SUMMARY KEYWORDS

women's healthcare, preventive medicine, puberty milestones, maternity discussion, menopause topics, intimacy education, adolescent exposure, sex education, mutual respect, communication skills, fertility issues, lifestyle factors, social pressure, infertility causes, emotional intimacy

SPEAKERS

Dr Ashwin Rao, Dr Lavanya Kiran & Arun Patre

321, stop.

Arun Patre  

Welcome to She's Healthier with Orya Care. I'm your host. Arun Patre. I've been a curious cat all through my life, the last 20 years of my working in healthcare, mostly, but others in water and sanitation as well as business and finance. Today we're talking about women's healthcare and how medicine 3.0 is going to define, you know, preventive rather than reactive medicine, and how audio care is wanting to bring some of these lesser known topics out in the fray, more focused on women's health care, and we have two very prominent gynecologists with us. Let me start with Dr Lavanya Kiran. She hails from Mandia, and she's brought up under the police officer's very tutelage, guidance. She's delivered 20,000 babies till date, and close to 650 robotic surgeries. And she's also cosmetic gynecologist practitioner, as was a lacrosse Copic surgeon coming to Dr Ashwin. He's a third generation gynecologist practicing in Salem, Welcome to both of you. Thank you. On this show today, we are going to talk about, you know, all the different three milestones in a women's life, which is puberty, maternity and menopause, all of which are very less spoken about and quite sidelined too. So we're talking about, how can we bring in some elements of each of these milestones out in discussion? Some of these topics are very intimidating and quite shy for me to to bring it in the open with that note, let me say that doctors, one things that I have always wondered is, you know, how does one get introduced to the topic of, you know, intimacy? Does it happen in adolescence or teenage or much later? For me, I'll just say that, you know, for me, it was a conversation that I had on a terrace that I distinctly remember with a friend of mine. And this friend happened to be, you know, both his parents are doctors. I spoke to him about the wet dreams that I had for the first time. And that was my initiation into, you know, intimacy and what it was. And he taught me what this is with the explanation of a rocket launch. And that's how it was for me, maybe you guys can tell me what it was for you. Ma'am,

Lavanya Kiran  

yeah, I think this is indeed the right topic you have chosen, and I think this is something to be definitely discussed about, like Arun said, this is very less spoken about, and I think it's very good to have the right information, because that is when it sets the path for you for the future. And when you say, when does it get exposed to people? Is it adolescent? Is it teenage, or is it adult life? I think the answer remains unanswered, because for each individual, it is going to be different. But considering the present generation of Gen Z and alpha, I think it's way before time, because when I go for health talks, I see kids as young as nine years, 10 years. Know about it. But when you come to a different generation, it's all together, a different thing, like when you said, you know, a talk in the parents for somebody is different. For me, I think I've always wanted to be a doctor, and so I think I've been more attentive in the biology classes, and that's how it's been. But then, yes, of course, in school, you know, when you get to hear about, you know, there's a guy touching the girl the next door, you know, the girl sitting right next to him, so that becomes the gossip of the class. And this is how my first thing started. Or, you know, how does it feel? And those things, is my exposure, I would say,

Arun Patre  

 Doctor, maybe you could share a little bit more about, you know, was it any different for you in med school? How do you get initiated to this topic, to talk about this uncomfortable topic to your clients exactly like I'm feeling that right now to even talk to both of you,

Ashwin Rao  

oh, you're definitely justified in feeling that way, because I think all of us felt that way when there was a topic about intimacy and sexuality and everything. I think I mean, what all of us have been brought up in a way of thinking is that intimacy is basically something that you have with a crush or a lover or something. But I feel intimacy comes to the point of when, how you feel nice, how you feel safe, how you feel I mean, respected, basically, is what intimacy actually means, because that's how it tells you about how well you can discuss it with your parents, with your friends or with somebody. Who won't take it in the wrong sense. So I feel in school, I came from a place like Salem, and then in school, we were asked to sit separately, boys separate and girls separate. And also, what would happen is the funny exactly, and the funny thing is that when the teacher decided to punish us. They would ask her sit next to a girl, and we would feel so embarrassed. Did you really think it was the punishment at that point of time? At that point of time, I did find a punishment because you felt so conscious about yourself and how you would behave, how to act. And then, in case they had to sit very close to each other, you suddenly touch her. Your leg touches her, and then you feel like, Oh, I'm sorry I didn't feel this way. And did you also agree you would be ranked up to the classes Exactly, exactly, you'd be so worried about it. But then exactly and when and when, during school, during the younger part of schooling, is when I felt this way. When you're much older, your first decision came right in the toilets, because that is where in the toilet you would see, you'd see, I mean pencil sketching or pen sketching, saying, This one loves so and so. And then that's how you'd get details about what intimacy you'd be like, and what how to feel intimate, or how to start liking somebody or loving somebody, and how you would actually say I love you, and all those things, and what love actually means, and that is how you got charged me in first place. And then you'd be surprised that none of us actually received much of a sex education in school, although, I mean, med school is totally different. I would really say that doctors as such, we would just get exposed to those intimate parts during dissection. The first time, actually, I happened to see a female genitalia was off, yes, in during dissection sessions where we would have, we would have embalmed bodies there to dissect for the first time and learn about anatomy and everything. That's when we really first get an opportunity to see and then your imagination runs wild, and then you start picturing that with other women and say, Okay, this is how it probably is. And this is how you'd go ahead, tell me

Arun Patre  

doctor to talk to a stranger about this topic, which is what both of you have to do day in and day out, because otherwise, you know, that's the way to win over your patients confidence. How did you get trained into this?

Lavanya Kiran  

First of all, I have another perspective what Ashwin was saying. You know, he was talking about medical school and the anatomy dissection. I think the first time that we actually get exposed to a real patient is when you go to the clinical posting, and that is when you actually see a live patient, and then you asked her to strip, and then see these things. And that's quite thick, because even in school, like he said, you know, such a taboo topic, even for a science teacher. And then I remember, like, forget

Ashwin Rao  

you find them running over the topic. In fact,

Lavanya Kiran  

just forget boys and girls sitting separately. How it was for Rao comes from another generation. Yeah, even the class of reproductive medicine would be taught separately, and very few teachers would talk openly about it. I think being into science, we would only want to say, I'm sure Ashwin wants to echo the same that talking about it is very important, and earlier days are much better. And you were talking about, how do we talk about this to our patients? And how comfortable are we talking about, though we are in the field of gynecology, like post Impa, then we do masters in gynecology. I think these things are not actually taught for us in the school days, or the career days, or your post graduation is not taught. This is something I picked up over the years of practice traveling to several other countries, getting your affiliations, getting your degrees, getting your fellowships across different countries, visiting different hospitals made me open up how they were to their patients, of how they were openly talking about it, and how the doctor patient relationship changed for them. And I think that is how I learnt. And decided that the more open you are to the patients about intimacy, the sexual habits or the sexual culture that you need to be following, made me more closer to the patients. And I decided when I talk about it, only then the patients were open about it. So this is what changed my perspective, which was much after my training,

Arun Patre  

to be said. Dr Ashwin, maybe you can tell us a few key words of how you make

Ashwin Rao  

that see. Basically, what I would like to really tell you is communication is something is never taught in med school or during MBBS or during masters as well. Whereas Arun, you come from an im background, and I'm sure that the. Communication is the key to come key to achieving anything, any kind of, any kind of, if you want to really get some kind of project done or something, we push through. I think communicating the right things is when you can really make sure that the target, the project, is yours. The same thing is never done for us in med school or during post grad as well, and communication something that I think over time I have built it up myself, like how you come out of stage fright. It's like you come you have to come out of sex talk fright. That's what you would say exactly. Because if you're not able to come out of it, I think just the part where in your body language shows that you're little worried, or you're you're kind of inhibited, or you feel that you can't really talk about that is something what your patient gets on to as well. And then the more confidence you emit, the more likely the patient will actually discuss certain things that they are finding difficult to talk about.

Arun Patre  

I mean, India is today the world's youngest population. If we don't do this right, then it's quite a public health disaster. Thanks to both of you, we will have more gynecologist feel more confident of addressing this topic. In fact, one while I was doing my research on this topic, I went through this laden India report, which was alarming for me, it's a close to 31st 34% of the people didn't learn about intimacy till date, like even in their adulthood, whereas 38% of them learned from their friends. We

Lavanya Kiran  

don't know the statistics, but definitely in our clinical scenario, when we compare, I think we are almost there, yes,

Ashwin Rao  

yes. I think I could definitely agree on those numbers, because, in fact, more because, again, here, during these studies and during these survey that are taken, not everybody is willing to openly say that they knew about or did not know about it, but I see, I think the numbers are going to be more than what you describe them to be is what I would I would personally feel you

Lavanya Kiran  

see like how he was talking about talking about sex, or difficulty in having an intimate life. Patients will see that confidence in you, because see if, as a clinician, if I'm not making an eye to eye contact with my patient while talking about sensitive things, like about sexuality, about their comfort, about being close to their partners, or their difficulty in having a sexual life. If I don't talk about these things on eye to eye, I think that is when the patient's not even going to talk about it. Or sometimes you have to understand, get down to the patient level, talk to them and try to give a leading questions. And that is when they're going to be comfortable trying to talk about these things, and that is when the openness comes. Because

Ashwin Rao  

in a clinic, if you look at it like as a male gynecologist, the first thing I realize is, how am I even going to get patients to come to me and and, and how many patients are going to say, Yes, Doctor, I want to see you. I don't mind being examined by you, and I'd be happy. And I came to you because I want you to see me. Initially, I felt that when I started practicing gynecology, I felt most patients would come to me, would come to me and say, Okay, Doctor, please jot on my complaints. Let me get examined with somebody else. Let the somebody else tell you what my problems are, and then you diagnose my diagnose what I have, and then treat me accordingly. But then you'd be surprised when you're really confident with what you do and you're able to talk to them with some amount of openness and honesty. How many people come to me and if I'm not available the particular day, they won't mind going back and coming back again if they haven't taken an appointment, and I'm very clear, okay, I tell them, Okay, you come to me. I'm not there. You can see another gynecologist. I can come back and see you much later. And they said, No, I've come to see you, and I'll see only you, which is actually a real fat on my back. In fact, as a male gynecologist, I would honestly say,

Arun Patre  

how long did the transition take? I mean,

Ashwin Rao  

you'd be surprised that it took just about two or three months, because secret sauce, no, the secret sauce, honestly, is about how confident you are with how you talk to them.

Lavanya Kiran  

This is why I said, you know, I think I'm sure you agree with me, yes, this communication, that confidence and making the other person more comfortable with the topic. And I think that is the same when it comes to partners as well, where, you know, if the partners are not comfortable with each other, how would they get intimate? They may not calling it intimacy, then it's like the other word, the rape or something is the one. Because if the communication is not there, the respect to each other is not there. And it's the same culture that we practice in the clinic as well, communication, respect and, you know, trying to listen to them. I think that this itself is going to solve the knowledge Doctor lavini,

Arun Patre  

I think that brings me to the next question of, you know, how do you really define intimacy? Is it just the physical part? What's the emotional part? Definitely not. You know, how, how is that? Much varied with either partners, like there's a male and a female standpoint to both these aspects. If you could throw some light on that, definitely, for me,

Lavanya Kiran  

I would say intimacy is not just physical. It's about emotional, mental, intellectual and physical as well. And I think I would place physical intimacy as the last because if you have to get physically intimate respectfully, I think you will have to develop this emotional bondage, this mental equation should be the same and comfort for the other person to talk about, what do they feel, about their deepest thoughts, or how are they feeling, I think, is the most important thing. So when I say intimacy, though, majority of them think about we're talking about physical intimacy. It's definitely not, because intimacy can be in different relationships, like not just the partners, with family members, with friends. So it's an extended thing. So intimacy is something that you're comfortable with the other person, be it emotionally, be it physically, or be it intimately. I think that is what is important. And if we are talking about physical intimacy, and I think it's something, communication is very, very important for the partners, because only when you talk about your deepest thoughts or how are you feeling about anything. How are you feeling about each other? I think that's what's going to make a difference. And when you gain that bondage, which starts off emotionally, that is when the intimacy can also be more pleasurable, comfortable, and something which both of them share equally, I think that's what is the most important thing. I would say,

Arun Patre  

Dr Ashwin any real time, examples of how this, you know, distinction between physical, emotional and the mental. Part was, you know, seen in some of your minds, maybe see,

Ashwin Rao  

I feel intimacy, something as as the Avani had said, is about mutual respect. Yeah. So what happens is that? How often, when you when I talk to patients, I realize that when a couple decides to have sex, I find that most couples telling me that once the man has his erection and his orgasm, he is done within and he is out. How often do you really ask your partner whether she had the orgasm as well. That is what I mean by mutual respect. Because, for example, is it just your personal pleasure, or is it going to be mutual orgasm and mutual respect and mutual intimacy? That is what I really learnt to look into. Because that is something that I find with lot of my patients saying that, okay, the woman comes to me for a gynaec consult. And she tells me, okay, sir, he just comes home. He is away most of the time. He works in some he works in a different place. We meet each other probably once or twice a week, and we decide to have a child, and we do have some amount of intimacy, or we have a relationship, or we decide to have intercourse. The moment he gets it, he's away to his next thing, he decides to go watch TV, he decides to have food, or he says, sleep. What about me? I'm just lying over there, not knowing what has happened. And in the end, when I decide talk about him, the first thing that he says, You want to have a child, right? This is how you have a child, and we're done. What about my personal interests? What I feel about myself? What am I in this marriage, and where am I in this family? Is something that would you agree

Arun Patre  

that, you know, man has a different perspective from you know, Lady in the whole aspect of mutual respect,

Lavanya Kiran  

definitely more than respect here, I think it's about communication, and I think respect is a part of this community. I would say, yes, these examples are something that we see all the time, day to day, especially we both being fertility, especially, it's very common for us, like it's more of a mechanical sexual life. And

Ashwin Rao  

there are questions which say, What do you mean by foreplay? That is amazing.

Lavanya Kiran  

So I wanted to talk about that. So that's that's when the point of communication comes gone. Are those days the scenario we see less but I will not say we're not seeing it at all. Definitely it is there, because I think India at large is consistent with all kinds of people from urban to rural to semi urban to semi rural. So how many of them are open to talk about it to their partners? Is the most important thing. So when we say that if the lady is not talking about what she needs, or what is it that she likes, and how does she like, it is very important. And until, unless they don't open this open about it. It's not going to make difference. But when would she open when she has this emotional connection? Exactly?

Arun Patre  

But do you, both of you also agree that, you know, does sex education affect intimacy like in the sense? Is. It. You know, if you're taught that you have to cringe when you talk about this subject, or you know you have to be guided to be curious in a respectful way, how does some of this impact intimacy? I

Lavanya Kiran  

would only say you're opening up an international debate topic now, because I think it's a growing moment. In fact, I think talking about sexual education introduction, when are you introducing it? When are you talking about these things? Makes a lot of difference. I would definitely agree these things should be talked about from the days of school. And anybody who has a education about sexual life or about intimacy will be more respectful to the other person, and not only about intimacy, I think here we are also bringing them awareness about safe sex, which, not only you know, helps them limit their partners, also limiting themselves or refraining from early sexual activities, also talking about contraception, using condoms, preventing sexually transmitted diseases. I think these are something that we will put early into their brain, because your first question is, how early were anybody exposed? So I think when they have this as an education and somebody speaks about it openly to these people, they'll be aware so they're more guarded, or they're more educated about it, and they take a sensible step, is what I would say.

Arun Patre  

So in that sense, you know, you know, educated in the safe way makes sense for India as a public health effort to and not just from, you know, an awareness standpoint, not

Lavanya Kiran  

only India, across the globe, yes, because the number of sexually transmitted diseases, AIDS, lot of other problems, unwanted pregnancies, for that matter, multiple partners, cervical cancers, I think, will all have to be cut down. And the way to go forward is introducing

Ashwin Rao  

education. So basically, if the teacher in school who's taking sex ed who is actually a zoology professor or a Botany teacher who's taking a class on safe sex, I think they should be actually a training program for them, from a gynecologist perspective. Because the reason why they find it difficult to talk about it is because they're not very sure as to what education they're giving students is the right thing to do or not. And what they feel is that whether educating students on these lines would probably increase the rates of premarital sex is what I feel prevents them from communicating this particular part. But I feel some amount of confidence on their side to tell them that, see, contraceptives is one thing, but contraceptives are not completely preventive. They just have a percentage of how much they can actually prevent the possibility of a child. So once this is taught, I feel personally that curiosity comes a little bit and the worry goes up as to, what if unsafe sex or unplanned sex can lead to something which can probably cause a lot of complications, because you do get a lot of unmarried pregnancies these days, and on most occasions, over the counter, pills Available from a pharmacy without a proper consultation by a gynec can lead to a lot of complications, and I feel, I still feel unsafe. Medical termination of pregnancy is one of the leading causes of death among young women,

Arun Patre  

yes, and in fact, so there you have just busted a myth, which is, you know, sex education causes unnatural curiosity and passion stories, whereas we see it's the opposite. Exactly. You're busting this myth that, you know, we need to educate right early and safely so that we don't lead into

Ashwin Rao  

this. Yes, definitely, this

Lavanya Kiran  

will bring in the awareness the right over here, because

Ashwin Rao  

it unsafe or unplanned sex is because of curiosity as to what it actually means. If you are able to describe something, or if people are able to see what it actually means, I feel that that curiosity gets killed, and then it is more likely that there is some emotional connect before a physical intimate relationship. So

Lavanya Kiran  

that also means it is the, I would say, changing the mindset of the provider. So the provider, provider is the healthcare worker. It could not just mean doctors. It could be a nursing staff, or anybody who works in the hospital, because I feel patients are a commoner. Anybody who has a problem doesn't mean they always go to a doctor. They could be talking to a nursing staff because they think she's working in a hospital setup. So they will be talking to somebody like this. So the awareness needs to be created with lot of people. So I think changing the mindset of the provider is very, very important. And I'm sure you can remember. I'm not sure if you related to yourself. But then I definitely knew it when I got into first year medicine, so they assumed that I could diagnose all diseases and I could start treating my first year while I was still trying to learn how to check

Ashwin Rao  

and if you are not able to tell them what is wrong with them, they will. They really ask you, you are a doctor, how come you don't know about this? Then you're I'm not a doctor, I'm a medical student, and it takes me five and a half years to understand which Google tends to give you in a minute.

Lavanya Kiran  

So it takes a lot of effort. You know, every case is just putting medical knowledge, and then takes your masters of three years, and by the time you put it into practice, learn it the right way. What is more comfortable to the patients takes lot of years, 20 plus years. Yes, definitely. So I think that's how the practice brings in. It

Ashwin Rao  

takes a lot of time for people to understand as to what it actually means. Because see all of us undergo something called training in basic life support, but I think none of us doctors undergo a training on how to communicate about the basic necessity of life that is sex and and the idea of reproduction, that is something that none of us have any idea or any clue, whether it's in school, college or masters, or even once we go into clinical practice, we are not really taught to hand over that knowledge to the paramedical staff so they can do some amount of counseling before the patient comes and sees you. But

Lavanya Kiran  

do you agree? You know, I think you asked us a question in the beginning, when did your mindset change, or how comfortable Did you agree? I mean, it was for me the same that once I got qualified in cosmetic gynecology, things changed from your what all you can treat, what all questions to ask, how to approach a patient? Was it the

Ashwin Rao  

same? I think, I think the same. The cosmetic gyne training that you went through was a real Pandora,

Lavanya Kiran  

ice breaking for us,

Ashwin Rao  

yes, yes. Like a new word to me, yes. We'll

Arun Patre  

talk about it. The Gloria care, yes, we take a break. Doctors, I have a myth that I am really curious about, because I had an arranged marriage myself. But please tell me, is intimacy less important in an arranged marriage, because you have more time to know each other.

Lavanya Kiran  

I will only ask, is it so? I don't think so. Mine is an arranged marriage too. But then I think intimacy shouldn't be dependent on arranged marriage and love marriage at all, or I didn't know that the Gen Z, should we ask it as a question, marriage and force marriage?

Ashwin Rao  

So mine was a love marriage. So I mean, I have a lot of friends who had arranged marriage as well, but I don't think intimacy has changed any way in either of our marriages. Because when we go out on family trips together. We don't really feel there's a huge difference in that. What do you feel? Ma'am, what do you feel about I don't think so. I don't think that changes. But in your practice, doctors, you know, choice, marriage versus arranged, what is the scenarios that you have seen that they come to you? Are the questions different or the people who tag along for this consultation are different this. This makes it

Arun Patre  

deal with each other or talk to each other, because in a Harish marriage, I think it's the same. Even in a love marriage, where you're going into an unknown family, it's just the partner is known and the family, they still remain unknown. So getting used to that and going through a lot of emotional changes, environmental changes, for the ladies especially, I think takes a little longer time. But then intimacy again can be mutual respect consent and forceful as well. So that becomes opens like a Bangalore box into a different perspective. I have a question differently for doctors, although Dr Lavanya practice is very much in the prime of Silicon City of India, in Bangalore, in electronic city, but you practice in silo. So I and maybe there's a cultural difference of you know how this intimacy question, with the kind of marriage, influences that maybe you could tell us more of that see, if you look at my kind of practice, the only difference you see from there, from from where Dr Lavina Pratt, where I practice, is that I feel. I do think similarly. But if you look at it, see, even if it's the love marriage or knowledge marriage, even in Love marriage, you translate transitioning from the face of being a girlfriend to a face of being a wife. Yeah. So again, as a girlfriend, you're in your own house, you're safe. Things are done for you. Everything is taken care of. But when you transition being a wife, what happens in an Indian household is that you're suddenly given a lot of other responsibilities as well, other than just being your husband's wife or being passionate or being respectful or being intimate and emotionally connected. So I feel that first few months, whether you're whether you've got had a love marriage or an arranged marriage, works very, very similarly, except that in a love marriage, you you're kind of slightly understood your husband in a different environment altogether, but you're still yet to understand your husband when he's with his mother. That is the part which is not really what love marriage. Couples don't really understand

Lavanya Kiran  

supportive husband rather Yes, yes,

Ashwin Rao  

yes, yes, that's the word to go with it. I think yes, while it is actually being support element Exactly, exactly how supportive your husband is when it comes to relationship and and and respect and mutual understanding, and then who he is more comfortable with, whether and how, how much of a stand he will take situation yes, and how much of a stand is able to take, whether it's with his mother or his wife. And there are two contrasting poles, like north and south, which on many occasions, don't really tend to meet. That's why I said,

Lavanya Kiran  

if it's different scenarios, it's okay. But on the same situation, I think that is where the problem

Ashwin Rao  

comes exactly.

Arun Patre  

As doctors, especially as gynecologists, you would be caught in a consultation where exactly, exactly. How do you handle what is the gang colleges role to, you know, make this

Ashwin Rao  

not from so I really want to take this one first before ma'am does. Because what happens is that in my clinic, when in a place from where I come from, whether it's a love or arranged marriage, generally, the consultation of a couple is not really understood that well. They feel that their parents have to be brought along for the consultation as well. A decision is never made by just the couple. That is why, what you find is that three months down the marriage, the in laws come in and come in with the daughter in law and the husband and say she is not able to conceive. Like what they tell you is okay. And the first thing is, like, I had my first child when I was one year through my marriage, like at the end of one year I've delivered the child, is what most of them tell me. And then they come and tell me they are now married for six months, and there's nothing. There's no good news. That's the word they use. No good news. I've come to you to for a consult and to help me obtain the good news. It's like as if I'm saying, like I'm saying Tatas two. I say Tatas two and the child is born low the child is born that's that is something that we they still need to mean, educate them. That there is something with regard to career paths as a professional and career paths as a family

Arun Patre  

man. Would you agree the same as to what's the doctor's role in, you know, counseling the family

Lavanya Kiran  

on the overall Yes, but then for me, I think considering or taking the advantage of my age, I become pre generation doctors. So more of a family doctor you become because I would have treated the mother or the mother of the bride or the mother of the groom for hysterectomy or gynec issues, and now we have the newly wed couple, and somebody in the family would have delivered, and those kids are coming for vaccinations, so you can already guess what my age would be. So this is how. Thank you for that. So it's pre generation doctors. You become a family doctor for them. So it may not be a typical consultation and coming and forcing, but then I do agree, and that also means I have people coming from different sectors, though you mentioned, I'm sitting in the Silicon Valley and sitting in an electronic city between the it hub. I also have lot of patients coming from the rural sectors and from different parts as well. So I understand when you say we have in laws or the parents, even, in fact, coming along with the couple and asking the same question of, forget three months? I was surprised, because I have lot of couple who come back with especially more than the couple. I think it's three last come back and say, it's already a month, and nothing has happened, you know? And I also have, because majority of my clientele is The IT Crowd, so I think they're more matured enough, and we also have a different statistics. Or the other end of the spectrum. I have where couple come in, even at 3035, married as long as eight, nine years, coming back to me and asking, I want to postpone my pregnancy for another couple of years, or we are not even looking at children. Or I also have couple who do not want to be physically intimate. They're very happy as partners, is emotional intimacy and intellectual intimacy, and definitely not so. I have couples of all varied kinds. But then just the question of mother in laws or the mothers or the parents coming with them is quite common, not uncommon. But then we have couple who take decisions for themselves and talk for themselves.

Ashwin Rao  

The same thing with me as well. What I would say is, since I am a third generation gynec, people who have been delivered by my mother or my grandmother tend to come to me, but with a different thing, like the girl's mother comes to me saying that I have two daughters. The first one has been married for four years. The second one has been married for one year. The second one achieved pregnancy, where the first one is not achieved pregnancy. Yet they tend to set up a competition within the family as to who reaches the target first. And in case, the younger one is a target first, they make sure the old one gets to know about it, and they put forward the question to the older one, asking, Why haven't you achieved this? What is wrong? They even talk about intimacy and sexual relationship for the first time with the older one, only after the younger one has achieved pregnancy ahead of the older one.

Arun Patre  

Well, this is quite a stark contrast when, you know, in teenager adolescents, Indian parents are very shy about this topic, whereas when it comes to this juncture, it seems

Ashwin Rao  

quite different. Yes, they talk about it then, for the first time, that's

Lavanya Kiran  

because, I would say it's a social obligation, you know, because I think still in India, far say that having a child is more of a social obligation, then what do the couple actually want? So especially for the family and the elders in the family, it's like a statement that their status symbol, statement that their son has been able to reproduce, or their daughter is fertile, and this is why they've achieved a pregnancy at the earliest. So I don't think that thing is gone in but of course, like I said, you know, it depends on your brought up, your exposure, and what your personal thinking is. But Fauci we do have lot of percentage of people belonging to this category, and this is why the family forces the couple to have a child much earlier,

Ashwin Rao  

and even if the girl wants to postpone her pregnancy, the likelihood of them undergoing an IVF, even without a reason, could also mean due to stress behind this entire situation of putting so much pressure on the girl for not being able to achieve pregnancy, not being able to have a child, and The first thing the mother of the girl comes and tells you is that I am not able to go out to any parties, because the first thing that my friend asked me is, when is she due or When is she going to achieve pregnancy? Is she ever going to achieve pregnancy? But what they don't understand is that different couples have different targets in mind. You. It's not necessary for every couple to achieve pregnancy. They can also think of not achieving pregnancy, not having a child. It is something left to them to decide about how to go ahead with their lives, which is something that puts it puts enormous stress on them. I

Arun Patre  

think that's, you know, a very evolved statement for us as a society to can maybe accept that. But, you know, with changing landscape in the society, I'm sure you know, we will evolve to that. That brings me exactly to that question, you know, how do we define fertility? And an often that we hear about, the myth is, you know, it's the women who it's it's a woman problem, ma'am, please help us. Definitely not,

Lavanya Kiran  

you know, because for me, I would say fertility is a natural way of reproduction where the couple can conceive or consummate and have a, you know, normal reproduction within a year of marriage, or within a year of consummation, I would say. And here things would change. If you're a little older person, like more than 35 then we would definitely want to say, come in early, at the end of six months, and then you need to be worried, or if you are worried, so that also says that we need to respect the other person, because I think choices have changed now, because people want to postpone their pregnancies, and the priorities have changed with education, financial independency and all. But I'm sure the women are sensible, and it is very much needed to be sensible to thinking of postponing the pregnancy only till the right time and not unnecessarily postponing too much, because there are lot of things associated with the age and lot of these things. And this is also a sad scenario, like how he said, you know, the family is forcing the couple to conceive, to us, extent that we have couple married for three months, six months, because of the pressure of the family or the friends, they come in and say, I'm ready to go through an eyewit Because we can't go through the stress and especially the social engagements that they are involved with, how they are getting questioned, and they want to push themselves to any kind of treatment modalities. Again, on the other side, we also have girls coming in at 3035 saying, Look, I want to postpone my pregnancy at a later date, or until I find the right partner. I want to do fertility preservation. So I think these are all something that we need to educate the community and bring in this awareness that modalities are there. Just important to talk about it to the right doctor that you want

Arun Patre  

to see. So maybe as Doctor, this is very common to you, but this the first time I'm seeing this angle of, you know, infertility. They adopt this just due to social pressure, because they're not able to, you know, live up to that situation. Whereas I always thought, as somebody who's watching this industry and generally our lifestyles which have led to infertility. You think that's not the only factor. That's definitely not

Lavanya Kiran  

the only factor. And you also brought up a question that you know, is it just the females who are the cause of a fertility? It is not, you know, because I think it's equal for both of them. In fact, I would say 30% female factor, 30% male factor, 30% both of them. And we have something called the explained one, which is contributing to 10% so it's like everything together as a couple on the whole who needs to be evaluated, and not just

Ashwin Rao  

exactly. And another point I'd like to add to this, which I feel is very important. As Dr Lavanya had said, one year of proper intercourse or proper but intercourse done the right way, you don't know whether done the right way or not. Have they been even taught what the right which door to approach. Which door to open? Am I opening door number one, two or three? That's the most important thing.

Arun Patre  

Reminding me of the movie, Dr G and

Ashwin Rao  

i Exactly, exactly, wow. That is how we understood this situation for a client, exactly.

Lavanya Kiran  

Forget the movie. I've had real case scenarios. Can you believe it? I had a couple married for two, three years, and they came in saying that they couldn't have a child. Forget consummation. We have lot of people who come in non consummated marriages because of lot of pathology involved or psychological problems involved. And that's a different thing this couple, specially, when I asked them, Do you have a penetrative sexual contact? They said, yes. But then when I examined her, you, I couldn't believe that behind

Ashwin Rao  

me was intact time and yes, yes, they were

Lavanya Kiran  

doing was the wrong way. Neither the girl had any idea about it, nor the male partner had an idea about it. So. I think the right sex education is very important, and that is how we can save a lot of

Ashwin Rao  

exactly, exactly emotional trauma like not having proper sex education has led to so much from a sex, I mean, improper sex leading to not being able to have a child, so much of mental trauma, so much of pressure. Why? Just because it all goes back to the point of saying improper sexual education, I feel that is so important when it comes to this particular statement, Sex Education. Dr

Arun Patre  

Ashwin, this is more a pointed question. Male gynecologist also this point of view of a male mostly women have felt, you know, made to feel that it's that problem. And also the man in the relationship tends to be dominating about how this is not addressed. Give us some pointers to, you know, fellow doctors, how should they counsel this? And, you know, to

Ashwin Rao  

the male counterpart, exactly. So see, basically, they need to understand any couple trying to achieve pregnancy, to understand that there are four basic points. One thing is, as far as the female is concerned, the ovarian reserve, the uterine factors, like, if there's nothing wrong with the uterus, the uterus is perfectly okay to have a child. And the third thing is the fallopian tubes, which is actually the natural incubator where a child is actually incubated before it comes into the interest. And the fourth most important thing is the sperm count. The sperms are okay. And again, to decide to clap, you need both hands. You cannot just say that the woman is all important, or the man is all important. It's basically having all factors intact. I mean, forget about unexplained inferiority or or combined inferiority, just a man and a woman being okay on these lines, can also achieve pregnancy, provided they are doing it the right way. In

Lavanya Kiran  

fact, I would say some scenarios I'm sure you would have faced the same where couple come in and the male is not okay to do his analysis or get examined, or even to be spoken to and asked, Have you done your evaluation? The female would have gone through so many investigation, couple of visits with lot of doctors. And of course, if anything missed, we will ask as a fertility specialist. But then equally, at that point, when I ask him, have you gone through any evaluations, or you need to do these things, I've had prompt things. And say, like, Doctor, you get her test done first. If nothing comes up, then I'll think about it. Or, you know, I've had scenarios where the male says, there's nothing wrong with me. I don't want to do my test. You just check I'm here, and I've got her for you to check her. So still, those scenarios are there. So that is where the education comes in for the couple to understand the problem could be with anybody. And as a clinician or a gynecologist or even a fertility doctor, we are not here to pinpoint and say, Whose problem is it. We are here to address the problem and to find solution. I think that is what the people also need to understand when they come I

Ashwin Rao  

think that way, as a male gynecologist, at least, I find a few husbands coming to me and telling me, Doctor, I would like to have my cement tested just to be sure I do have that kind of patient as well. And as Dr Lavanya had said, you do have certain persistent husbands who feel that I am Superman and Exactly, exactly, or you've had very tight underwears on your pants. That's why it's preventing you from having a child. But that's something that in a lot of counseling can help, and in certain situations, doing the women's test first and telling them that okay, the woman is absolutely okay. And since you had issues with achieving a pregnancy, getting the guy to get his semen tested. Actually can be easier once you have once you've told him that okay, the woman is okay. But just to be sure, we'd like to test you as well. So keeping him comfortable and keeping him keeping his masculinity intact, is what really helps to get him into it.

Lavanya Kiran  

I would definitely acknowledge those men. And we've had, you know, scenarios where you said they volunteer to say, Doctor, do you want me to do any investigations? And yes, couple of scenarios, how Dr Ashwin mentioned, we've had only the male partners come in first for whatever reasons. You know, either they've had multiple partners in the past, or whatever reasons they come in to say, can you do my check? I'm planning to get married, or I'm planning a pregnancy. So yes, we should acknowledge those kind of men and others who are not I think should care for that,

Ashwin Rao  

and think you, I mean, you need to be really happy on those lines, that those are the guys who really respected the women who feel that they could also be a cause. Yes, for her stress in fact, about not having a child. But those guys are the real heroes. Is when you really tell them that they are willing to come and get tested, and when men come and say, Okay, we have been having intercourse frequently, and I am not so happy. I feel my erection is not very great. Or if he tells okay, I ejaculate even before I go in. So that takes a lot of courage, from the man's point of view, to come and acknowledge that he's got there is something wrong with him, and he would like a consultation. Based on that,

Lavanya Kiran  

I would definitely agree, and then I would say the scenarios have changed. The percentages of couple reporting this, or the male partners reporting this, is definitely increasing. This is all because of the awareness that has been created, because the male also could have a problem, and I think that's very much important. Do both

Arun Patre  

of you agree that you know, most of us been made to believe that it's only lifestyle changes that causes to solve infertility, as doctors, do you want to? Must bust this myth a

Lavanya Kiran  

simple factor, I would say, no, definitely. Lifestyle is one of the factors, one of the factors changing a lot of things like stress and especially Westernization of our Indian culture, leading it more to the wrong pathway. Rather, I would say, in affecting the fertility, like I already mentioned, education, financial strength, independency, postponing pregnancy is not going actually in the right direction. I would say I'm doing this that looking at fertility preservation and talking about it, of how, when and how early, I think, makes a difference. Along with that, I think, Ashman already mentioned, the factors as a female and the male, because, you know, there could be causes in the uterus, the ovaries, the tubes, and lot of endocrinological problems or hormone going haywire, those needs to be checked. Oval reserve is important, similarly, for the man as well. I think men analysis, lot of hormonal changes, even in the male, I think makes a lot of difference. And sometimes, you know, as particular specialists, I always say we play gods. We can only play gods. We can't become gods. And whatever said and done, there are some 10 person factors where we none of us can help them. So these are lot of things. Are there immunological factors? So many things you know, that that would take an entire day for us to discuss on the causes of fatigue. So multiple factors, lifestyle is one of the factors. And definitely people need to work on the stress levels, especially with the modernization of the work and the target setting, stress has become one of the major factors. But then, yes, there are multiple factors for the couple not to conceive.

Arun Patre  

Well, on that note, I think we would say that, you know, there's quite a bit to talk more definitely, and the audience will She's Healthier with Orya Care. Yes, this is our first episode doctors, and there's more to come. Our goal as Orya care is primarily to help women reclaim their confidence in winning their health care, and not just, you know, through clinically, but also with their mental and well being in all that's bring me to the end of this episode and tune in, like, share and subscribe this with your friends and other fellow you know, friends of yours to learn more about, you know, women's health care and how we talk. Introduce this to sex, intimacy and fertility. Thank you all. Thank

Ashwin Rao  

you. Thank you to finish my this part. You when you're ready. What about you? Dr Ashwin,

Arun Patre  

please. Dr Ashwin, you're concluding comments on

Ashwin Rao  

lifestyle. See, lifestyle also means about talking about personal habits like smoking and alcohol, which makes a huge difference as well. It also makes a difference when it comes to relation, personal relationships, sex and everything and reduction as well. And we found that smoking and alcohol and obesity makes a huge difference with the reproductive outcome and also with physical intimacy as well. So I feel lifestyle is a very important factor to think about and shouldn't be just set aside saying that doctors can do everything. I feel some introspecting about what you can do in your personal life to make a difference to your family is also important. So I think that is what I would say regarding lifestyle factors

Arun Patre  

very well. Said, I think I learned a lot from both of you. I hope our audience did the same.

Lavanya Kiran  

A lot of myths where we enjoyed interacting. Yeah,

Ashwin Rao  

I think it's a real myth buster as well. And I really think that we should have a lot more on this to educate our audience better on these. Lines as well.

Arun Patre  

So with that, you know, orya care is much more than just about health care. It's about helping women regain their confidence and well being. It's also about, you know, how do you create that confidence as a family for you to, you know, overcome some of these situations where that truly today is sidelined and made the center of being the problem. That's not the case, so let's start a conversation and create a new blueprint for women's health care and wellness. Like share and subscribe to She’s Healthier with orya care. See you next. You.