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Indian Express
a day ago
- Health
- Indian Express
Too young, too female: At 25, all I want is a doctor who listens
The smell of hospital disinfectant, unsettled nerves and a sense of impatience hung in the consultation room as I sat in front of the 60-something-year-old doctor. But I was prepared to be a good patient. I had a mental list of all my symptoms and was ready to answer the 'whys' and the 'hows'. 'Fever, sore throat, body ache, excessive fatigue. Worse after…' 'Did you have a long day out recently?' The doctor cut me off, already reaching to jot down the prescription. 'Yes, we were out in the sun right at noon; it was very, very hot. It became even worse because I got my period the same day—' 'Yeah, that doesn't make a lot of difference. It is exhaustion and vitamin D deficiency,' the doctor interrupted again. 'Very common in young people, especially those who spend all day working indoors on their laptops,' he continued. He took a beat to look at my father, almost seeking approval for his diagnosis-cum-judgement on a whole generation. The consultation at a prominent Delhi hospital's Outpatient Department lasted barely five minutes. I walked out feeling sicker, hopeless, and angry. Medically, I was later diagnosed with a viral fever for which I ended up taking an extended antibiotic course, just because I didn't start my medication soon enough. The outcome would have likely been different had I been heard during the consultation. A 2016 essay, published in the National Medical Journal of India, states that of all the communication strategies available to medical professionals, they are most likely to dismiss 'listening' as 'passive and weak'. The essay cites a book titled Skills for Communicating with Patients, which was first published in 1998, and explores strategies for effective doctor-patient interaction. 'Doctors have traditionally controlled the interview via closed questions that limit patients' contributions and render them more passive,' the third edition of the book (2013) notes. At 25, I belong to a generation that expects to be heard. We seek healthcare that is collaborative, not judgmental and exclusionary. The dawn of the internet democratised knowledge, even around health and medicine, which were previously locked up in medical textbooks and journals. So, we grew up Googling our symptoms. Many healthcare practitioners seem to view informed (younger) patients as those looking to question their authority rather than partners with a common aim. The concern isn't entirely unfounded. When bordering on self-diagnosis, an Internet search does more harm than good and can lead to wrong or improper remedies. But I wasn't trying to play doctor. I just wanted to explain my condition as clearly as possible, present all the relevant facts, for the expert to help me better. This was lost in the shotgun approach to communication. The dismissal I faced has a name in academic circles. In 2007, Miranda Fricker first described 'epistemic injustice' or the injustice inflicted on someone 'in their capacity as a knower'. In the context of healthcare, the National Institutes of Health uses this broad concept to define 'testimonial injustice'. It's when a patient explaining their experience of a certain illness is 'dismissed or under-played' by the specialist. This leads to the selection of only parts of the patient's testimonial, which the specialist considers 'useful', for diagnosis or treatment options. When age meets gender The communication gap deepens when you are both young and female. My 28-year-old friend in Chennai, dealing with a persistent toothache and consequent headache, swung between various dentists and doctors, unable to understand the cause behind her problems. It took her several weeks and a gracious doctor who inquired enough to deduce that she needed a root canal. All this could have been avoided had she been advised to get an X-ray on the first visit itself. But her symptoms remained largely unheard and, worse, dismissed. She bore the double burden of being seen as too young to understand the intricacies and too female to trust her own body. Dr Rageshri Dhairyawan, in her 2024 book titled Unheard: The Medical Practice of Silencing, chronicles how 'not listening to patients' has been ingrained in medical science since its inception. 'All patients are silenced to some extent, but some — notably, people of Black, Asian, and minority ethnicity, women, and people who are sick or disabled — are more severely and consistently silenced than others,' Dr Dhairyawan, who is also a UK-based consultant physician, writes. Neither my friend nor I were asked what triggered our symptoms, or the severity and the duration of the discomfort. The immediate dismissal mostly came wrapped in the language of generic concern: 'Beta, it happens in this age', 'resting well should do it', or 'you are too young to have these problems'. Variations of these phrases exist across doctors, specialists, and even cities. It's harder to challenge them when family members resort to 'doctors know best, trust them'. While nobody would describe a visit to the doctor as inviting, these unpleasant encounters create barriers to seeking medical help. Self-doubt creeps in. Maybe the pain isn't so bad. Maybe it means nothing. Those who listen It takes one step from both sides to make things better. For me, the step was witnessing a balanced doctor-patient interaction. 'Tell me all that you have been feeling' — just watching another doctor sit across from my cousin and patiently ask him questions that nudged him to delve into details was reassuring and encouraging. It emphasised how the dynamics and the experience change when doctors view listening as a clinical skill. As the 2016 essay notes: 'Through active listening that recruits the emotions as well as the intellect of the listener, the doctors could move from defensive planning to empathic understanding.' The many doctors who already embody the art of listening genuinely ease the discomfort of hospital visits. Their conversations break free from the tired scripts where patient voices get lost between symptoms and treatment plans. These doctors remind us: even if consultation rooms still smell of disinfectant, they don't have to reek of dismissal. Vibha B Madhava is a sub-editor at the news desk for She is interested in writing about gender, culture and politics of ableism. Having specialised in digital journalism, she is keen to explore various forms of interactive, multimedia storytelling. Apart from that, she also likes to experiment with social media. Qualification, Degrees/other achievements: Bachelor's degree in Media and Communication from Manipal Institute of Communication, Manipal Academy of Higher Education. PG Diploma in Integrated Multimedia Journalism from Asian College of Journalism, Chennai. With The Indian Express, this is Vibha's first stint in pursuing journalism in a full-time capacity. Previous internship experience: Deccan Herald, Bengaluru; The News Minute, Bengaluru; The Mojo Story; Radio Indigo 91.9 and Fever FM 94.3 (Hyderabad) You can find her on Twitter as @VibhaBMadhava , on LinkedIn (Vibha B Madhava), or write to her at ... Read More
Time of India
25-04-2025
- Health
- Time of India
Steroids, Sperm Count Decline, and Stigma: India Faces Silent Male Infertility Crisis
New Delhi: Male infertility is quietly escalating into a public health crisis in India, yet remains among the most under-discussed medical conditions in the country. With traditional masculinity still tied to physical strength and social expectations, the subject of male reproductive health is too often buried under layers of stigma, misinformation, and silence. Startling data reveal that only 25 per cent of Indian men meet normal semen parameters—meaning 75 percent face issues related to semen volume, sperm count, motility, or morphology. Male-factor infertility accounts for nearly 40–50 percent of all infertility cases in India, supported by studies from the Indian Society for Assisted Reproduction (ISAR) and National Medical Journal of India. These findings emphasise the critical need for a shift in focus towards male infertility, as it is a significant contributor to the overall infertility rates in the country. This concern takes on added urgency as the country observes National Infertility Awareness Week , aiming to shed light on the challenges of infertility and the importance of inclusive reproductive health conversations. 'The conversation around infertility still centers heavily on women. We urgently need a shift toward inclusivity and science-backed awareness,' says Dr. Prachi Benara, Senior Consultant and Centre Head at Birla Fertility & IVF. "One of the most alarming contributors to declining sperm health is the unregulated use of anabolic steroids and gym supplements. In the race for rapid muscle gains and social media-worthy physiques, many young men are unknowingly compromising their fertility," Dr. Benara added. Even a few months of steroid use can bring sperm count down to zero. 'Most over-the-counter supplements in India don't disclose their ingredients properly. Many men fall prey to quack advice or misguided gym trainers,' she warns. Worse, some men unknowingly take testosterone injections, which can shut down natural sperm production. Beyond supplements, several other lifestyle factors are contributing to the decline: tobacco use, poor diet, high BMI, sedentary work, and increased age. While women face a biological clock, men experience a more gradual reproductive decline called andropause. Studies show sperm quality begins to significantly deteriorate after the age of 40—a challenge for many urban men delaying parenthood. Data Deficit and Diagnostic Gaps Despite the growing threat, India lacks comprehensive data on steroid-linked infertility. Most men don't disclose supplement use unless directly asked, making it difficult to trace the root cause of fertility issues. However, experts believe early testing—especially semen analysis—is crucial. Clinicians assess four key parameters: volume, count, motility, and morphology. Ideally, a sample should have more than 1 ml of semen, over 16 million sperm/ml, 40 percent motility, and a morphology score above four percent. Yet, only 1 in 4 Indian men meets these benchmarks. The good news: recovery is possible. If steroid use is discontinued within a year, many men show significant improvement in sperm quality within six months, she stated. Another hidden aspect of male infertility is the issue of non-consummation of marriage, often due to psychological conditions like vaginismus or erectile dysfunction. 'Up to 90 percent of such cases improve with conversation and counseling alone,' Dr. Benara adds. At Birla Fertility, initial consultations last up to an hour and prioritize mental health and emotional well-being before recommending diagnostics or IVF. 'Many couples don't need IVF right away. What they need first is someone to listen—without judgment,' she says. With India's Total Fertility Rate (TFR) dipping to 1.99—below the replacement level—the implications of untreated infertility loom large. However, the rise of technology and affordability is bringing hope. Today, an IVF cycle costs ₹1.7–1.75 lakh, down from ₹2.5–3 lakh, and EMI options are widely available. Some employers have even started including IVF in insurance plans. Advanced technologies like AI-assisted lab procedures and microfluidics are enhancing outcomes. While CRISPR and genome editing are not yet used in Indian IVF, DNA-quality assessments are emerging as the next frontier. The Road Ahead: Replace Silence with Science India is at a crossroads. Without proactive steps, the socio-economic fallout of untreated infertility could mirror aging societies like Japan and South Korea. Between the ages of 35 and 50—coincidentally peak career years—many Indians are also at peak fertility risk. Without proactive steps, the socio-economic fallout of untreated infertility could mirror aging societies like Japan and South Korea. Between the ages of 35 and 50—coincidentally peak career years—many Indians are also at peak fertility risk. 'This conversation needs to evolve—from one filled with fear and shame to one grounded in empathy, education, and empowerment,' says Dr. Benara. The stigma must end. Science must speak. And the silence around male infertility must finally be broken.
