Socio‐cultural, psychosexual and biomedical factors associated with genital symptoms experienced by men in rural India

Abstract

SummaryBiomedical, anthropological and psychiatric frameworks have been used to research different elements of men's sexual health -sexually transmitted infections, psychosexual concerns and psychological distress -but rarely within the same study. We combined these in a study in rural north India. In Tehri Garhwal and Agra districts, we explored male perceptions of genital and sexual symptoms through focus group discussions and then conducted a clinic-based survey of 366 symptomatic men who presented at rural private provider clinics. Men's urine specimens were tested for gonorrhoea and chlamydia infection using polymerase chain reaction techniques. Researchers screened them for probable psychological distress by administering the General Health Questionnaire (12-items). Results revealed that local and traditional notions of health influenced men's symptom perceptions, with semen loss their predominant concern. Dhat, commonly perceived as an involuntary semen loss, corresponded most closely with the symptom of urethral discharge, but was attributed mainly to non-infectious causes. It could also manifest as a syndrome with physical weakness and mental lethargy. FGD participants lacked correct and complete information on reproductive health. Around 75% of the symptomatic men presented with dhat, but only 5.5% tested positive for gonorrhoea or chlamydia. Application of syndromic sexually transmitted infection (STI) guidelines in these settings could result in over diagnosis and over treatment with antibiotics. In contrast, there was a significant association between dhat and probable psychological distress as detected by the GHQ (Adjusted OR, GHQ case positive: 2.66, 95% CI: 1.51-4.68). Our study confirms the existence of a dhat syndrome in rural India, which is culturally influenced and reflects heightened psychosexual concerns as well as mental distress states. Comprehensive health services for men should include assessments of their psychosexual needs and be supported by reproductive ⁄ sexual health education. STI treatment guidelines for urethral symptoms should be revised and be based on epidemiological data.

Dhat Syndrome and its Social Impact

“…Few previous studies conducted by Chaddha, et al, 14 Grover S, et al 15 and Gautam M, et al 16 reported that patients complaining of Dhat Syndrome are typically more likely to be young people, who are recently married or single; of average or low socio-economic status, coming from a rural area and belonging to a family with conservative attitudes towards sex while a study conducted by Verma R, et al 17 reported more prevalence from urban area.…”

Analysis of Patients Presenting with Dhat Syndrome and its Impact on Society

“…Few previous studies conducted by Chaddha et al 12 , Grover S et al 13 and Gautam M et al 14 reported that patients complaining of Dhat Syndrome are typically more likely to be young people, who are recently married or single; of average or low socio-economic status, coming from a rural area and belonging to a family with conservative attitudes towards sex while a study conducted by Verma R et al 15 reported more prevalence from urban area…”

Cultural misconceptions and traditional healing practices for sexual problems: a mental health perspective

“…Misconceptions that semen loss is dangerous are still prevalent in our culture (Kendurkar Kaur, Agarwal, Singh, & Agarwal, 2008). Rural and illiterate people seek help from faith healers mainly 84 V. Agarwal and S. Mahapatra because of the non-availability of sex education, of shame and guilt associated with discussing sex and sexual problems with their family due to cultural inhibitions and because of advertisements by ayurvedic, unani or unqualified practitioners at rail or road approaches to cities offering cure to these problems (Gautham et al, 2008), which is what happened to the father of the patient.…”

“…Because of ignorance, guilt and shyness people seek help from local trusted faith healers, quacks and self-acclaimed sex specialists who are not trained or licensed, especially in rural India. These healers-through-advertisement recognize normal processes like nocturnal emissions as illness and propose cures that are likely to reinforce these myths and sexual misconceptions, rather than treating patients by providing correct information (Gautham et al, 2008;Schensul 2002). Such irrational help-seeking leads to stress and magnification of symptoms, which may further lead to psychiatric disorder.…”