Conflict And Chemistry

Women in Kashmir has highest prevalence of Post Traumatic Stress Disorder

Militarized conflicts affect every aspect of social and private life. In Kashmir the last two decades have brought about a mental health catastrophe, but experts are now pointing to the widespread effects of the conflict on sexual health of the Kashmiri population. MAJID MAQBOOL reports.

Asrar (name changed), a recently married young man from Baramulla was unable to consummate his marriage. He soon sought help from a sexologist in Srinagar. Sustained counseling revealed the cause of his sexual problems. A decade ago soldiers killed Asrar’s father in front of him. Scenes of death keep flashing in front of his eyes, he told the doctor during counseling sessions, and it continued to haunt him even after marriage. The stress, caused by torturous memories of witnessing the death of his father took a toll on his marriage.

Asrar is one of the thousands of Kashmiris whose sexual health has been affected by stress caused due to decades of conflict in Kashmir. Besides affecting mental health, the ongoing conflict in Kashmir has also taken a toll on the sexual health of people in the valley.

Dr Masroor Wani, a practicing sexologist, with over 16 years of experience in treating various sexual health-related ailments, says he is used to seeing such cases in his clinic at Hazoori Bagh in Srinagar. Every day he sees more than 30 patients who come from all districts of the valley to be treated for sexual health-related problems.

“A maximum number of people with sexual problems that come to me are past and present cases of hypertension and anxiety,” says Dr Wani. Many people who came to him with sexual problems have been to jails, he adds, some have seen some of their dear ones die violent deaths, while others have been under some constant threat and fear caused by living in the conflict conditions of Kashmir.

Dr Wani has treated many people who have been released after serving long jail terms. Long periods of separation from their partners also develop sexual problems in the detenues, he says. “When they are away from their home for 10-14 years, they develop psychiatric ailments, which then affects their sexual health as well,” Dr Wani explains.

Over the years, conflict in Kashmir has given rise to increasing cases of psychiatric and cardiac problems among people, and these, in turn, resulted in sexual health-related issues over time. “When a person has psychiatric and cardiac problems, naturally he will take medicine for those problems, and those medicines have side effects, like causing impotency,” says Dr Wani.

“In the last two decades, people here have been living under a constant threat to their lives. The resulting stress affects the normal circulation of blood, and then it affects the sexual health of both males and females.” He cautions that people with a history of cardiac and psychiatric ailments should not take anti-impotency drugs on their own, and instead, consult doctors.

Experts say a lot of myths surround the sexual health among people here who often take recourse to self-medication, going to saints and other unqualified people, except for consulting doctors. “There is not much awareness about sexual health and many myths have spread about sex,” says Dr Wani. “Night emissions in males and urethral discharge are common and a normal phenomenon in young males and females. There is no need to take medication for these normal processes,” he says. “But people here go to saints and other unqualified people, and then they get wrongly medicated which results in sexual problems even when there are none to begin with.”

Many people go to the doctors complaining of a smaller size of their sexual organs, he says, but this is not abnormal, and shouldn’t be a cause of worry.

Doctors and medical store owners say there has been increased use of sex and impotency drugs in the valley. These drugs are freely available in the market and sold without the prescription in medical stores across the valley.  “Most people here take drugs like Viagra on their own without consulting doctors,” says Dr Wani. “But this is a very dangerous trend. If anyone is hypertensive or taking nitrate medicine for a cardiac problem, there is a chance of his death if he takes drugs like Viagra as it can cause cardiac arrest,” he warns.

He says drugs like Viagra are increasingly consumed in the valley. The drugs are easily available in the market, and over the counters from the medical stores, and are often consumed without any prescription. “Viagra is consumed like Paracetomol here,” says Dr Wani. “People don’t know about its dose, and they can’t talk about it much because of the social stigma.”By taking these impotency drugs without a prescription, he says, people end up creating more health problems for themselves.

Medical store-owners and chemists also say over the years there has been increased consumption of sexual drugs like Viagra. Some estimates suggest that at least two million tablets for improving sexual performance are sold every month in Kashmir. Chemists say there is a good market for these sex and impotency drugs. Drug companies regularly come up with ads on television and the Internet to attract people.

“Since people are shy about going to doctors about sexual matters, they buy these drugs over the counters from the medical stores where they are freely available,” says a chemist. “Paramilitary forces are also increasingly asking for Ayurveda sexual drugs from drug stores,” says another chemist.

Drug store-owners and chemists say not more than five percent of sex and impotency drugs are sold on prescription. “Ninety-nine percent of sexual drugs are sold without a prescription. People ask for these drugs themselves as they come to know about them from ads on TV and Internet,” says a chemist in Chanapora.

“There are many unlicensed chemists across the valley and they freely sell these impotency drugs without asking for doctor’s prescription from them,” says a chemist. “There are many unqualified chemists whose license has expired but they continue to sell drugs without any checks by the authorities,” says a drug store owner. “In Batamaloo bus stand there are many unqualified chestore ownerquacks who freely sell various impotency drugs to people especially from rural areas,” says another chemist.

In 1997 a detailed study was carried out in SKIMS by a team of endocrinologists headed by Dr Abdul Hameed Zargar to access the magnitude of primary infertility in Kashmir region. Titled “Epidemiologic and etiologic aspects of primary infertility in the Kashmir region of India,” for the first part of the study, data was collected by interviewing a stratified random sample of 10,063 couples from six districts of the Kashmir valley about the prevalence of infertility, both resolved and unresolved. In the second part, 250 consecutive couples with primary infertility were evaluated for the etiology of infertility. “Of these 10,063 couples, 1,517 (15.07%) couples had infertility,” the study revealed. “Fifteen percent of the couples interviewed had primary infertility, among whom 4.66% had unresolved infertility at the time of the survey. The etiology of infertility in 250 consecutive couples revealed a female factor in 57.6%, a male factor in 22.4%, combined factors in 5.2%, and an undetermined cause in 14.8%,” the study says.

A study by Dr Zargar, former Director SKIMS, reveals that the stress disorders have reduced the reproductive age of Kashmiri women by almost 10 years. The finding shows that 11 percent women out of the 2,000 examined between 2004 and 2006 in J&K suffered from premature menopause — a rise of 2 per cent from the late 90s.As per a SKIMS survey on infertility among Kashmiri women, 14 per cent of women were unable to conceive. Experts attribute the alarming number to stress.

In the past decade, after failing to conceive within a few years of marriage, increasing number of women in the valley have turned to procedures like IVF for child birth. Rotunda, an IVF centre in Srinagar, has handled 1,500 IVF cases since its inception in 2003.

“There is a higher prevalence of premature menopause in females in Kashmir,” says Dr Zargar. “Globally it has been found to be 1.5 to 2.5 percent, but our studies show it is around eight percent in Kashmir region,” he says. Dr Zarger says there has been a resurgence of diabetes cases in the valley, especially over the past two decades of conflict.

“The lifestyle of people also became sedentary as people return home early and stopped going out for early morning and evening walks as was the norm in the past,” he explains. “This has resulted in increased cases of obesity and diabetes, which, if not controlled, affects the sexual organs as well,” he says. “These ailments affect the nervous system which then affects the reproductive health,” he adds. “There has been an increase in prevalence of erectile dysfunction in males and loss of libido in both men and women in the valley.”

When you live in a conflict zone, he says, the depression levels get doubled, and then it comes to affect the sexual health of people. “Apparently there is no relief, and as long as the conflict continues, people will continue to suffer from such problems,” says Dr Zargar. He says the military forces stationed in the valley are also affected as they are living under tremendous duress and face a constant threat to their lives. “There is a higher fratricide rate and sexual health problems among the military personnel as they are deprived of their partners for long periods.”

Dr Zarger says the free availability of sexual drugs like Viagra is a problem and needs to be checked by the government agencies. “These drugs should be given only after proper prescription by the doctors,” he says.

A study carried out by the Department of Endocrinology at SKIMS in 2008 revealed that 15.7 percent of women in Kashmir who are of child-bearing age will never have a child without clinical intervention.

Poly Cystic Ovarian Syndrome (PCOS) is believed to be one of the main reasons for this problem. Dr Ashraf Ganai, a renowned endocrinologist and Associate Professor Endocrinology at SKIMS, says conflict is one of the major factors for increased prevalence of PCOD in females, which manifests itself in abnormal male-pattern hair growth in females.

“PCOD is 2-3 times more prominent in Kashmir than in the rest of the country,” says Dr Ashraf. A specific unpublished study revealed that 90 percent of female infertility problems are due to PCOD and related diseases, five percent are due to POF (Premature Ovarian Failure) and another five percent due to other stresses in our lives.

Stress adds to falling sexual health of conflict ridden Kashmirs

According to Dr Ashraf another common sexual disorder among females is the premature menopause or premature ovarian failure. “In the last few years I have myself seen around 150 women who had this disorder,” he says. Over the years there has been a sharp increase in the infertility in males and a high prominence of infertility in women. “Stress of living in conflict region and other factors has resulted in increased cases of erectile dysfunction, and the sperm count in males is also decreasing,” he says.

The last two decades have also recorded thyroid disorders are on the increase in Kashmir, which then comes to affect the reproductive health in women.

Dr Ashraf complains that there is no regulation from government agencies as the sexual drugs are freely available in the market, and are given over the counters without prescription. “People come to know from ads in television and Internet, and the drug companies, including some Ayurveda drug companies, put up their advertisements on large boards on the streets,” says Dr Ashraf. “People then buy these drugs without caring for their side effects, and they don’t consult doctors before using these drugs.”

Doctors say the practice of torture used by the military forces over the past two decades of conflict in Kashmir has also come to affect the sexual health of males in Kashmir. “In jails males were interrogated on their private parts resulting in their infertility,” says Ashraf. “Females have also got equally affected, and PTSD (Post Traumatic Stress Disorder) leads to their infertility.” For the rape victims, he says, it is very difficult to conceive.

In 2006, a study by Medicines Sans Frontiers (MSF) titled, “Prevalence of PTSD in conflict-hit Kashmir”, revealed that the high rate of abortions and miscarriages among women in Kashmir is due to the Post PTSD. According to the study out of around 63,000 patients who visited the hospital in 2006, 15 to 20 percent were suffering from PTSD. Sixty percent of the 63,000 patients were women.

Another survey, carried out in 2009 by the Kashmir chapter of Action Aid International, said that 29 percent of unemployed males in Kashmir smoke to relax themselves. According to the survey, 12 percent, which includes women, take sleeping pills to overcome stress. Four percent of the respondents of the survey take drugs to reduce mental stress.

The problems related to sexual health in Kashmir are compounded by less awareness regarding sexual issues among the people, unregulated availability of impotency drugs in the market, and few qualified sexologists in the valley who can treat people suffering from sexual ailments. Doctors say people go to dermatologists for solving their sexual problems when in fact they should seek consultation with trained sexologists to receive proper treatment.

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