma and these women share very varied sexual concerns amongst them. One of the participants from India also listed out specific concerns shared by men be it concerns regarding their self-esteem and body image such as the length, size etc or about their sexual performance and whether they are able to ‘satisfy’ the woman.

Several participants suggested that there was a need to have dialogue between different stakeholders to build a holistic approach towards the subject of sexual concerns. Communication about sexual concerns in inter-personal relationships was termed as very important by several participants in the forum.

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In this subtopic we tried to look at the broad ways in which sexual concerns are manifest in various cultures and contexts. The responses, as was expected, were varied. Some participants categorised sexual concerns in terms of sexual violence and abuse, while others talked of issues related to the physical body and its appearance.

A participant from Sri Lanka said that, when she thought of a 'sexual concern' it was more in the nature of the sexual abuse and violence that people face whether as children or as adults and how that could pose a problem in their future relationships whether with an abusive partner or a caring one. It becomes more of a concern when most often people may not know that the trauma they had faced earlier could influence the nature of their present relationships. She further said that, survivors of sexual abuse often feel traumatized in their non-abusive relationships as well and it poses an additional fear in them to voice these concerns because they are scared of being judged or rebuked. In the words of one of the participants, ‘if talking about positive sexual desire, sexual pleasure and sexual orientation is fraught with anxiety, risk, ridicule, and possibility of violent censure, then how much more frightening it can be to express one's fears and concerns about sexual desire, pleasure and practices that are already being perceived by the individual as shameful and labeled by society as deviant?’ There are hardly any spaces for people in general and women in particular to address these concerns. A participant pointed out that, 'there is no quick fix solution'. The trauma undergone takes a long time to heal.

For women it is often a case of double jeopardy. According to a female participant, ‘there's already so much blaming of women either for wanting "too much" sex or "not enough" sex, where are the safe spaces to talk through sexual concerns that would further label and stigmatize them -- like not wanting oral sex or wanting multiple orgasms or feeling violated by certain sexual positions?’ It is very instant and real to see these concerns being pathologised. She added, that there is not even a guarantee that the person with whom she is sharing her concern, whether in the form of a partner, friend or a therapist, is sufficiently informed or comfortable about such issues.

Marital rape is another sexual concern or problem, which many women are known to face in the South and Southeast Asian region. Most of the countries in the region do not have a law against marital rape and nor is there any acknowledgement that it exists. How do women in these contexts then voice their concerns when their husbands feel 'entitled' to have sex with them? As a participant pointed out, 'none of these sexual concerns are mutually exclusive since for some people, there have been multiple and different forms of violations resulting in multiple traumas'.

One of the major concerns is the silence around issues of sex and sexuality. According to a participant, even as it deters people to talk about sexuality in a safe and non-judgmental space, it poses even higher risks for people who have undergone sexual abuse whether as children or adults as they feel doubly stigmatized and silenced. With sexual concerns, there is also the constant fear of pathologising all of these concerns and treating them homogenously. One must take care to avoid that path.

The other concerns, which surfaced during the discussions, are about certain myths and misconceptions. For example, about size. Whether it is penile size or the size of the breasts, with the popular notion being 'the bigger, the better'.

Even though most societies (in the region) thrive on the belief that sex happens mostly within marriage, it is ironical to find an lack of information on sexuality even among married couples; so much so that there is no clear communication between the couple. There is a high premium on virginity for women and 'romanticisation of the wedding night'. There is a huge pressure to be perfect on the wedding night. According to a participant from TARSHI helpline, ‘we have had men calling with pre wedding-night jitters - "what if I don't get an erection?", "what if I ejaculate too soon?", "what if she says my penis is not big enough?", "what if I can't satisfy her?" Women in similar contexts call to ask, "what if I don't bleed on the 1st night? Will he believe me when I tell him I am a virgin?", "I have heard it is very painful the 1st time, is this true?", "I have had an abortion before, will he be able to tell?"’

Inadequate information and lack of spaces to talk about sexuality often translates into fears related to sexual performance among men and women alike. Interestingly, one of the participants said that women's concerns are usually defined by the men. In heterosexual relationships, there are men who complain that their women do not cooperate. On the other hand when women show more initiative in sexual relationships, men treat it with suspicion and keep wondering where these women are getting their interest and information from.

A participant who is a practicing medical doctor in India took the whole discussion about Child Sexual Abuse as something, which is ‘unnatural’ and ‘abnormal’. In the same vein, he shared his views about how homosexuality was 'abnormal' and that it was 'natural' or 'normal' for people to be heterosexual and be able to procreate. It was however pointed out by other participants that homosexuality was no more abnormal than heterosexuality. Additionally, not everybody is able to or would want to procreate and that does not make them 'unnatural' in any way.

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Sexual concerns occur across countries, cultures, genders and ages. Various service providers address these in various ways. One of the most common ways of dealing with these concerns is through the medical professionals, who often club and categorise the concerns into a set of disorders, which then need to be treated. In the process, people are usually compartmentalized into predetermined groups. The fact that individuals are unique and distinct from each other is often disregarded. We know that sexual concerns affect different people in different ways.

Despite the fact that spaces to address sexual concerns are inadequate, different communities do find ways and avenues to address these concerns, in part if not in whole. Various cultures and sub-cultures are known to come up with indigenous and traditional ways. While some work, some don’t. It would be interesting to look at these.

On the e-forum it emerged that most of the sexual concerns of women in the South and Southeast Asia region are largely to do with their reproductive health and rights. The approach to sexual concerns has mostly been medicalised, categorizing most of them as disorders. There was a great deal of discussion on how these concerns differ across genders and sexualities for example, the popular notion that a man's sexual urge is greater than that of women.

There were discussions about the AIDS and Sexual Health Info Line in Canada and the TARSHI helpline in India. These are helplines on which callers remain anonymous. A number of questions were posed by the participants regarding how callers present their concerns, whether women call as much as men do and whether the presentation of concerns differ across gender. A few of the participants observed that anonymity tends to encourage more people to call voluntarily and to share their concerns. According to one participant, the foremost reason for seeking anonymous services is 'the need for information, reassurance and counselling on issues that they cannot speak about with anyone else in their lives'. Another participant said that 'because these helplines are voluntary in nature, the callers have the choice whether to call back or not'. She added, 'it is also important for counselors on helplines to keep talking to the callers irrespective of whether they condone their [the callers'] actions or not'.

Many callers call because they are not sure whether their actions are right or not. In response to a question on whether many callers on the helpline call to enquire if their sexual behaviours are harmful, a participant from the TARSHI helpline confirmed that, ‘many do because there is so much stigma about talking about and acknowledging one's own pleasure, that many callers tend to (often falsely) believe that their sexual feelings and behaviours are harmful to themselves and others. For example, some believe that masturbation is harmful (that it causes acne or premature ejaculation), fantasising about someone they know (usually adults) is harming the other as well as themselves, women initiating sex in a heterosexual relationship is wrong and will ruin the relationship (because the man will feel inferior/ distrust her/ 'know' that she has had other sexual partners), men attracted to and sexually involved with older women, etc’. The participant added that the TARSHI helpline has received ‘very few calls seeking help for being sexually inappropriate with a child or engaging in non-consensual sex. Often, while speaking to these callers, it emerges that they disregard their partner's desires and often force them to have sex/ perform activities that the partners are not keen on (for example, fellatio and anal sex). Many of these callers report feeling bad that they have to force their partners but don't know how else to go about it! Also, many men who call complain that their wife/partner is 'not cooperative', totally disregarding the consent of the partner or the fact that there is often no negotiation or communication when it comes to issues of sexuality. During these calls the counselor remains non-judgmental but talks about how sex could be more pleasurable when there is consent and no coercion is used, trying to make callers aware that they are violating the other person's rights. This kind of non-judgmental stance possibly makes the callers' more receptive and open to change.

Participants also said that fewer women are known to call helplines and many who do, hesitate talking about being abused, especially if the abuser is a family member or the husband. Many of these women who call are often more worried about the repercussions, if they were to quit their partners, on their social and financial life.

These examples show the lack of safe and non-judgmental spaces for people to talk about their sexual concerns and the fact that people are trapped in the images or identities that society has constructed for them. In some societies, these 'identities' condition a woman to be submissive and not take the initiative in sex, similarly they condition men to be more 'masculine' with all the baggage that entails.

A female participant from India talked about ‘quacks’. She said, mostly men approach quacks to seek remedies for their sexual problems. According to her these quacks are not medically qualified or licensed but prescribe medicines for ‘problems’ such as nocturnal emissions and masturbation. The clients on the other hand hardly flinch in paying for these services as it pertains to their ‘masculinity’. This shows the presence of alternate systems or services to address sexual concerns although how reliable they are remains a point to ponder.

A participant pointed out that, education and awareness could go a long way to inform people about their rights and at the same time not violate the rights of others. Media promotion on issues of sexuality could also help in dispelling a lot of myths and misconceptions attached to sexuality. Another participant added that 'men will be more likely to participate responsibly in reproductive health (which is largely regarded as a woman's domain) if they begin to do so at a very young age'. Another participant observed that 'programmes should also aim at understanding and learning about young men's perceptions of their roles and responsibilities as sex partners in order to make successful interventions'.

The participants then discussed frameworks and models which categorize and group sexual concerns and place them in hierarchies of sorts such as the medical classification by the American Psychiatric Association for its Diagnostic and Statistical Manual of Disorders which divides sexual problems into various categories of sexual dysfunction. There was also a discussion on the critiques of these models as well. Another model discussed was the New View of Women's Sexual Problems. Though an excellent critique of the medical order, this has its own shortcomings as it homogenizes women and men within water-tight compartments and leaves out all those people who may not conform to binary notions of gender and sexuality.

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Different people approach their sexual concerns in different ways. Some approach medical professionals, some approach traditional healers and some are unable to deal with them at all. The diversity of concerns regarding sexuality differs across genders and sexualities.

Though the nature of these concerns could be similar for a certain set of people, their manifestation could be very different depending upon unique and individual experiences. The absence of violence and abuse in sexual relationships does not necessarily imply the presence of pleasure. As much as spaces are needed to talk about negative concerns of abuse and violence, there is an equal need to create spaces to address issues of pleasure.

The focus of the discussion in this subtopic was on what the participants thought of as 'sexual rights'. A few of the participants thought of sexuality and sexual rights more in the context of women and girls. Some thought that sexual rights are closely linked to factors such as 'poverty, unemployment, violence, sexually transmitted diseases, population explosion, gender discrimination and sex pre-selection'. Participants largely felt that in order to achieve sexual rights, greater intervention would be needed not just from the sociological and economic points of view but also from cultural, religious, medical, legal and political perspectives as they are all inter-linked.

A few of the participants said that when they talked about sexual rights it was more often from the purview of sexual abuse and violence and that which mostly involved women and girls as the victims. This hints at two things: one that the notion of sexual abuse and violence is still limited to women and girls as victims; and second that in this region the concept of affirmative sexual rights is yet to fully develop. A participant (who is originally from Sri Lanka and now works as a Senior Lecturer in the University of Sydney) related cases of sexual abuse of young girls who migrate from villages to live in cities in Sri Lanka. This is not limited to one country but could apply to several other countries in the region. Another participant said that sometimes women in the Indian states of Bihar and Uttar Pradesh are traded for the sole purpose of producing a male child. What reproductive rights do these women have? Participants seemed to find it easier to talk about sexual abuse and reproductive rights of women, while the lines between reproductive and sexual rights seemed to remain unclear and unstated.

A participant who is a medical doctor by profession raised the point that the notion of gender equality and empowerment is different in tribal societies, where women are supposed to have more power than they do in urban societies. He talked about the 'gotul system' in tribal societies where men and women cohabit before marriage to find the best partner and it is often the woman who chooses her spouse. He added that although physical violence does occur on women in tribal societies too, it is mostly by men under the influence of alcohol. He felt this was 'natural' because men are physically stronger than women. Although this was not discussed in the forum, these are the very myths regarding violence against women that the women's rights movement has been trying to challenge for the past many decades. It is a myth that men are violent because they are physically stronger than women, or that men who use violence against women do it under the influence of alcohol.

A participant shared the greatest difficulty of her friend, who is a sex worker, that 'many of her male clients have a sense of entitlement over her, refusing to see her as a person providing sexual services, but as a body they had leased for a certain amount of time - and combined with the notion that they had a right to receive sexual pleasure'. The participant suggested the use of the phrase 'right to seek sexual pleasure' instead of 'right to sexual pleasure' because the former does not pre-suppose that 'the sexual needs of everyone involved are satisfied'. Other participants strongly felt that 'pleasure has to be a mutual exchange between willing partners'.

Another participant said that there should be no coercion involved and neither should there be any exchange of money (for sex, between the people involved). However, the latter idea assumes that pleasure does not form a part of any kind of transactional sexual relations.

The participant stated that although sex workers should not be condemned, but that 'casual use of prostitution or bachelor parties at strip clubs' should not be accepted. Further, according to this participant, clients of sex workers should be condemned and punished and economic alternatives should be made available to sex workers. The underlying message is that sex work per se is not acceptable as 'work'. Also, some people feel that most people in sex work are not doing it out of choice and have somehow been forced into it, while many who have been engaging with the sex work movement would say that this may not be wholly true. As another participant pointed out, prosecution of clients could lead to other problems such as the clients being 'less willing to talk about the ill treatment of sex workers whether by other clients or by the employers or could create problems for the sex workers themselves for they would have to look for other working locations where the clients will not have the fear of being prosecuted'. Another participant said that 'all approaches to the issue of sex work are problematic within the context of patriarchal society'.

The participants were engaged in the discussion and continually challenged and questioned each others' viewpoints. While a participant talked about sexual pleasure between two persons, there were others who challenged the notion of why pleasure could not be derived by just one person or more than two. While a participant shared the idea of why sexual relations could not or should not involve the exchange of money, there was another who challenged the idea and raised the concept of 'sexual surrogacy, which is increasingly being used to help people discover sexual pleasure and/or to provide sexual healing'. She pointed out that criminalising any kind of transactional sex could cause the sexual surrogates to lose their jobs.

Most participants agreed that it was legitimate to claim sexual rights as a set of entitlements, but there was one who said that sex and the pleasure derived through sex is a private matter and making it an entitlement or a right, which can then be claimed in a court of law, could result in a situation where the privacy of people is violated and private matters are thrown into the public domain. The participant strongly stated that the privacy of individuals or groups should not be compromised for the sake of justice.

The participants agreed that education and awareness have a significant role to play in talking about sexuality and claiming sexual rights. A participant observed with irony that matters related to sexuality are always talked about secretly although it is something that most people engage in and derive pleasure from. She is hopeful that with time this silence and secrecy will be removed and a time will come when people will be comfortable talking about it.

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The E-Discussion Forum gathered an array of views and opinions on given sub-topics /lines of enquiry. The first sub-topic What do we mean by sexual Concerns engaged the participants with the medical and social aspects, and the individual and inter-personal aspects as well. The boundaries to the second and the third subtopics i.e., Varieties and Manifestations across Cultures and Sexual Concerns: Approaches and Management were very permeable and fluid and participants often drifted from one to the other. The third subtopic especially had a lot of contribution from two telephone helplines (on sexuality) from two different parts of the world. The participants from both the helplines provided useful experiences, accounts and examples. The New View Manifesto on Women’s Sexual Problems was also discussed. The fourth sub-topic on What do Rights have to do with Them had an exchange of views on issues of pleasure, of violence and on sex work issues. A compilation of Web sources that were shared during the forum was made available at the end of the discussion.

The forum gathered participation from far and wide, not only including countries of South and Southeast Asia but also Australia and the United States. There was a range of participants including activists, medical doctors, service providers (on the issue of sexuality), and many more.

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A Compilation of Web Resources


A link to find more information on help lines in Canada to deal with HIV/AIDS / Sexual Concerns

A link to a blog on sexuality

A link to 'Express Healthcare Management'

A link to 'A New View to Women's Sexual Problems'

HERA [Health, Empowerment, Rights and Accountability] Action Sheet

A link to the Graduate Program in Sexual Health in the University of Sydney

A link to the Declaration of Sexual Rights by the World Association for Sexual Health

A link to 'The Links between Prostitution and Sex Trafficking: A Briefing Handbook'

A link to the 'Sex Workers Critique of the Swedish Prostitution Policy'

A link to the International Union of Sex Workers

TARSHI (Talking About Reproductive and Sexual Health Issues)

The South and Southeast Asia Resource Centre on Sexuality