'Shubh Mangal Saavdhan' writer and a urologist talk about erectile dysfunction
Dr Sumit Mehta (left) and Hitesh Kewalya exchange notes. Pic /Bipin Kokate
Last Wednesday, Dr Sumit Mehta caught a late night show of Ayushmann Khurrana and Bhumi Pednekar starrer Shubh Mangal Saavdhan after a long day of consultations at Hiranandani Hospital, Fortis in Vashi, where he is a consultant urologist. It was less entertainment, more prep for a chat he was to have the following afternoon with the film's writer, Hitesh Kewalya.
"I hadn't heard a lot of good stuff, but I wished to see it for myself. I thought I was going to give him [Kewalya] grief, but, I came out of the theatre feeling differently," he smiles.
Not once using the term erectile dysfunction -- a condition where the male is unable to achieve or maintain an erection during the sexual act -- the 90-minute film tells the story of the soon-to-be-married Sugandha and Mudit, and the challenge before them. A limp-biscuit dipped in chai is the closest we get to an analogy.
Kewalya and Dr Mehta meet to discuss, how close we are to reality.
In the film, nobody talks about erectile dysfunction directly. How common is it for men to approach a doctor or counsellor?
Dr Sumit Mehta: Most people don't know of qualified andrologists or sexologists. Most medical universities, by the way, doesn't offer an andrology degree unless you are an urologist. So, most doctors identify as sexologists, although they actually deal with the urinary system as a whole. It took me six years after acquiring an MBBS degree to become a qualified urologist. A lack of awareness is the problem, besides, of course, a feeling of shame. A man's ego prevents him from admitting he has the problem, even to himself.
Hitesh Kewalya: Female friends, in general, are more free with each other and seem to discuss sex. A group of men, even if childhood friends, find that tough. It's hard for a man to talk to another guy about such a problem. His friends are only left to guess, as we see in the film.
Do families get involved if the couple is married?
SM: I have received requests from the girl's family to certify that the man can't perform, when they are going through divorce. In most cases, unless the sexual organ is malfunctioning, it is difficult, if not impossible for a doctor to give such a certificate. In a given situation, he may or may not perform. It depends on so many factors -- the situation, the partner.
HK: Often, men in the family, make it about themselves. If you are questioning my son's manhood, you are questioning me. I've grown up in a social circle where the problem existed, but, was never discussed. You hear cases of a sudden divorce after three months of marriage, with no clear reason. The people in question are not spoken to, but tongues start wagging. The layers [of secrecy] start peeling, until everyone has a view on your private life.
SM: When people start taking sides, things spiral out of control. Every situation need not be explained to a patient's parent. Parents cannot help a couple perform sexually. We tell the couple to sort it out without involving seniors.
How can they do that?
SM: Eighty per cent of erectile dysfunction cases are a result of psychological reasons, one of which is performance anxiety. I could identify with Mudit [Ayushmann's character] because he is like so many of my patients – stressed, wearing a look of having given up. He's going through situational impotence. A single episode where he is unable to perform dents his self-confidence so severely, he is afraid to face the situation again. The couple must have a frank conversation, and give the problem the time and patience required to solve it. If the man is unable to perform, the woman needs to stand by him, and vice versa.
In my experience, 90 per cent of such cases can be treated with medication and counselling. But, it is a slow process and both partners need to stay invested.
HK: Unfortunately, there is this notion that such a problem cannot be solved. In the film, Sugandha's [Bhumi Pednekar] father asks her to run away.
SM: Exactly. Most people think running away is the only way. Because they want fast results and fail to get them. Some couples say, fix it so we can have a child. A child is not the answer to compatibility. The relationship needs to go beyond the problem so that the problem becomes one tiny part of the whole experience. That's how you tackle it.
In your experience, what are the overriding causes?
SM: Excess stress, overworking, alcohol, smoking and lack of sleep are contributors. Other causes could be lack of blood supply to the penis, leaky veins, tight foreskin, etc.
In a bizarre sequence in the film, the girl's father takes her fiancé to a vet!
HK: I wished to say that sex is after all, an animalistic instinct. No matter how complex it seems, at the core, it's a carnal act. I don't know if animals have performance anxiety.
SM: I am not a vet, but as someone who grew up with four dogs, I can say that animals have reservations too. Female dogs tend to see the human family as their own. They won't mate in the presence of their parents. Vets often ask pet parents to leave their dogs alone and go away for a while so that they can mate. So, the animal connection may not be far-fetched after all.
HK: The stereotypes are out on full display, especially when the protagonist visits a doctor, but turns back because she happens to be a woman. (That scene was removed).
SM: Male gynaecs are common, but how often do you hear of a female sexologist or andrologist? And sometimes, the media doesn't help. With articles that run down doctors and highlighting culprits from the medical fraternity, we are pushing people towards quacks, and porn, for advice.
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