Semen Loss Research Articles

Dhat Syndrome East and West: A History in Two Acts.

The intriguing story of dhat syndrome is that of medical modernity (psychiatry, clinical sexology) declaring medical premodernity (Ayurvedic concepts of semen loss) as its object. The early history and prehistory of this "culture-bound" diagnosis help understanding it as a dynamic confrontation of local, shifting knowledges. For instance, semen loss anxiety was an established motif both in European early twentieth-century psychoanalysis and again in several Indian psychodynamic texts of the 1960s. Moreover, it became problematically tied to notions of "Indian character". Little realized is that European venereologists were dealing with much comparable clinical presentations since the late eighteenth century, often resolving them in strikingly similar ways. For centuries, European proto-endocrinological ideas tied masculinity to theabsorption and recirculation of semen, informingpopular conceptions of "semen loss" (spermatorrhea) much comparable to those driven by dhatu physiology, dovetailing in colonial-era medicine. Expressive of growing controversy concerning this physiology after the mid-eighteenth century, a leitmotif of exaggerated fears tied to both "quacks" and proselytizing leading authorities such as Tissot and Lallemand, informed diagnoses of "tabes imaginaria", "spermatophobia", and "imaginary spermatorrhea."

A Female Variant of Dhat Syndrome and Associated Co-Morbidities: A Case Report

Dhat syndrome is a pathological problem linked to semen loss, specific to a particular culture. Here, a case of adult female is described with clinical presentation comparable to that of males with Dhat syndrome. Thus it necessitates thorough management and assessment that address cultural difficulties as well as biological, social, and psychological aspects of both males and females.

Unraveling Cultural Perceptions and Attitudes towards Dhat Syndrome in Asian American Communities: A Window into Diagnosis and Treatment Influences

Dhat syndrome is a culture-bound syndrome originating from South Asia, characterized by a strong belief in the harmful effects of semen loss on health. The fear is fueled by the belief that the loss of semen leads to physical and psychological problems, including a perceived loss of sexual potency and vital energy. This research aims to explore the cultural beliefs and attitudes surrounding Dhat Syndrome and its impact on Asian American populations. The goal is to examine the cultural attitude towards the diagnosis and treatment options of semen loss.

(025) Evaluation of the Efficacy of the Novel Treatment Strategy to Treat Dhat Syndrome: A Pilot Study

Abstract Introduction Dhat Syndrome, a syndrome which has obtained the status of culture-bound sexual neurosis, is difficult to treat due to the unwavering belief of the patient that his symptoms are attributable to semen loss. At present, the treatment is aimed at relieving anxiety and depression associated with this condition and not at addressal of the root cause. The best way to address this is by direct demonstration to the patient that the prevention of ejaculation has no health benefits. Objective To prospectively evaluate the efficacy of a novel treatment strategy to alter the mental construct of the dhat syndrome patients by demonstrating zero health benefits of total prevention of semen loss during treatment with silodosin over occasional semen loss during treatment with placebo in a randomized double blind placebo controlled two arm switch over study design. Methods After obtaining ethical committee approval and written informed consent from the participants, the adult males attending to the out-patient department with complaints suggestive of dhat syndrome were recruited as study participants. Those with pre-existing psychiatric disorders, sexual disorders, endocrine disorders and disorders referable to the genitourinary system were excluded. All the study participants were administered Dhat Syndrome Evaluation Questionnaire (DSEQ), Physical Activity Scale for Persons with Physical Disabilities (PASPPD) modified for the study and Hamilton Anxiety Rating Scale (HARS) at the beginning of the study. PASPPD was again administered to the participants at monthly intervals till the end of the study. Following recruitment, the participants were randomly assigned to two groups. Group 1 received daily dose of oral placebo and weekly counseling for 2 months whereas Group 2 received oral silodosin 8 mg daily and weekly counseling for 2 months. Then, the treatment with silodosin and placebo were switched between the groups for two more months. In the end, the responses to PASPPD at monthly intervals were compared and the details were shared with the participants during a special individual counseling session, after which, the participants were again administered DSEQ and HARS and the responses were compared with the responses recorded at the beginning. The difference was considered statistically significant if p value was ≤0.05 Results A total of 32 males grouped as 1(N=18, mean age 28.9±4.8 years) and 2 (N=14, mean age 27.4±4.3 years) were part of this study. All the participants reported total anejaculation during the treatment with silodosin. 59.4% patients reported occasional semen loss during treatment with placebo. The PASPPD scores showed no statistically significant difference irrespective of the type of treatment in 90.6% of the participants. At the end of the study, there was statistically significant improvement in HARS in 71.9% of the patients and 62.5% of the patients had the insight that semen loss was not harmful. Conclusions The alteration of the mental construct of the dhat syndrome patients using novel treatment strategy was successful in majority of our study participants. A larger multicentre trial with a bigger sample size could bring in a paradigm shift in the management of dhat syndrome, which is very difficult to treat. Disclosure No

Dhat Syndrome: Epidemiology, Risk Factors, Comorbidities, Diagnosis, Treatment, and Management.

Dhat syndrome is a culture-bound psychiatric syndrome most commonly found in the Indian subcontinent. It has been characterized as the experiential fear of losing semen through ejaculation, nocturnal emission, or other means. While Dhat syndrome is common in the Indian subcontinent, given the lack of representativeness, generalizability, and closer connection to Ayurvedic system, there have been limited studies or recognition of symptoms among healthcare providers around the world. In this review, we describe Dhat syndrome, its epidemiology, risk factors, comorbidities, diagnosis, treatment, and its management. For patients with Dhat syndrome, it becomes important to appreciate how generalized depression and anxiety may persist alongside the disorder and those symptoms can be common and non-specific. Related to its strong cultural connection with South Asia such as the belief on Dhat's role in health and vitality influence, it also becomes important to recognize that the syndrome can be found in other populations and the importance of cultural humility and nonconfrontational approach for patient care. In summary, this review provides an informative understanding of Dhat syndrome for non-Indian clinicians who may not be prepared for a patient encounter with vague somatic symptoms in the context of semen loss. Treatment for Dhat syndrome is the same as treatments for major depressive disorder.

Phenomenology, disability and sexual functioning in female Dhat syndrome: a study of tertiary care gynaecology outpatients

BackgroundDhat syndrome, a clinical condition related to semen loss in urine often found among males in India, has rarely been described as a separate clinical condition in females. Women with...

Married men’s sexual and reproductive health concerns and related health-seeking behavior in Bangladesh: A mixed methods study

BackgroundIn Bangladesh, men’s sexual and reproductive health (SRH) needs and related services are often neglected. Little is known of men’s SRH concerns, and of the phenomenal growth of the informal and private health actors in the provision of sexual health services to men in rural and urban areas of Bangladesh.MethodsUsing a mixed methods approach, a survey of 311 married men in three rural and urban sites was conducted in three different districts of Bangladesh and 60 in-depth interviews were conducted to understand their SRH concerns and choice of providers to seek treatment.ResultsThe research findings reveal that- men’s various SRH concerns are embedded in psychosocial and cultural concerns about their masculinity and expectations of themselves as sexual beings, with worries about performance, loss of semen and virility being dominant concerns. Sexually transmitted infections (STIs) were also mentioned as a concern but ranked much lower. Informal providers such as village doctors (rural medical practitioners and palli chikitsoks), drug store salespeople, homeopaths, traditional healers (Ojha/pir/fakir, kabiraj, totka) and street sellers of medicines are popular, accessible and dominate the supply chain.ConclusionThere is a need of appropriate interventions to address men’s anxieties and worries about their sexual abilities, well-being and choice of providers. This would go a long way to address and alleviate concerns, as well as identify and push men to seek formal care for asymptomatic STIs, and thereby reduce costs incurred and gender tensions in households.

Assessment of Frozen Semen Quality through Foldscope Microscopy- A Novel Application of Frugal Science to Reduce the Infertility Rate

Background: Quality determination of frozen semen before using for Artificial Insemination (AI) in cattle is of paramount importance. The success of cattle AI programs is largely depends on the use of good quality semen and thus assessment of semen quality parameters before AI will improve the conception rate and reduces the loss associated with repeated breeding. Among the various semen quality indicators, sperm motility is one of the important parameter and it should be evaluated immediately after semen collection (before freezing) and 24 hrs after freezing as per minimum standard protocol in frozen semen production. Though the motility is a major determinant of spermatozoa ability to reach the site of fertilization and it is affected by cryopreservation and subsequent poor cold storage facilities, motility is not frequently evaluated under field conditions. In the current scenario, many of our government AI sub-stations in remote villages are not equipped with microscope facility for semen quality evaluation before AI. Methods: In this study, we used foldscope, an origami-based paper microscope which give optical quality similar to conventional microscopes (magnification of 140X and 2-micron resolution), to evaluate the frozen semen motility at field level. In this study, the motility of spermatozoa was observed under foldscope and concluded that foldscope is very useful to asses the motility befor AI and improve the fertility in dairy animals. Result: We revealed that, utility of foldscope to assess the motility of spermatozoa was evaluated under field conditions and observed that 46% of sperms were motile. Further, evalaution of sperm motility before AI is not very common practice due to lack of microscope in many AI centres. Therefore, foldscope will be very useful at field conditions to avoid AI using poor quality semen and subsequent loss associated with repeat breeding problems.

Abstract- Poster

Background:Dhat Syndrome,term coined by Dr.N.N.Wig, also described under ‘semen loss syndrome’ or ‘semen loss anxiety’, is a culture bound syndrome predominant in the South Asian sub continent. The patient believes that he is incurring energy loss (physical and psychological) through loss of semen by various ways which leads to depressive or anxiety features.Aim:To discuss Dhat Syndrome and associated symptoms in a young male patient.Methodology:A 26yr old male hailing from rural background presented with generalized weakness,feeling tense,low mood,decreased concentration and sleep since 5yrs. Detailed exploration revealed the apparent cause behind patient’s complaints to be loss of semen through masturbation (Arizona Sexual Experience Scale showed no sexual dysfunction).His systemic physical examination and blood investigations showed no abnormality though patient was convinced that he was losing ‘important minerals’ due to masturbation and wanted to desist the harmful act forever.He was diagnosed with Dhat Syndrome(F 48.8) with moderate depression(F 32.1) and was started on Tab Escitalopram 10mg/day increased to 20mg/day over 2 weeks plus T.Clonazepam 0.5mg/day along with weekly supportive psychotherapy sessions. He showed improvement over next 3 months (Beck Depression inventory score 28 to 15 and Hamilton anxiety rating scale score 16 to 10)Conclusion:Dhat syndrome is a curable disorder more common than appears worldwide(described under different terminologies) and requires multidimensional treatment approach.

Sociodemographic Profile and Co-morbid Symptoms among Individuals with Semen Loss

Background: Semen loss and associated problems, sometimes known as ‘Dhat syndrome’ or ‘Semen loss anxiety’, are found specially in the cultures of South Asian region including Bangladesh. The aim of this study was to assess the physical, psychological and sexual problems in the patients complaining semen loss. Methods: This cross-sectional study was conducted at the outpatient department of National Institute of Mental Health, Dhaka, Bangladesh. All the male patients (aged 18-60 years) with self-reported complaints of semen loss were included in the study. Within three months, data were collected from 95 respondents through face to face interview with a semistructured questionnaire. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 24. Results: Mean age of the respondents was 23.7 (±5.1) years. Almost half (47.4%) of the respondents belonged to the age group of 21-30 years. Majority of them was Muslim (94.7%), married (54.7%), completed primary education (42.1%), currently unemployed (46.3%) and resided in urban area (87.4%), Most of the respondents complained of semen loss through urine (57.9%), followed by through night emission (18.9%) and masturbation (16.8%). All respondents complained more than one other symptom. Common physical symptoms were physical weakness (89.8%) and vertigo (50.5%), psychological symptoms were anxiety (49.8%) and depression (38.9%) and sexual symptoms were premature ejaculation (42.1%) and erectile dysfunction (31.6%). Conclusion: There were various other physical, psychological and sexual problems among the patients with the complaints of semen loss. So, other symptoms should be considered and managed when dealing with these patients. Bangladesh J Medicine July 2022; 33(1) : 64-69

Dhat syndrome: Systematic review of epidemiology, nosology, clinical features, and management strategies.

Dhat syndrome is a culture-bound syndrome prevailing in the Indian subcontinent, first described in the 1960s. Over time, newer studies are exploring various aspects of Dhat syndrome, including its epidemiology, nosology, clinical features, and management predominantly in South Asia. We aimed to review the epidemiology, nosology, clinical presentation, and management of Dhat syndrome over the last six decades through a systematic review of studies. We searched PubMed and Scopus using the following search terms - "Dhat syndrome," "Semen loss syndrome," "Semen loss anxiety" together with the Boolean operator OR. We collected the articles from inception till March 2021. We included articles in the English language published in peer-reviewed journals. A total of 89 articles were included in the analysis. Most of the articles were published in the last decade (2011-2020). Most of the publications were cross-sectional studies and of unsatisfactory quality. Most of the studies lack representativeness of the population; hence the generalizability of the findings was poor. Most of the articles discussed phenomenology (64%), overview (52.8%), and cultural basis of Dhat syndrome. The comorbidities associated with Dhat syndrome were discussed in 37.1% of the articles. The nosological status of Dhat syndrome and management of Dhat syndrome was discussed in 18% of publications each; whereas, the outcome of Dhat syndrome was discussed in 5.6% of articles. Though Dhat syndrome is a commonly diagnosed entity in the South Asian population, the research on Dhat syndrome is sparse and of poor quality.

A Bibliometric Analysis of Dhat Syndrome

Dhat syndrome is a culture-bound syndrome, mostly prevailed in South East Asia that has been systematically defined approximately six decades ago. Assessment of the published literature would help to identify the research density as well as the gaps. We aim to do a bibliometric analysis of published global scientific literature on dhat syndrome. The Scopus database was systematically searched by using the keywords “Dhat syndrome”, “Semen loss syndrome”, “Semen loss anxiety” from inception to 11th August 2021. A total of 89 articles on dhat syndrome were found in the Scopus database. Most of the articles were from India and were published in the Indian Journal of Psychiatry and Asian Journal of Psychiatry. The majority (>58%) of research on dhat syndrome was published in the last decade. The PGIMER (Chandigarh), AIIMS (New Delhi) & KGMU (Lucknow) are the leading institutes in dhat syndrome research. The year 2004 had the highest number of total citations (n = 135), while the year 1975 had the highest number of citations per article (60 citations per article). This bibliometric review identified that despite dhat syndrome is a common condition in the South East Asian countries, research on the condition is limited.

엘렌 화이트(Ellen G. White)의 생기(vital force) 개념과 갈홍(葛洪)의 환정보뇌(還精補腦) 개념 비교 연구

Despite its historical importance, relatively little attention has been paid to the theory of vital force that nineteenth century health reformers put forward. Allegedly, the vital force is a life-sustaining energy peculiar to living organisms, including human beings, and different from all the other forces found outside in non-living creatures. In this vein, this article examines ideas of vital force that Ellen G. White, one of the co-founders of the Seventh-day Adventists, maintained in her series of books called The Spirit of Prophecy. Also, this article shows the historical context of contemporary vitalism that presumably induced her to discourage masturbation (self-abuse or solitary vice as she called it) because ostensibly vital force could be expended by reckless ejaculation. She believed that devout Christians’ aim to maintain a holy body would be seriously thwarted by arbitrary semen leakage. For the purpose of comparative explanation, the article compares White’s ideas with those of Daoists. According to the Daoist Ge Hong (葛洪), an ancient Chinese thinker from the Wei-Jin period, in his book “Neipian” of Baopuzi (抱朴子), anyone can become an immortal Daoist hermit (神仙) by means of ancient chinese sexual arts (房中術) by which one should refrain from wastefully expending his semen (jing 精). Finally, this article discusses the relationship between semen loss and brain damage in the context of White’s masturbation taboo as well as Daoist semen-keeping arts called haijingbunao (還精補腦).

Concept of Dhaat Syndrome in Unani System of Medicine: A Review

The term “Dhat” was derived from songskrito and the ancient Vedic depiction of body fluids called “dhatus” and among the seven different body fluids (dhatus) mentioned in Veda; semen is perceived to be most precious one. First of all Indian doctor Narendra Wig coined the term Dhat syndrome in 1960 and described it as being characterized by vague psychosomatic symptoms of fatigue, weakness, anxiety, loss of appetite, guilt, and sexual dysfunction, attributed by the patient to loss of semen in nocturnal emission, through urine or masturbation. Several local terms have come to imply the passing of semen in urine as “dhatu rog” and named also as “jiryan.” Ayurvedic scholars regard semen loss as a severe illness, leading to physical debilitation, ill health, thereby promoting herbal and dietary therapies. In Unani system of medicine there is no as such description of Dhaat Syndrome but the concept of Jiryan-e-Mani is well described by Unani scholars. The signs and symptoms of Jiryan-e-Mani is almost very similar to Dhaat syndrome. Many Unani Physicians like Ibn-e-Sina, Buqraat, Ibn-e-Nafees, Hakeem Aazam khan etc., describes jiryan-e-Mani in detail.

Dhat syndrome and its perceived impact on psychological well-being

Background: Dhat syndrome is a culture-bound syndrome originating in the Indian subcontinent, primarily among men characterized by the fear of loss of semen. Objective: The article discusses the perceived impact of Dhat syndrome on the overall psychological well-being of the individual. Method: Four patients from hospitals in Kolkata, West Bengal, were screened using MINI and then interviewed using semi-structured interview to assess presenting concerns, interventions, psychological well-being, attitude toward sex and masturbation, and their sociodemographic details. The data were then categorized based on the dimensions of the questionnaire, which was then analyzed individually and separately based on the dimensions. The differences and commonalities between the dimensions as conveyed by the participants were then reported. Results: The analysis showed that the participants reported lower levels of psychological well-being based on the categories of Seligman's PERMA model and attributed it to the symptoms experienced by them. They traced the beginning of the hindrances to achieving optimal well-being to the onset of symptoms. Conclusion: This article proposes the incorporation of integrative therapeutic interventions and advocacy of sex education to address the psychological well-being over the current symptom reduction interventions used.

A case of two culture-bound syndromes (Koro and Dhat syndrome) coexisting with obsessive-compulsive disorder.

Sir, Koro is a culture-bound syndrome and is quite prevalent in both epidemic and sporadic forms in South East Asia. Several reports on Koro in the literature have proved that India, after China, is a Koro prone country. India had a massive Koro epidemic in 2010, involving states of West Bengal, Maharashtra, Assam, Tripura, and Kerala.[12345] Here, we report a case of Koro from the 2010 epidemic background in West Bengal, who is having two culture-bound syndromes – Dhat and Koro with comorbid obsessive–compulsive disorder (OCD). An 18-year-old single Muslim unemployed male (who has consented for this study) from a rural community visited the hospital with complaints of perceived excessive semen loss through urine, lethargy, disturbed sleep, and weakness for the past 4 months and an inward pulling sensation of the penis toward the abdomen with severe anxiety and fear of serious illness for the past 3 days. There was an ongoing “Koro” epidemic in his locality for the past 2 weeks, and several others were reported to be having similar symptoms. Mental status examination revealed severe anxiety (hamilton anxiety rating scale (HAM-A)-29) along with strong masturbatory guilt. He was diagnosed as a case of Koro with Dhat syndrome (international classification of diseases-10th revision (ICD 10)-F41.1) and treated with sertraline 50 mg/day gradually increased to 100 mg in a week, clonazepam (1 mg/day in two divided doses), and supportive psychotherapy. The patient reported on an unscheduled visit 5 days later with a new complaint of having recurrent intrusive distressing blasphemous thoughts, the content being vulgar sexual abusive thoughts directed toward Allah (God). He experienced severe guilt and anger and started repeatedly abusing and beating his head to stop the thoughts though the relief was temporary. He was now additionally diagnosed as a case of OCD (ICD-42.0), with yale brown obsessive compulsive scale (Y-BOCS) score 30. The dose of sertraline was increased to 150 mg/day over 2 weeks and clonazepam 0.5 mg thrice daily was reinstituted. He was also referred for cognitive behavior therapy. Improvement was noticed gradually after a month. DISCUSSION This is an interesting case of two coexisting culture-bound syndromes along with OCD. Initial examination was not enough to detect the OCD spectrum as it was camouflaged with predominant complaints of Dhat and later Koro-like symptoms. He displayed Koro-like symptoms not classical Koro. The ongoing Koro epidemic at the background increased his vulnerability. It is interesting that both the culture-bound syndromes were related to genital organ and function. The association of Koro and Dhat has also been reported in the literature (2), and they found the role of peer pressure in the development of Dhat syndrome. Furthermore, in one report, there were some hints about the association of Koro with OCD spectrum (4) which focused “continual compulsion to manually pull” penis or ritualistic regular tying of the penis with cloth before sleep and another case (3) focused the thoughts of penile retraction as intrusive and repetitive, with obsessive doubts. Koro has been reclassified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition as under “other specified obsessive–compulsive and related disorders” (5). In view of these findings, the authors believe that all Koro and especially Koro-like cases (with subacute/chronic presentation) should be screened for OCD spectrum. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Dhat Syndrome: A Review and Update

Dhat syndrome is known as a culture-bound syndrome of South East Asia. Its manifestations mimic the phenomenology of neurotic spectrum disorders. Myths related to semen loss are the core belief around which anxiety, depressive as well as somatic symptoms develop. Often the patients respond to psychoeducation focusing on resolving the sexual myths and misconceptions. There is an ongoing controversy regarding the nosological status of Dhat syndrome. Extensive research on Dhat syndrome may provide an answer to this controversy through understanding about the entity. This review is a synthesis of literature on Dhat syndrome from its inception till date.

Dhat Syndrome: Study of Clinical Presentations in a Teaching Institute of Eastern Nepal

Background: “Dhat syndrome” is described as a culture-bound syndrome, common mainly in the Southeast Asian region, including Nepal. We have limited data on this problem from Nepal. Objective: To study clinico-demographic profile of “Dhat syndrome” cases, with the focus on its clinical presentations seen in psychiatry out-patient clinic of B. P. Koirala Institute of Health Sciences (BPKIHS). Methodology: All consecutive out-patients with the diagnosis of “Dhat syndrome” coming into contact of the investigator in psychiatry OPD were enrolled during 12 months of study period. A pretested short questionnaire, including their view about “semen loss” and “masturbation,” was used. Psychiatric diagnoses were made according the International Classification of Diseases, Tenth Revision (ICD-10). Results: Majority of the subjects were of productive ages; average age was 25 years. More of them were of Terai origin and from villages, though there were people also from other ethnic groups and urban settings. Most of them were educated but up to a middle/secondary level only. Most of the cases presented with depressive and anxiety symptoms, and semen loss, and were worried because they had heard or read that semen loss or masturbation was bad for health. They viewed semen as precious, something to be preserved, and masturbation a bad practice. Beside Dhat syndrome, two-thirds of the subjects (68%) had other ICD-10 psychiatric disorders, the most common being depression. Conclusion: Psychiatric diagnoses are common among patients with “Dhat syndrome.” Most of these people view semen loss as a bad sign and masturbation a bad habit. Sex education is warranted for better health.

Dhat syndrome: past and present - the journey of an Indian culture-bound syndrome across the globe

Dhat syndrome, originally thought to be a culture-bound syndrome restricted to the Indian subcontinent, has now been found to be spread worldwide. This “semen-loss anxiety” is excessive preoccupation with loss of vitality resulting from loss of semen either through urination, nocturnal emission, or masturbation. Semen has been linked to strength and power in the Ayurveda. The ethno-cultural beliefs of a community are important in shaping the expression of underlying psychological disturbances. In developing countries, the repressed emotions usually find expression through somatic symptoms. The presentations can range from depression, anxiety, fatigability, sexual dysfunction, and other somatic symptoms. Dhat syndrome is akin to shen-k-uei in China and Taiwan and shukra prameha in Sri Lanka. Even in the seventeenth century west, the nobility distinguished themselves from the common by way of sexual sanctity. This poses a question to the usual assumption that Dhat syndrome arose in the east and was prevalent among the less educated classes only. The lack of understanding of the phenomenology and a deficient universal language of reporting has made it difficult to be placed under any specific category in the diagnostic system. The tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) mentions Dhat syndrome under other unspecified neurotic disorders (F48.8) while the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) mentions it under “the cultural concepts of distress.” A better understanding of the disorder requires a comprehensive approach and integration with allied system of medicine as well as community awareness is required to address this problem.

Sexual Dysfunction among Men in Rural Tamil Nadu: Nature, Prevalence, Clinical Features, and Explanatory Models.

Background and Aim:There is a dearth of community data on nature, prevalence, clinical features, and explanatory models related to sexual dysfunction among men, particularly from rural India. This study attempted to examine different aspects of male sexual dysfunction and misconceptions in the community.Materials and Methods:Villages in Kaniyambadi Block, Vellore district were stratified, and four were randomly selected. Men living in these villages were recruited for the study. The following instruments were administered: (i) International Index of Erectile Function, (ii) Chinese Index of Premature Ejaculation (iii) Short Explanatory Model Interview, and (iv) Revised Clinical Interview Schedule. The data were analyzed using standard bivariate and multivariate statistics.Results:A total of 211 men were recruited. The majority were middle-aged (mean 40.73 years), literate (84.8%), married, and with children (72%), from nuclear families (99.6%), followed the Hindu religion (87.7%), reported satisfaction with their marriage (51.2%), had a single sexual partner (99.5%), and practised contraception (88.2%). A minority reported erectile dysfunction (29.9%), premature ejaculation (19.4%), and depression/anxiety (30.8%). Erectile dysfunction was associated with single marital status (P < 0.001), premature ejaculation (P < 0.001), worry about nocturnal emission and loss of semen (P < 0.02), and punishment by God as causal beliefs (P < 0.001). Premature ejaculation was associated with diabetes mellitus (P < 0.05), alcohol use (P < 0.05), anxiety and depression (P < 0.01), guilt about masturbation (P < 0.001), and belief that nocturnal emission is causal (P < 0.001) and erectile dysfunction (P < 0.05).Conclusion:Sexual misconception and dysfunction in men are significant problems in rural communities in India. They mandate the need for sex education in schools and the empowerment of physicians in primary and secondary care to manage such problems.