Sitting in front of me is a couple dealing with infertility. They had seen other providers prior to the appointment with me. I run through the labs and imaging tests ordered by the previous providers. All had returned normal.
At this point, I have few options left to explore for the etiology of their infertility. I run through the rare causes for infertility, but none seem to fit the presentation of the patient in front of me. I begin to discuss evaluation for assisted reproductive technology. They agree to proceed.
Three months later, I see the couple back in my clinic. They had finished another round of extensive and expensive evaluation by the subspecialists. Again, the results continue to be normal. They seem to have come to terms with the need for in vitro fertilization to begin their family.
Prior to wishing them well and sending them home, I hand them a pamphlet on healthy sexuality and timed intercourse.
Three months later, I receive an email from the patient announcing their spontaneous pregnancy. I am thrilled and send them my congratulations. They reply stating that they were unaware of the need for ejaculation into the vagina for conception until reading the pamphlet I had handed out at the last minute.
I stare at my computer screen in disbelief.
After thousands of dollars spent and countless hours worrying, the solution to this couple's "infertility" was simple, yet one that all providers had missed.
Following this patient encounter, I began to ponder why most of us presume the "how" of sex is to be common knowledge. Maybe it is because of the wide availability of online information that will quickly answer the most explicit of questions. Maybe it is because we are constantly engaged in dialogues of preventing unwanted pregnancies that the thought of someone not knowing how to engage in sexual intercourse never enters our mind.
Yet amidst these assumptions, a quick glance at news headlines reminds me that sexual education in America continues to be a polarizing topic. The majority of American discourse revolves around the appropriateness of sexual education in schools, with staunch conservatives arguing sexual knowledge is a sure way to destroy young people's lives. But having now witnessed the effects of inadequate knowledge of sexual intercourse, I wonder to what degree the opposite might be true.
One cannot think of the issue of sexual education without acknowledging the culture and family values in which individuals are brought up. Sex and intimacy continues to be stigmatized in many cultures which paradoxically equally prioritize families and grandchildren. Growing up in such environments are sure to affect one's knowledge of intimacy, but I wonder if we as nation have an obligation to teach individuals about their bodies, intimacy, and the "complex" art of human reproduction. In the meantime, I have started to hand out the sexuality pamphlet a lot more.
Jerome Chelliah is a resident physician in Obstetrics and Gynecology and a 2018–2019 Doximity Author.