LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 4 | Page : 245
Per-anal discharge: A new face of Dhat syndrome
Sujita Kumar Kar, Amit Singh
Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
|Date of Web Publication||25-Nov-2015|
Sujita Kumar Kar
Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kar SK, Singh A. Per-anal discharge: A new face of Dhat syndrome. J Hum Reprod Sci 2015;8:245
Dhat syndrome is a culture-bound syndrome, commonly prevalent in South East Asia. , The common manifestations of Dhat syndrome, being decline in sexual performance, depression, anxiety as well as vague somatic complaints which are attributed to semen loss mostly during "night falls" and "defecation."  Loss of semen is always a per-urethral phenomenon in an individual with intact anatomical integrity, it may occur during masturbation or sexual intercourse or nocturnal emission or during defecation. However, atypical presentations seldom challenge this anatomical fact.
A 26-year-old unmarried male, school teacher from a rural background presented with complaints of anxiety, generalized weakness, easy fatigability, nonspecific musculoskeletal pain, and burning sensation during urination for last 5 years. On detailed exploration, he had expressed his concerns about loss of semen through nocturnal emissions (which he used to describe as "night falls"), during urination, and per anally during defecation. He had also reported about constipation. Constipation used to increase his perceived semen loss per-anum and urethra, when he would strain during defecation. He had also reported about the use of paraffin-based laxatives for his problem of constipation and paradoxical worsening of semen discharge per-anum after laxative use. On detailed exploration, he depicted the "per-anal discharge" to be whitish to cream-colored, sticky, slimy discharge, and described it to be semen. He had attributed all the presenting complaints to semen loss. He was much worried about per-anal discharge and attributed low backache to it. His physical examinations and routine blood investigations including routine and microscopic examination of urine were within normal limits. Local pathology was ruled out after surgical opinion.
In this case, the patient had wrongly perceived the normal physiological, per-anal mucous discharge as semen and pathologically attributed it to his psychosomatic complaints. Such abnormal beliefs are unusual as reported earlier.  Overstraining during defecation due to constipation and use of paraffin-based laxatives, increased mucous secretion in our patient, which was wrongly perceived by him as semen. Poor knowledge about anatomy and physiology of genital system was responsible for such catastrophizing pathologic attribution. The focus of treatment in such cases of Dhat syndrome is to impart adequate knowledge about the genitourinary system, in addition to psychoeducation, relaxation therapy for stress reduction, and antidepressant medications for anxiety and depressive symptoms.
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Conflicts of interest
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| References|| |
Prakash O, Kar SK, Sathyanarayana Rao TS. Indian story on semen loss and related Dhat syndrome. Indian J Psychiatry 2014;56:377-82.
Kar SK, Sarkar S. Dhat syndrome: Evolution of concept, current understanding, and need of an integrated approach. J Hum Reprod Sci 2015;8:130.
Grover S, Avasthi A, Gupta S, Dan A, Neogi R, Behere PB, et al.
Phenomenology and beliefs of patients with Dhat syndrome: A nationwide multicentric study. Int J Soc Psychiatry 2015; Jul 3. pii: 0020764015591857. [Epub ahead of print].
Balhara YP, Goyal R. An unusual presentation of dhat syndrome. J Neuropsychiatry Clin Neurosci 2012;24:E19-20.