Help-Seeking Behaviour and Care Delays in Indian Patients Attending a Speciality Sexual Health Clinic: A Retrospective Cohort study

Abstract

Background:

Sexual disorders such as erectile dysfunction (ED), premature ejaculation (PE), low sexual desire (LSD) and vaginismus substantially affect psychosocial well-being yet remain underreported in India due to stigma, limited provider training and fragmented care pathways.

Aim:

The aim of this study was to examine help-seeking patterns, delays in care and prior treatment attempts amongst patients presenting with sexual disorders.

Settings and Design:

This was a retrospective observational study using anonymised records from a specialised sexual health clinic in India (January 2022–December 2024).

Materials and Methods:

Records of patients with ED (n = 8980), PE (n = 9460), LSD (n = 1135) or vaginismus (n = 318) were analysed. Variables included symptom duration, previous consultations and self-medication.

Statistical Analysis Used:

Descriptive statistics were analysed using the Statistical Package for the Social Sciences.

Results:

Most patients (72%) had not sought formal care before presentation, and 46% reported symptoms for more than 1 year. Self-medication was common in ED (12.7%) and PE (11.3%), particularly amongst individuals over 30 years, but uncommon in vaginismus (0.6%). Prior consultations were limited (ED: 24.5%; PE: 21.0%), and patients under 30 years were least likely to have accessed care. Older age correlated with greater self-medication (r = 0.32, P < 0.05), and longer symptom duration correlated with previous consultation attempts (r = 0.28, P < 0.05). Diagnostic category influenced delay, with ED and PE associated with the longest help-seeking intervals.

Conclusion:

Substantial delays in help-seeking persist across sexual health diagnoses, especially amongst younger patients and those with ED or PE was observed. These findings highlight gaps in awareness, accessibility and confidence in seeking care. Strengthening clinician training, improving public education and expanding telehealth pathways may support earlier presentation and better outcomes.

INTRODUCTION

Sexuality is an integral aspect of human identity, significantly influencing emotional well-being, relationships and overall quality of life.[1] Despite its fundamental importance, sexuality-related topics often remain taboo in many societies, including India, due to prevalent social stigma, cultural conservatism and discomfort around open discussion of sexual issues.[2,3,4] In India specifically, conservative attitudes towards sexuality have been associated with limited sexual health education and communication, often resulting in misinformation and misconceptions around sexual health disorders.[4,5] This cultural environment contributes significantly to feelings of shame, embarrassment and ultimately delayed help-seeking behaviour for sexual dysfunctions such as erectile dysfunction (ED), premature ejaculation (PE), low sexual desire (LSD) and vaginismus, conditions known to impact psychosocial health and relationships profoundly.[6]

Globally, the burden of sexual health disorders is substantial.[6] In India, ED is highly prevalent amongst men with type 2 diabetes, with estimates approaching 79%.[7,8] PE shows cross-cultural variability; standardised studies report ~5%–15% globally,[9] with Indian community estimates in men reported within this range.[10] In rural South India, community data show female sexual dysfunction domains across desire, arousal, orgasmic and pain, with prevalence roughly 0.4%–8.9% (e.g. Hypoactive Sexual Desire Disorder [HSDD] ≈9%).[3]

Evidence from Indian urban slum and rural settings indicates that sexual health help-seeking is diverted or deferred by structural and sociocultural barriers: men frequently consult private or unqualified providers due to shame and low confidence in allopathic care, while women underuse services owing to symptom normalisation, stigma, shyness, lack of female providers, distance and household socioeconomic constraints. These factors channel patients into informal pathways and prolong time to appropriate care, reinforcing delays observed in speciality settings.[2,3] Telehealth and digital platforms provide convenient, confidential first-contact points for sexual concerns. Indian analyses of online query patterns indicate active patient help-seeking via web-based channels,[11] and population data suggest digital interventions can support access and signposting.[12]

Despite improvements in awareness and therapy availability, delays in consultation persist. This study aims to quantify these delays, prior care patterns and gender differences in patients attending a specialised sexual health clinic, filling a crucial knowledge gap in Indian sexual health research.

METHODS

A retrospective cohort study analysed anonymised patient data collected from Allo Health Clinics, a dedicated sexual health clinic that offers confidential, online and offline consultations with certified professionals specialising in sexual medicine. Diagnoses were established by qualified sexual medicine physicians trained in sexual health using the International Classification of Diseases 11^th Revision (ICD-11) criteria. Self-reported symptoms were differentiated from confirmed diagnoses during the structured intake process. Patient details with incomplete data or instances where the sexual dysfunctions were secondary to medical illnesses (e.g. diabetes or cancer) or psychiatric illnesses (e.g. depression and anxiety disorder) were excluded from this study. This research was done in accordance with the principles that conform to the Helsinki Declaration. Ethics committee approval for this study was obtained from the Institutional Ethical Review Board and pooled data without any patient-identifiable information used. Patients included in the study were those who sought consultation at any of the Allo Health Clinics between January 2022 and December 2024 either in-person or online. We looked at common sexual dysfunctions, namely ED, PE, LSD and vaginismus. All diagnoses of vaginismus were confirmed following in-person clinical examination by trained sexual medicine physicians and not based solely on online consultations.

Descriptive statistics were analysed using the Statistical Package for the Social Sciences (SPSS Version 12). Data were analysed using SPSS with descriptive statistics, Chi-square tests and Pearson’s correlations to examine delays in care by demographics. Significance was set at P < 0.05.

Key variables included for the analysis were the delay from symptom onset to first consultation, categorised as <3 months, 3–12 months, >1 year or not answered; prior consultation history and its details and any reported use of self-medication without a physician’s opinion, use of over-the-counter medications or alternative treatments. Patients were stratified by age (<30 vs. ≥30 years) and gender. Data were extracted from the structured intake forms completed at first contact, and descriptive statistics were used to summarise trends across conditions and demographic groups.

RESULTS

A total of 19,893 patients met the inclusion criteria for major sexual dysfunctions (ED, 8980; PE, 9460; LSD, 1135; vaginismus, 318). The rest of the diagnoses were clubbed under others and not reported since they are lower in frequency. The cohort included both online and in-clinic consultations between January 2022 and December 2024. The sample represented a broad demographic distribution, with both male and female patients from urban and semi-urban areas.

For understanding the delay in help-seeking, the division was made based on how long patients had been experiencing erection-related concerns and desire-related concerns, which helped differentiate primary ED from primary LSD, while acknowledging that the two conditions can often be interrelated. Some patients chose not to answer the question and have not been considered for the trend analysis. The sample set for analysis took into account ‘at least (diagnosis) present’ to help simplify understanding and avoid confusion due to overlapping or double diagnoses. The mean for each category was calculated to understand the general trend amongst the population with regard to the diagnosis. These distributions and mean delay scores are illustrated in Figures 1 and 2.

Figure 1.

Delay in help-seeking across diagnosis. Key: 1 – <3 months, 2 – between 3 months and 1 year, 3 – >1 year

Figure 2.

Mean trend of delay in help-seeking

Across all diagnostic categories, a prolonged delay before the first consultation was a consistent and dominant finding, with more than half (51%–63%) of all patients postponing professional help for over a year after their symptoms began. This delay was most pronounced for vaginismus, where only 15.8% sought consultation within 3 months, while a majority, 63.2%, waited for more than a year (mean delay score = 2.47), and notably, no patients in this subgroup reported prior treatment attempts. Similarly, patients with LSD exhibited significant delays, with only 11.4% presenting within 3 months and 58.6% delaying for over a year (mean = 2.47).

While patients with ED sought help earlier – 34.9% within 3 months – a substantial 36.2% still delayed beyond a year (mean = 2.01). When ED was complicated by comorbid LSD, 39.6% delayed beyond 1 year (mean = 2.08), and a majority of patients with PE comorbid with LSD (52.4%) or comorbid with ED (53.0%) also postponed consultation for over a year (means = 2.29 and 2.31, respectively). The detailed distribution of delay categories across diagnoses is presented in Supplementary Table 1.

Supplementary Table 1.

Delay in help-seeking across diagnoses by patients

Diagnosis	Duration of concern before consultation
	<3 months, n (%)	3 months–1 year, n (%)	>1 year, n (%)	Total	Mean delay score*	SD
Erectile dysfunction
Erection problems faced since	377 (35)	311 (29)	391 (36)	1079	2.01	0.844
Desire issues faced since	244 (31)	219 (29)	303 (40)	766	2.08	0.842
Premature ejaculation
Erection problems faced since	127 (12)	143 (13)	304 (28)	574	2.29	0.811
Desire issues faced since	135 (22)	138 (25)	301 (53)	574	3.00	0.823
Low sexual desire
Desire issues faced since	8 (11)	21 (30)	41 (59)	70	2.47	0.696
Vaginismus
Desire issues faced since	3 (16)	4 (21)	12 (63)	19	2.47	0.772

SD=Standard deviation

Correlates of delay in help-seeking

Factors correlated with this delay included age, which was positively and significantly correlated with delay for both LSD (r = 0.064, P < 0.01) and ED (r = 0.055, P < 0.01), suggesting older patients were more likely to postpone consultation. These associations are presented in Table 1. Furthermore, patients experiencing both erection and desire problems showed a strong intercorrelation in their delays (r = 0.509, P < 0.01). Marital status also played a small but significant role, with married, separated and divorced individuals generally delaying care longer. Correlation data for marital status are shown in Table 2.

Table 1.

Correlation between age and delay in help-seeking for sexual dysfunction

Variable	Age	Desire concern	Erection concern	Mean	SD
Age	-			0.6	1.07
Desire concern	0.064**	-		0.28	0.75
Erection concern	0.0.55**	0.509**	-	0.63	0.48

**Correlation is significant at the 0.01 level (two-tailed). n=20,181. SD=Standard deviation

Table 2.

Correlation between marital status and delay in help-seeking for sexual dysfunctions

Diagnosis	1	2	3	4	5	6	7	8	Mean	SD
1. Low sexual desire	-	0.509**	−0.028**	−0.047**	0.051**	0.026**	0.014*	−0.006	0.28	0.75
2. Erectile issues		-	−0.013	0.006	−0.006	0.027**	0.020**	0.005	0.63	0.48
3. Single			-						0.22	0.41
4. In a relationship				-					0.18	0.39
5. Married					-				0.57	0.50
6. Separated						-			0.02	0.13
7. Divorced							-		0.01	0.11
8. Widow								-	0	0.04

*Correlation is significant at the 0.05 level (two-tailed), **Correlation is significant at the 0.01 level (two-tailed). n=20,181. SD=Standard deviation

Before consulting the clinic, self-directed treatment or self-medication was common, particularly amongst the 90 cases in the ED with comorbid LSD subgroup, often involving over-the-counter vremedies, herbal products or advice from non-specialist sources.

DISCUSSION

This large, clinic-based analysis offers a detailed view of help-seeking delays for sexual dysfunctions in India, encompassing nearly 20,000 presentations. Prolonged symptom duration before the first specialist consultation was common across diagnostic categories. The proportion of patients reporting delays exceeding 1 year was particularly high amongst those with comorbid PE, exclusive LSD and exclusive vaginismus, while over one-third of exclusive ED cases also presented after more than a year.[2,3,4,13] These patterns align with previous global reports indicating low disclosure rates and under-utilisation of formal services for sexual concerns and highlight the psychosocial consequences of untreated dysfunctions.[7,13]

Correlational findings provide further insight. Age showed a small but positive association with delay for both LSD and ED, consistent with reports that older individuals may normalise sexual difficulties as age-related or attribute them to chronic illnesses.[3,6] Delay for low desire was strongly correlated with delay for ED, suggesting that help-seeking behaviour may share common determinants rather than being disorder-specific.[13] Associations between marital status and delay were statistically significant but minimal in effect size, with a trend towards longer delays amongst married or separated individuals compared to single or dating patients. Given the small magnitude of these effects, such differences should be interpreted with caution.

Gendered differences in pathways to care warrant particular consideration, as patterns of help-seeking may vary substantially between men and women. In this dataset, exclusive vaginismus did not present earlier than male dysfunctions; most cases involved prolonged delays and no prior treatment. Although the valid sample for exclusive vaginismus was small, the observed pattern is consistent with prior Indian community and clinic-based studies describing stigma, privacy concerns and limited provider readiness to address women’s sexual pain and desire issues.[2,3,4,8] In contrast, conditions perceived as overt performance impairments, such as ED, may be more salient to couples and thus prompt earlier consultation, whereas desire-related or pain conditions are often normalised or concealed.[7,14]

Care pathways preceding specialist attendance frequently involved informal or unregulated strategies. A subset of patients, particularly those with erectile and desire-related concerns, reported self-medication, mirroring community-level findings that men often resort to over-the-counter remedies or unqualified providers before seeking professional care.[2,4,11] Such practices may offer temporary reassurance but risk delaying effective, evidence-based treatment and extending psychological distress. The high burden of ED in diabetic populations further underscores the value of proactive assessment within metabolic and primary-care settings,[9,10] while complex clinical environments such as opioid-agonist treatment services illustrate additional barriers to disclosure and timely assessment.[14] Psychiatric variables were unavailable in this dataset; however, existing literature highlights a bidirectional relationship between sexual and mental health, particularly in ED, which could contribute to delayed presentation when unrecognised.[15,16]

Despite the increased availability of confidential digital consultations, delayed presentation remained common. Online platforms in India capture substantial help-seeking demand and facilitate privacy, yet cultural taboos, misinformation and limited clinical pathways continue to restrict timely care.[12,17,18] Integrating digital access with proactive education campaigns and streamlined referral systems to trained clinicians may better convert initial help-seeking into effective treatment engagement.[1,12,17,19]

Persistent delays reflect broader educational and system-level deficiencies. Inconsistent training in sexual medicine across undergraduate and primary-care curricula contributes to variable recognition, limited counselling and uncertain referral practices.[5,6] Adoption of the ICD-11–aligned terminology can standardise case identification and documentation across services, improving continuity and comparability of care.[18] Routine screening for co-occurring sexual concerns is recommended, given the observed overlap in delay across dysfunction types, and documenting prior informal care during intake can inform safety counselling and treatment planning.[14]

This study benefits from a large, real-world cohort and a standardised categorisation of delay across diagnostic groupings. Limitations include its retrospective design, reliance on ordinal rather than continuous measures of delay, missing data for some subgroups and the small valid sample for exclusive vaginismus. Socioeconomic, educational and rural–urban variables highlighted as important in prior Indian work[2,3,13] were not captured. Selection bias is possible as the cohort represents those who accessed specialist care. Correlations indicate association rather than causation, and the modest effect sizes for age and marital status require cautious interpretation. Future research should incorporate psychosocial and healthcare system variables to identify modifiable determinants of delay and evaluate interventions that shorten pathways to evidence-based treatment.

From a public health standpoint, these findings highlight the need for nationwide awareness initiatives and early screening strategies that normalise sexual health discussions within primary care. Strengthening clinician training, expanding telehealth integration and addressing gender-specific barriers, especially for women with vaginismus or low desire, represent practical steps towards improving timely access and quality of care.

CONCLUSION

This study highlights that across diagnostic categories, a substantial proportion of patients presenting to a specialist sexual health clinic in India had experienced prolonged symptom duration before seeking care, particularly those with LSD and comorbid PE, while a smaller subgroup with exclusive ED sought help earlier. Exclusive vaginismus cases, though few, also demonstrated extended delays and absence of prior treatment. Modest associations between age and delay, and the coupling of delay across desire and erectile concerns, indicate shared and potentially modifiable determinants rather than disorder-specific factors. These findings underscore the need for a coordinated, system-level response: strengthening sexual health competencies in undergraduate and primary care training, standardising assessment through the ICD-11 terminology, embedding routine screening for co-occurring dysfunctions and linking clear referral pathways with public communication that frames sexual disorders as common and treatable. Confidential digital platforms can facilitate access but must integrate with trained first-contact care. A unified approach across education, primary care and specialist services can enable earlier help-seeking and improved sexual health outcomes in the Indian context.

Author contributions

TS: Data analysis, interpretation of results, manuscript drafting, literature review and final approval. NG: Conceptualisation, data curation, statistical input and critical revision of the manuscript. AS: Data management, participant records review and support in manuscript preparation. SD: Conceptualisation, manuscript drafting, study supervision, clinical validation, critical review for intellectual content and final approval of the manuscript.

Conflicts of interest

There are no conflicts of interest.

Data availability statement

The study used confidential clinical records from our clinics. Individual-level data contain protected health information and are not publicly available due to privacy and ethics restrictions. De-identified, aggregate results are provided in the article; any additional aggregated outputs may be shared on reasonable request to the corresponding author, subject to institutional approvals.

Disclosure on use of Artificial Intelligence

No artificial intelligence tools were used for data analysis, interpretation, or content generation. Language and grammar were edited using standard editorial tools only.

Funding Statement

Nil.