Bengaluru: After 18 years of marriage, a couple approached a psychiatrist -- not due to conflict, but because they had never had sex. Their decision came when they suddenly wanted a child.Sharing the case at a panel discussion titled 'Behind closed doors: Marriage, Intimacy and mental wellbeing' on Sunday, Dr Sandeep Deshpande, chief medical officer at Allo Health, said it reflected the silence and misinformation that continue to surround sexual health in Indian marriages. "She was a teacher, he was a postgraduate -- yet their understanding of basic human sexuality was shockingly poor. It's not just their story; it's a symptom of a larger problem," he said.Deshpande said the lack of awareness begins within medical education itself. "The medical council doesn't recognise sexual medicine as a discipline, and medical colleges don't train doctors to handle such issues. We produce professionals who can treat the brain and heart, but not matters of intimacy and desire," he said, adding that this gap has encouraged unregulated alternatives.Neha Bhat, an arts-based sexual trauma psychotherapist, said intimacy starts with the individual, not just within relationships. "Sex is not something you do with another person; it's a connection to the self. People are not only ashamed of the act -- they're ashamed of their own feelings," she said.Clinical psychologist Shobha Managoli highlighted how cultural expectations and family influence shape intimacy. "Pre-wedding advice, gender roles, and social conditioning create emotional scripts that often turn into conflict," she said.Experts noted unaddressed sexual issues often manifests as anxiety, depression and strained relationships, with many women seeking therapy over pressure to conceive, family expectations, marital discord, infertility, and emotional fatigue.