A journey into the murky world behind the little yellow posters that you see on every grimy wall in every Indian city

I am in a narrow, crowded lane in a seaside suburb of Chennai, opposite an old yellow building that has clearly seen better times. It’s a hole in the wall beside a kabaddiwalla’s overflowing storefront. Up a flight of grimy stairs, past the abandoned paint tins and construction equipment, is Everest Clinic. The board outside the door proudly proclaims the domain of Doctor Biswas, BAMS. Underneath the glued-on plastic lettering, are the visible remnants of a previous doctor, Baul, who presumably used the same board and premises. A quick search of the Central Council of Indian Medicine’s database reveals that the registration number displayed on the board belongs to a man from Muzaffarnagar whose license has long been revoked.

The doctor is out, so I give him a call and take the opportunity to explore the clinic before he arrives. The cabinets are full of empty white plastic bottles with their labels peeled off and the walls are inexplicably decorated with several posters of various kinds of fruit — the kind you’d find in a nursery classroom. But otherwise it is a fairly normal if slightly low-rent doctor’s chamber.

Eventually, he arrives. A well-built, immaculately-groomed young man, presumably in his late 30s, dressed in jeans, a colourful shirt and black leather shoes. “So what is your problem?” he asks.

I explain that I am a journalist and I just want to talk. About what? Well, I say, there are all these posters on male sexual health all over the city. The address on one of them led me to him. “Just talk?” he asks suspiciously, “No problem?” “No problem,” I repeat, and launch into a volley of questions.

His Tamil has a thick out-of-state accent that prompts me to switch to Hindi midway. He tells me how he moved to Chennai from Kolkata five years ago, following in the footsteps of his brother who arrived nearly 15 years ago. I ask about his education. He mumbles something under his breath. I barely make out the word ‘polytechnic’. Or maybe I imagined it.

***

Male sexual health is rarely discussed openly in India: the assumption is that everyone’s plumbing works just fine and if it doesn’t, a fervent prayer to the deity in the street-corner temple will take care of any leaks and blocks. But divine intervention is notoriously flaky, and those whom it fails often find their lifeline in a bright yellow poster on a decrepit wall abutting the same temple. The address on the poster leads to clinics like the one I am in.

The posters, strategically positioned on fuseboxes and dark walls where men are likely to urinate, are impossible to miss. Every Indian city has them, with their comical and graphic descriptions of various sexual health issues: “sperms water type, penis small size, shortly sperms come out, impotency, gonorrhoea.” The template is largely unaltered across the country — many feature a saucy picture of a couple embracing and a “100% guaranty” that you will soon replicate their apparent delight.

I had tuned them out over the years, dismissing them as another quirky piece of art that is part of the rich and often unintentionally hilarious tapestry that defines urban India. Until recently, when a particularly long wait on a badly-lit street corner littered with these posters got me wondering about the people, the patients and the world behind these ads.

“There’s nothing special about the advertisements,” Biswas says, surprised at my curiosity. “Everybody in my line uses them. How else will people know there’s a cure for their problem?”

Then, unprompted, he launches into an explanation of the kind of problems people come to him with. “Most complaints are related to over hand-use,” he explains, helpfully clenching his fist and moving it to make sure I understand. “They do it too much before marriage and then find they cannot raise their temper when they want to have sex.”

And what kinds of treatment does he offer? Biswas launches into a practised pitch. “I treat with Ayurvedic medicines,” he explains. “They take time to work, but they always work. And there are no side effects at all.” But before he can really get into his stride, he spots a patient waiting outside and politely indicates that I should probably leave. I ask if I can come again. “If you have a problem,” he replies, indicating there will be no further interviews.

The conversation had been short but revealing. Biswas’ portrayal of masturbation as the root cause of all sexual maladies is startling, to say the least. Over the next few days, I visited a few more clinics, and all those who were willing to talk said the same things, highlighting the perils of masturbation and the magic of Ayurveda. Registration numbers were impossible to find and unavailable even on request. Educational details were even harder to elicit.

***

Before following yet another poster to its presumably seedy source, I decided to seek out a certified opinion beyond reproach. Enter Dr. Narayana Reddy, perhaps Chennai’s most famous and respected sexologist. Back in 1982, he started the first clinic devoted to sexual medicine in South India and the list of his achievements in the field since remains unparalleled.

Entering his clinic in a quiet residential pocket in the heart of the city, I find the contrast between my present and previous environs striking. An articulate, English-speaking assistant shows me to a seat in a large, air-conditioned waiting room provided with a variety of reading material. The quiet confidence of expensive medicine permeates the air.

“I would not like to use the word doctor to describe them,” Dr. Reddy interrupts, as I describe my recent explorations. “I would call them quacks.”

“Anyone who advertises cannot be qualified. As per the rules of the Medical Council of India, doctors cannot advertise. I cannot advertise and I cannot guarantee,” he explains. “These quacks have high visibility because of these posters, and since people cannot discuss these issues with anybody else… they run to them.”

I ask if masturbation is indeed the cause of all sexual issues. Reddy laughs. “These quacks bank on the common fears of people. It is exploitation of the gullible by the unscrupulous,” he says. “Masturbation cannot cause any health problems. Unless a person is doing it several times a day, in which case it becomes obsessive compulsive behaviour. But the fear that it causes health problems really scares people. Whether he is a rickshaw puller or a nuclear scientist, they all have these fears.”

Reddy explains that the treatments offered in such cases largely have one of two effects — they either act as placebos or, worse, actively harm the body due to the presence of heavy metals or microbes.

***

Piqued, I decide to find out first-hand how these bogus diagnoses are peddled to unwitting patients. I go to a clinic posing as one.

A young man, not much older than 25, sits at the entrance, playing a game on his cell phone. I ask if the doctor is in. He steps aside to let me in and motions for me to take a seat. He then slips on a coat that might have once been white, and sits across the table. I am taken aback but quickly collect myself and pretend that nothing is amiss. I remark that he is awfully young to be a doctor and ask about his qualifications. He tells me the clinic has been running for 20 years and his brother, who ran it before him, trained him.

Sensing that he is getting defensive, I change the topic. I tell him I’ve been having problems getting an erection. He nods understandingly and on cue pops the masturbation question. “Yes,” I say guiltily, “For several years.”

He says he will need to do a physical examination. I steel myself and try to think of the story at hand. Thankfully, it is over in seconds. “Yes,” he says. “I can see the problem clearly. You are not able to get erect, because you have masturbated too much. In fact, I can see that your penis is shrinking due to this.”

As he begins to scribble on a prescription pad, I put on my best petrified face. I look for names of medicines, but instead his pen produces a giant penis on the paper. He then uses the diagram to go over my condition in great detail. No new facts are added, of course. The existing narrative is reinforced with some fire and brimstone thrown in. When he is finally convinced I have grasped its gravity, he starts talking treatment.

“Don’t worry. It can definitely be fixed,” he says reassuringly. “Lots of people come to me with this problem. And they’ve all gotten better.” He tells me I will need to take a course of medication that will last a month and cost Rs. 8,000. He says no prescription is required, as he will supply the medicines himself — “homemade and brought in from East India”.

He also brandishes a clear plastic tube shaped like a phallus and offers to add back what I’ve lost in inches for a small extra fee. I recognise the contraption from the spam folder of my email inbox. It’s a vacuum pump, commonly marketed as a penis enlargement device. I refuse the offer and tell him I only have Rs. 200 for the medicines and will come back for more.

A bit of the sheen immediately drains out of his manner, but he grudgingly agrees. He gives me six brightly-coloured pills, two of a kind in three zip-lock bags, and tells me that if I don’t come back the next day, they will be useless.

***

According to Reddy, the problem is systemic. “Sexual medicine is not taught in any university in India. And the modern medical fraternity is stupid enough to overlook this.” According to him, a course recently initiated in Chennai through the Indian Medical Association is trying to help doctors specialise in sexual medicine. However, he admits that the numbers look decidedly bleak. “For every one patient that I get, a hundred go to quacks.”

I relate my tale of unqualified and unregistered doctors doling out unnamed drugs to a senior government official who deals with Indian Medicine. A rueful smile spreads across his face. The official, who requests anonymity, is a practising doctor and complains about quacks giving Indian medicine a bad name. “Patients see advertisements and come to me thinking traditional medicine is some sort of magic,” he laments.

Unfortunately, he says, “The law provides them enough room to escape.” Section 33EEC of the Drugs and Cosmetics Act of 1940 exempts drugs manufactured by “vaidyas or hakims... for the use of their own patients” from any regulation. Thus, as long as the quack sells his medicine to patients who come to him of their own accord, no standards or safety regulations apply.

I have my colourful pills with me. I take them out and he examines them carefully; then he explains that he can take action only if I have an adverse reaction after taking them. That’s a bridge too far for me, even if it would make for a great story.

visvaksen.p@thehindu.co.in

Corrections and clarification: The article has been edited for a factual error. Drugs and Magical Remedies Act of 1954 has been corrected to Drugs and Cosmetics Act of 1940.