By Dr. K. Sohail

Dear Zeeshan!

When I look back at my teenage years growing up in a conservative Muslim and traditional Pukhtoon culture I realize that such an environment was not conducive towards a healthy attitude towards human sexuality. Most of us grew up ignorant about the subject and were full of feelings of fear, shame and guilt. We could not talk about our sexual feelings with our parents or teachers, as the subject was a taboo. There was no sex education at home or in the school. Adults did not prepare their children to be aware of their choices and make responsible decisions about their sexual lives. Parents believed they knew the best about their children. Many aspects of human sexual relations were considered unnatural, illegal or immoral. It took me a long time of studying medicine and psychology and living in the Western world and enjoying loving relationships to feel comfortable discussing it with my fiends and patients. I consider it as one of the most significant aspects of human relationships.

You have asked me what are the ten things I wish I knew about sex as a teenager. I admire your courage to ask such questions. I hope that you and your friends do not live in the same darkness and with the same inhibitions as I did thirty years ago. I sometimes wonder that in those thirty years, so much and so little has changed.

When I thought about your question the following things came to my mind.
1. It is quite normal for boys to have wet dreams as teenagers.
2. It is quite natural for girls to have menses when they reach puberty.
3. Semen is a secretion not excretion
4. Masturbation is self-pleasuring not self-abuse
5. It is better for all of us to know about male and female sexual anatomy and physiology.
6. It is better for all of us to be aware of different stages of sexual development.
7. Foreplay and after-play is as important as sexual play
8. Mutual orgasm  (cuming together) is not the most important part of love-making
9. We should all be knowledgeable about different forms of contraception to experience different forms of sex (to choose between reproductive, relational and recreational sex)
10. We should learn to accept rather than judge others who have different sexual tastes and lifestyles.

Dear Zeeshan! I have no idea what Pakistani parents feel about their children’s sexual lives. Who they think will give them sex education. There seems to be no preparation for accepting the puberty. Boys are not told that when their sexual hormones become active, alongside change in their voice and facial hair, they will also have erotic and sexual dreams which will be associated with nocturnal emission. I think they need to be reassured as it can be quite a scary experience. They have to know it is quite natural and there is nothing to worry about. Reaching puberty can be far more scary for girls than boys, as their menses can start during the day and can last a few days. I met many girls who were terrified when they had their first periods. Some of them had that experience when they were in school. As they were not prepared they did not know what to do. They were terrified, some even felt they were dying. They could not even discuss with their parents as there was no open communication. Many of them were as mystified when bleeding stopped after a few days it had started, not to know that it would return every month. They were also not aware that periods could also be associated with abdominal pain and mood changes. Since girls also have changes in the breasts it can also be embarrassing in front of relatives, friends and class-fellows. Most teenagers need a lot of emotional support and reassurance so that they do not feel abnormal or unclean. In our culture it is usually the opposite. Not only teenagers are not reassured and supported they rather have to face social embarrassment and humiliation. Many make fun of them. Many of them might have acne and other facial changes that they cannot hide. Since many teenagers are sensitive about their looks and body image, such changes make it far more challenging. Many girls like to do make up and wear adult clothes and jewellery identifying with their mothers. It is unfortunate that many parents do not see it as an innocent experimentation, they rather condemn and criticize. It broke my heart to see many parents tell their teenage daughters, ‘ When you do make up, you look like a whore.’ It is so devastating for girls to hear that from their own parents, while they are exploring their own sexuality. It is ironic that parents forget their own teenage years so quickly.

It is also sad that in many Eastern cultures people do not discuss human anatomy and sexual physiology without making reference to religious morality. Everything is discussed as right and wrong, good and bad and teenagers are overwhelmed with the feelings of sin and guilt. Many religions as institutions have great difficulty accepting that sex can be  innocent and loving even spiritual. It is presented as unclean and filthy. I was told that after I have wet dreams I could not pray because semen was unclean and I was supposed to take a bath to cleanse myself. Semen is considered an excretion in many Eastern cultures. It took me a long time to discover that it is a secretion not a excretion and that is why in the West it is called love-milk and many women swallow it as part of lovemaking. I met so many Muslims who enjoyed having oral sex but would not kiss their lovers afterwards. When I asked ‘ Why not?’ they said, ‘ Because she had semen in her mouth?’ and when I gently confronted, ‘ It was your semen after-all’ they kept quiet as they were lost for words.

Similarly many teenagers are ill-informed about masturbation. I have read horror stories in the local magazines and digests in Pakistan in which masturbation was associated with all kinds of physical and mental illnesses including blindness and mental retardation. It is also ironic that there are thousands of quacks earning millions of rupees treating those teenagers who are confused about their sexuality. I have not met very many Eastern parents who can give blessing to their teenage children about masturbation. They cannot say ‘ it is a form of self-pleasuring’ rather than self-abuse. Masturbation becomes even more important form of sexual expression in a culture in which young men and women are not allowed to date.

Most teenagers in Pakistan are not familiar with the basic human anatomy and physiology. Many girls are not aware of the relationship between their vaginas, uterus, fallopian tubes and ovaries. They do not know when they ovulate and do not know what function does menses serve. It is unfortunate that there are no words in Punjabi and Urdu to have a serious discussion with teenagers about sex. Many words used for different anatomical parts are slangs and sound vulgar and obscene. One cannot talk about penis, testicles, vagina, clitoris, uterus or orgasm in Urdu and Punjabi as one can talk in English. I think writers and linguists and psychologists and intellectuals have to meet with parents and teachers to coin words and expressions in Urdu that would make it easier for teachers and parents to provide sex education to their teenagers. In my book about Gay and Lesbian literature I had introduced a few expressions to bridge that gap (for example jinsi mairage for orgasm and dehni mubashirat for oral sex). I vividly remember that when I was in grade twelve and we were studying physiology one of our professors once drew the whole reproductive system of rabbit on the blackboard and uttered every word except penis and vagina. He was so inhibited he could not even utter the words. I used to wonder why we had poor role-models and how could those adults help sexually liberate us who were inhibited themselves.

It took me a long time to realize that the word sex has many meanings and can be used for different things. I became aware of it when I learnt about different stages of sexual development and learnt the differences between hermaphrodires, transvestites, transexuals and homosexuals. Many Easterners I met did not know the differences between them and sometimes used them synonomously.

Many teenagers and even male adults do not realize that the act of love making is more than just having sex. I met many women in my clinical practice who complained that their lovers, boyfriends were not sensitive enough to their feelings as they did not pay attention to fore-play and after-play. After they had their orgasm they rolled over and fell asleep. They did not cuddle and hug and hold them before or after making love. They said in a sarcastic way, ‘ For them it is screwing not making love. Slam bang thank you ma’am.’ For many women it is as important to go out for a nice candle light dinner, dance and have pillow talk about intimate things as it is to have intercourse. Many men I met are not tuned into such feelings of their partners.

There is also a lot of misunderstanding about the concept of mutual orgasm. Most couples do not realize that female and male sexual responses are significantly different. Many women take longer to have orgasm. That is why fore-play is very crucial for them to fully enjoy making love. It is interesting to know that most men who come for sex therapy complain of premature ejaculation. They want to reach orgasm later while most women who come for sex therapy complain of having orgasm too late. Men want to cum late and women want to cum early. It is the issue of timing. Many men I see in my practice I encourage them to stimulate their lovers and spouses other than genital stimulation by kissing and touching different parts of the female body so that women are ready to have orgasm before they have intercourse. It is also important for some couples to accept that some women may not always have an orgasm while having intercourse if there is nor enough clitoral stimulation. I think the more young men and women are comfortable with their bodies and are able to stimulate themselves individually to the point of having orgasm, the easier it is for them to enjoy making love. I encourage my patients to learn and enjoy masturbation if they want to enjoy intimate relationships with their lovers and spouses. It is ironic that many women in the East as well as in the West never experienced orgasm. Many men and women do not know that women can have multiple orgasms in a short time and not have to wait a long time before having second orgasm.

Because of lack of sex education many young men and women are not aware of their reproductive system and cannot choose different forms of contraception. Many are not aware about the methods of rhythm method, condoms, intra-uterine devises and contraceptive pill. They do not even know that pregnancy is directly related to ovulation. Since human ovum and sperm are only alive for 24-36 hours it is only a couple of days before and after that women are most likely to get pregnant. Many infertile couples have been trying to conceive but unsuccessful because they are not aware of this basic human physiology. On the other hand many unwanted pregnancies take place because of the same lack of awareness and planning. It is also ironic that in conservative Eastern cultures those contraceptives are not freely accessable to young men and women. I was shocked to find out in my medical school that most medical graduates believed that family planning was against Islam and that is why they did not recommend different forms of contraception to their patients. I met dozens of young women while doing my internship in women’s hospital, who wanted to stop having babies but their husbands did not support them. They did not allow them to take contraceptive pill or use intra-uterine device while they themselves did not use condoms as they believed they did not enjoy sex while wearing a condom.

It is unfortunate that in many traditional and religious cultures sex is only approved for the cause of reproduction. For couples to have sex to express their profound love for each other or just have fun is not accepted and blessed. So couples who have sex not to have babies feel guilty.

Because of the religious control couples are conditioned to have sex only in the bedrooms and only in certain positions (many religious institutions only bless missionary position, when man is on the top). For women to be on the top or have sex in many other possible positions is discouraged. No wonder after a while sexual relationships start to lose its spontaneity and sense of adventure. In the East there is also an issue of privacy. Many couples have to make love in the dark very quietly. They do not want to disturb others. No wonder in such circumstances many men have not seen the naked body of a woman even after being married for a number of years.

Religious institutions usually do not bless sexual experimentation and varied lifestyles. Many consider homosexuality and having more than one sexual partner as sin. They also have double standards. Many things are ok for men but not ok for women. In Muslim countries men can have more than one wife but women cannot have more than one husband.

When I was a teenager there was also no discussion about venereal diseases. No body discussed how men and women contact syphilis, gonorrhea or infectious mononucleosis. In the recent past there is lack of education about AIDS (auto-immune deficiency syndrome). Most young people do not know that AIDS can be contacted with other body fluids (exp blood) and may not necessarily be sexually contacted.

I feel that for young boys and girls, men and women to make adult choices and take responsibility for their actions, they need to be informed about the relationships of sex with pregnancy and venereal diseases. People who have multiple partners have to know the risks they are taking. I was surprised to meet three monogamous women who suffered from syphilis. They had never slept with anyone other than their husbands. They got it from their husbands who were promiscuous. So to be responsible one does not only have to take responsibility for one’s one sexual lifestyle but also for the lifestyle of one’s partner. For such choices we need open and honest dialogue between lovers and spouses and between children and parents and teachers.

I think time has come for the families and communities to create an environment for people to be sexually liberated and enjoy their romantic lives rather being burdened with fear, shame and guilt. I think that rather than associating sex with sin, we should associate it with love and spirituality, which are foundations of healthy loving relationships, families and communities. Sexuality is part of our humanity and we have to accept its responsibility individually and collectively. Sex education, I believe is the first step in that direction.

 Affectionately    sohail