Why India’s medical education regulator flip-flopped on ‘lesbianism’, ‘virginity’ | Explained News

The revised guidelines issued on Thursday also do not include topics such as hymen and its types, and its medico-legal importance, and do not define virginity and defloration, which the earlier (withdrawn) version did.

How did this back-and-forth about the forensic medicine curriculum come about?

First, what specifically about the now-withdrawn guidelines triggered outrage?

The curriculum, which details the topics to be covered under various medical specialties, had gone back on several changes that were introduced in 2022 to make medical education LGBTQI+ friendly.

Changes were also made to the disability curriculum and eligibility criteria for students with disability.

The following were some of the changes that triggered the most outrage:

* First, changes that were made in 2022 (more details below) to avoid regressive or offensive language on LGBTQI+ were done away with. So, the curriculum brought back sodomy and “lesbianism” under the category of unnatural sexual offences, equating them with incest and bestiality.

The curriculum identified transvestism (cross-dressing) as a sexual perversion, and clubbed together everything from voyeurism, exhibitionism, sadism, and masochism to necrophagia (eating of the dead) and necrophilia (sexual attraction to corpses) under a single category.

* Second, topics such as the importance of the hymen, definitions of virginity and defloration, and their legitimacy and medico-legal importance, which had been dropped in 2022, were re-introduced.

* Third, changes to the psychiatry module did away with a lot of positive language such as better understanding of sex, gender identity, and sexual orientation.

* Fourth, the seven hours of mandatory training on disability as part of the foundation course was done away with. The duration of the course itself was reduced from a month to two weeks. Training on disability was also not included in the module on ethics, disability rights activists pointed out.

* Fifth, some important conditions, marked by asterisks, were missing from the criteria for students with disabilities. The eligibility criteria did not specify (through an asterisk) that people with more than 40% visual impairment or hearing disability can be eligible for medical courses — and can avail benefits of reservation — provided their disability can be reduced to below 40% with assistive devices.

Without this important clarification, all students with more than 40% visual or hearing disability would become ineligible for medical courses.

How have the revised guidelines addressed these concerns?

Besides the omissions mentioned above (the first and second points in the answer to the question above), the following changes have been made:

* As per the revised curriculum, students will be taught about informed consent in sexual intercourse, history of gender- and sexuality-based identities, and the history of decriminalisation of adultery and consensual homosexual sex.

* Instead of the catch-all topic of sexual perversion, the revised curriculum says students will be taught about paraphilia and paraphillic disorders, which are unusual sexual fantasies and behaviours.

* The revised curriculum also states that students will be taught that the so-called signs and tests of virginity — including the infamous two-finger test — are unscientific, inhuman, and discriminatory.

* The revised curriculum has removed the section on disabilities, and stated that new guidelines for the next session would be published separately. For the current session, the guidelines from 2023 would continue.

But why were these changes made in the new curriculum if they had to be withdrawn, and a revised version had to be published?

The NMC has not officially given a reason. Some senior officials, however, suggested that the changes were unintentional — an error in preparing the document had led to some portions of the old pre-2022 curriculum being inadvertently included.

What had triggered the (positive) changes that were made in 2022?

In 2022, the NMC modified six modules in forensic medicine and psychiatry to reflect changes in Indian society and the law, with consensual homosexual relations being no longer illegal.

The forensic medicine module was supposed to teach students about informed consent, and the module on psychiatry was supposed to include the spectrum of gender and sexual orientations. Students were supposed to be trained on gender dysphoria (distress resulting from a mismatch between a person’s biological sex and gender identity), intersex, and sexual dysfunctions.

All these changes were made on the recommendations of an expert committee that was set up on the orders of the Madras High Court in a case involving a lesbian couple, whose parents were opposed to their relationship, and had registered a missing persons complaint.

The court had noted that queerphobia was being perpetuated in the education of future doctors. The changes of 2022 were important not only because they were progressive, democratic, and humanitarian, but also for practical reasons involving the work of doctors: for example, wrong ideas about consensual homosexual sex could lead to some patients not receiving appropriate treatment, or inadequate training on disability could lead to a failure on the part of doctors in understanding the problems faced by individuals living with disability.