|Year : 2008 | Volume
| Issue : 1 | Page : 18-22
Sexual behavior of clinic attendees in a tertiary care hospital in Pondicherry
Nidhi Singh, Sowmya Kaimal, Devinder Mohan Thappa
Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry - 605 006, India
Devinder Mohan Thappa
Department of Dermatology and STD, JIPMER, Pondicherry - 605 006
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The recent years have witnessed a renewed interest in human sexual behavior, partly because of the growing AIDS pandemic. We undertook a study of the pattern of sexual behavior among outpatients attending our dermatology clinic. Sexually active patients attending the dermatology clinic for non-STD complaints from March 2007 to June 2007 were randomly selected and interviewed about their sexual behavior using a questionnaire. The study included 500 respondents (240 women, 260 men). The mean ages of the women and men were 37.9 years and 38.9 years, respectively. Forty-two of the unmarried men (54.5%) were sexually active, while 55 of the married men (30%) admitted to having had premarital sex. A total of 81 men (38.8%) admitted to premarital sex, compared to only 2.9% of women. With regard to extramarital contact, 62 of the married men (33.8%) were affirmative in their response, while the corresponding figure for married women was 12 (5.5%). Nine men had a history of bisexual contact and, of these, one man admitted to having had exclusively homosexual contact. Fifteen men had indulged in anal sex; 48.3% men with pre/extramarital contact had more than one partner, and 43 (30.1%) had visited commercial sex workers (CSWs). Most of the respondents (141; 87%) with pre/extramarital contact had had unsafe sex. Among the women with pre/extramarital sexual contact, most (17; 89.5%) had only one partner; all were heterosexual and the majority had had sexual contact with relatives (73.7%). To summarize, men had overwhelmingly more pre/extramarital sexual contact as compared to women.
Keywords: Clinic attendee, extramarital sexual exposure, premarital sexual exposure, sexual behavior
|How to cite this article:|
Singh N, Kaimal S, Thappa DM. Sexual behavior of clinic attendees in a tertiary care hospital in Pondicherry. Indian J Sex Transm Dis 2008;29:18-22
|How to cite this URL:|
Singh N, Kaimal S, Thappa DM. Sexual behavior of clinic attendees in a tertiary care hospital in Pondicherry. Indian J Sex Transm Dis [serial online] 2008 [cited 2020 Jul 16];29:18-22. Available from: http://www.ijstd.org/text.asp?2008/29/1/18/42709
| Introduction|| |
Sexual behavior implies activities related to sexual expression and gratification. This forms a prime component of one's sexuality and is influenced by social, cultural, psychological, and biological factors. Understanding sexual behavior in the general population is vital for the prevention and treatment of sexually transmitted disease. The recent years have witnessed a renewed interest in human sexual behavior, partly because of the growing AIDS pandemic. There is very little information on patterns of sexual behavior in India. This study aims to address some of these lacunae.
| Materials and Methods|| |
All consenting, sexually active adults attending the dermatology outpatient department at our institute for non-STD complaints were included in the study. A total of 500 respondents were enrolled in the study during a 4-month period from March 2007 to June 2007. These individuals were interviewed about their sexual behavior using a questionnaire, and their responses were recorded and tabulated. The methodology used for collecting information about sexual behavior in this study was structured face-to-face interviews (FFIs). Two contrasting alternatives to FFIs have been widely used. The first attempts to get closer to respondents and erode barriers to disclosure by gaining their trust. This aim is achieved most commonly by unstructured, often repeated, interviews and, less commonly, by the ethnographic technique of prolonged participation in the study population. The second attempts the opposite by reducing or eliminating interaction between the data gatherer and the subject; the main techniques here include self-administered questionnaires (SAQs), computer-assisted self-interviews (CASIs), and audio computer-assisted self-interviews (ACASIs). There is justified skepticism that conventional structured face-to-face interviews (FFIs) are the most appropriate method for eliciting sensitive information such as nonmarital sex.  Descriptive statistics were used to analyze the results.
| Results|| |
Of the 500 respondents, 260 were men and 240 were women. Most of the respondents (75%) were from a rural background. The mean age for men was 38.9 years (range: 16-82 years) and for women 37.9 years (range: 15-72 years). Most of the respondents belonged to the 25-50 years age-group.
One hundred and eighty three (70.4%) of the male respondents were married as against 218 (90.8%) of the female respondents, with the mean age at marriage in the two sexes being 24.9 years and 17.6 years, respectively. The lowest reported age at marriage was 12 years among the women and 17 years among men. Sixteen men (8.7%) had more than one wife (polygamy), and 5 women (2.3%) had more than one husband (polyandry).
The age at first sexual contact in men ranged from 15-36 years, with a mean age of 23.76 years, whereas in women the age at which the first sexual contact took place was at 13-35 years, with a mean of 19.3 years.
Sexual behavior of male respondents
Out of 260 male respondents, 143 (55%) gave history of pre/extramarital sexual contact. Eighty-one (56.6%) of the men gave a history of premarital contact alone; of these, 39 were married and 42 were unmarried [Table 1]. This implies that these 39 married males were faithful to their wives after marriage. Forty-six (25.1%) married men gave history of extramarital contact alone and 16 (8.7%) had history of both premarital as well as extramarital sexual contact [Table 1]. The sexual partners were usually relatives or friends; sexual contact with a sister-in-law was the most common [Table 2].
Nearly half of both married and unmarried men had had only a single premarital partner, whereas the majority (93.7%) of those having both pre- and extramarital contact had multiple partners [Table 3]. Most of them had unprotected sexual contact [Table 2].
A total of 43 men gave history of contact with commercial sex workers (CSWs) [Table 3]. Twenty-six (60.4%) of them had multiple contacts and 34 (79.06%) had had unsafe sex. Importantly, 13 (30.2%) of these men had a past history of genital ulcers or discharge. Ten respondents gave history of homosexual contact; nine were bisexual and one was exclusively homosexual - multiple unsafe contacts with two partners (friends).
A past history of genital ulcers or discharge was elicited in 33 out of 143 (23.07%) male respondents with history of pre/extramarital sexual contact. Nineteen (57.5%) of these men gave history of premarital sex only, 8 (24.2%) reported having had extramarital sex only, and 6 (18.18%) had both pre- and extramarital sex. None of them had practiced safe sex. Twenty-five (56.8%) of these men had received allopathic medication for their complaints. Seventy-eight men (54.5%) out of the 143 who had had pre/extramarital sexual contact gave history of consumption of alcohol prior to their sexual experiences.
Sexual behavior of female respondents
Out of 240 female respondents, 19 had history of pre/extramarital sexual contact [Table 4]. Two (9.09%) unmarried female respondents gave history of sexual contact. Out of 218 married female respondents, five (2.29%) gave history of sexual experiences that were exclusively premarital, while 12 (5.5%) married women had history of extramarital contact alone [Table 4]. None of the women reported having had both pre- and extramarital contact.
Out of a total of 19 women who had engaged in pre/extramarital sex, 14 women (73.68%) gave history of contact with a relative. The majority of these were with a member of the previous generation [e.g., eight (57.1%) women had had sexual contact with an uncle]; five (35.7%) women reported sexual contact with brothers-in-law and one (7.14%) with a father-in-law.
The majority of the female respondents had a single pre/extramarital sexual partner. Only two women had multiple contacts with multiple partners (including CSWs), all of which were unsafe [Table 5]. One of these women was married and the other unmarried; one also reported a past history of genital ulcers.
A past history of genital ulcers or discharge was elicited in 8 (42.1%) out of the 19 female respondents with history of pre/extramarital sexual contact. Three (37.5%) of these women gave history of exclusive premarital sex and five (62.5%) reported exclusive extramarital sex. None of them had practiced safe sex. Six (75%) of these women gave history of allopathic treatment for their complaints.
None of the female respondents gave history of homosexual/ bisexual contact.
| Discussion|| |
Most of the respondents (75%) were from a rural background, coming to our institute from the surrounding villages and settlements. The demographic characteristics of the men and women included in the study were similar with regard to their ages. With regard to marriage, however, there were significant differences, with 90.8% of the female respondents being married, compared to only 70.4% of their male counterparts. These figures are not surprising, considering the universality of marriage, especially with regard to women, a concept that is deeply rooted in Indian culture. The legal age for marriage in India is 18 years for women and 21 years for men but the law does not seem to have many takers when it comes to women, with the mean age at marriage being 17.6 years for the female respondents and 24.9 years for the men included in this study. These figures, again, are most likely a reflection of the norm in most orthodox Indian families, where girls are generally forced into marriage based on the availability of a suitable groom. However, these figures do not correlate with the rise in average age at marriage that is being experienced in India: the figures were nearly 21 years for women and over 26 years for men in 1996. 
There are no hospital-based studies available that evaluate the prevalence of pre/extramarital sex in India. Surveys of adult students of schools and colleges in contemporary India indicate that although premarital sexual experience among them is not as common as in Western countries, it is not as rare as is widely believed. There is no evidence in India yet of premarital sexual experience among students being as widespread as that found in the 1991 US National Survey of Family Growth: 76% of young men and 66% of young women in the USA had experienced sexual intercourse by their final year of high school.  The corresponding figures for India indicated that 25% of male students in a Delhi school  and 28% of male college students in Hyderabad  had engaged in premarital sex, signaling an urgent need for appropriate sex education in Indian schools and colleges. In 1992, Savara and Sridhar analyzed the responses of middle- and upper-class men and women to questionnaires published in Debonair and Savvy (two expensive Indian magazines), only to uncover a very permissive attitude towards premarital sex, with 65% of male respondents reporting premarital sexual experience, the figure being similar to that among their counterparts in Western countries.  These responses were contradicted by a more rigorous study in demographically similar classes in Calcutta, Delhi, and Madras, which found a significantly less permissive attitude and behavior: 17% of male respondents aged 21-45 years and 8% of female respondents reported experience of premarital sex.  Studies among the urban lower classes show a wide variation in premarital sexual experience: 25.4, 32.2, and 12.2, respectively, were the percentages among 264 blue-collar workers, 258 migrant workers, and 139 loom workers in four towns of Maharashtra.  Our study showed a prevalence of 38.8% for premarital sex among all male respondents. These are higher than most of the previously reported figures for urban populations, but no definite conclusions can be drawn unless there are parallel studies in rural populations. Currently, no quantitative estimate of the practice of premarital sex is available for any rural community of India, but casual reports indicate that it is not uncommon, particularly among unmarried men.  A glaring discrepancy exists between the prevalence of premarital sex in men and women in this study population (38.8% in men vs 2.9% in women), a finding that corroborates the fact that gender inequality persists in Indian society in powerful and dangerous ways.
There is very little information on the female sexual partners of unmarried males in India. Neighbors, relatives, prostitutes, friends, and fiancιes have been mentioned as partners in a few surveys. There is an indication that the premarital sexual partner of a male is often a married woman who may be a relative or neighbor.  This trend is seen in this study as well, with 48.1% of all premarital contacts of male respondents having been relatives.
Although this study did not attempt to measure the prevalence of homosexuality in the general population, it did find that approximately 7% of the men who gave history of nonmarital sexual contact also gave history of homosexual contact. The general prevalence of homosexuality in the country has been found to range from as low as 1.2% in the general population in Pune to as high as 29.4% in educated urban men.  There are no reliable estimates of female homosexuality in India, although a study in Kerala found that 32% of 50 married women admitted to ever having enjoyed homosexual activities. 
In India, married men are much more likely than married women to engage in extramarital sex and more likely to be condoned for such behavior. Approximately a third (33.8%) of the married men in this study admitted to having engaged in extramarital sex, compared to only 5.5% of the married women. In addition, the married male respondents who gave a history of premarital in addition to extramarital sexual contact seemed to demonstrate more high-risk behavior than other groups, i.e., they had more number of partners and were less likely to use condoms. The violation of marital fidelity is considered more punishable for women than for men, and in India, where it remains socially imperative to be married, women cannot easily confront, challenge, or control their husbands' extramarital sexual behavior. The secrets and silences that result from these relationship dynamics can exacerbate married women's risk of HIV infection. Earlier studies have estimated the prevalence of extramarital sex in married Indian women to range from 3% in an educated middle-class group to up to 12% in a lower-class population. ,
The low level of condom use in this study is disturbing (86.7% of men with nonmarital contact never used a condom), as is the fact that 16.5% of male respondents had visited a CSW at some time. In addition, all 33 patients who reported a past history of genital ulcers/ discharge had never used a condom. The level of condom use in India, as reported by female prostitutes, is known to be very low, due mainly to the persisting unwillingness of customers to use condoms, and the prostitutes' powerlessness to insist on their use or to reject the customer. Behavioral research in the field of HIV/AIDS must assign a high priority to this area. 
| References|| |
|1.||Cleland J, Boerma JT, Carael M, Weir SS. Monitoring sexual behavior in general populations: A synthesis of lessons of the past decade. Sex Transm Infect 2004;80:ii1-7. [PUBMED] [FULLTEXT]|
|2.||Arunkumar TS, Kochumuttom J, Sankar PR, Sobhan K, Raju KP. Sexual behavior patterns in Thiruvananthapuram. THRANI center for crisis control. Available from: http://www.thrani.com/pap1.pdf. [cited on 2007 Aug 2]. |
|3.||Nag M. behavior in India with risk of HIV-AIDS transmission. Trans Rev 1995;5:293-305. |
|4.||Sehgal VN, Sharma AK, Bhattacharya SN. KABP study on AIDS among school boys. In 2nd International Congress on AIDS in Asia and the Pacific. Sydney: AIDS Society of Asia and the Pacific, 1992. p. 192. |
|5.||Goparaju L. Discourse and practice: Rural-urban differences in India. Paper presented to IUSSP seminar on Sexual Subcultures. Migration and AIDS, Thailand: 27 Feb - 3 March 1994. |
|6.||Savara M, Sridhar S. Sexual behavior of urban, educated Indian men: Results of a survey. Fam Welfare 1992;38:30-43. |
|7.||Basu DP. Appropriate methodologies for studying sexual behavior in India. J Soc Work 1994;55:573-88. |
|8.||Savara M, Sridhar CR. Sexual behavior amongst different occupational groups in Maharashtra, India and the implications for AIDS education. J Soc Work 1994;55:617-32. |
|9.||Khan S. MSM and HIV-AIDS in India. Naz Foundation International; January 2004. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]