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Dhat Syndrome in a Female- a Case Report Indian Journal of Psychiatry, 2001, 43(4),345-348 DHAT SYNDROME IN A FEMALE- A CASE REPORT GAGANDEEP SINGH, AJIT AVASTHI & D.PRAVIN ABSTRACT Dhat syndrome is a commonly diagnosed disorder in Indian male patients. Patients present with various physical and mental symptoms which are attributed to the passage of "Dhat"(commonly semen) in urine. A case of an adult female is described who presented with complaints of aches and pains, headaches and poor concentration which she attributed to "wetness" experienced per vaginum during sexual intercourse. Arguments are presented for the existence of "Female Dhat Syndrome" Key words: Dhat syndrome, female Dhat syndrome is a culture bound sex and vital component of the body which is made neurosis commonly diagnosed in Indian culture out of blood. Its loss is believed to lead on to loss (Bhatia & Malik, 1991; Bhatia & Choudhary, 1998). of vitality and hence various symptoms (Bhatia & Patients present with vague symptoms of Choudhary, 1998). weakness, fatigue, palpitations, loss of interest, Chaturvedi et al.(1993) argued for a similar headaches, pain in epigastrium, forgetfulness, syndrome in females. In a controlled study in a constipation etc.(Bhatia & Malik, 1991; Bhatia & psychiatric outpatient clinic, they found 53% of Choudhary, 1998; Singh,1985). They attribute these female psychiatric patients (with predominant symptoms to their belief of passing of semen somatic complaints) and 13% of normal healthy (Dhat) in urine as a direct consequence of either women, to harbour the belief that passing non- excessive indulgence in masturbation or sexual pathological whitish discharge per vaginum was intercourse (Bhatia & Choudhary, 1998; Bhatia et harmful to their health. They believed that the al.,1997). discharge was responsible for their symptoms. A prototype patient is likely to be a married The authors pointed out that in many such patients, or recently married male, of average socio­ vaginal discharge had an etiological notion, as economic status, coming from a rural area and loss of "Dhatu"(vital fluid). It was regarded as a belonging to a family with a conservative attitude medium of communication about health related towards sex (Bhatia & Malik,1991; issues and an understandable explanation for Akhtar, 1988; Behera & Natraj, 1984). somatic complaints. The authors regarded these Patient's knowledge and attitude towards symptoms as some sort of signal about issues sexual processes which is coloured by information related to sexuality But by drawing a corollary from friends, colleagues or relatives and lay between symptoms and their attribution, a magazines is a major aetiological factor behind suggestion for "Female Dhat Syndrome" was manifestation of this syndrome (Bhatia & made. Malik, 1991). Patients regard semen as a precious Here we report a case of a 23 year-old 345 GAGANDEEP SINGH eta/. housewife who presented with what might be continued as before. As a result, she started termed as "Female Dhat Syndrome". remaining sad thinking that she would get weaker and weaker and will not be able to work normally. CASE REPORT She sought help in gynaecological outpatient department. A detailed gynaecological evaluation K.K., a 23 year old matriculate housewife including a vaginal swab examination did not from middle socio economic, Sikh nuclear family reveal any obstruction or infection. Her routine of urban background presented to our outpatient investigations (including hemogram, routine urine clinic with complaints of weakness and vaginal examination) revealed no abnormality. She was discharge for the last 3 years and "fear" of sex of referred to psychiatry outpatient henceforth. 6 months duration. A diagnosis of Dhat syndrome (Other Before marriage, patient hailed from a Neurotic Disorder-F 48.8 as per ICD-10, conservative joint family of rural background where WHO, 1992)with Non-organic Dysparuenia (F 50.0) open discussions about sexual topics were was kept after detailed evaluation in the Marital discouraged. She never masturbated and had no and Psychosexual Clinic of the Department of history of premarital sexual contact. She regarded Psychiatry. She had a knowledge score of 8(out sexual intercourse as a shameful and painful of 35) and attitude score of 27 (out of 60) on Sex activity. Knowledge and Attitude Questionnaire (Avasthi At about 20 years of age, she started etal.,1992). She had poor knowledge in areas of feeling 'wetness' in the vagina whenever she menstruation, masturbation, sexual desire, thought of the act of sexual intercourse or on anatomy and physiology of the female occasions spontaneously too. She did not report reproductive system and pregnancy. She also held any foul smelling discharge or local itching. She a negative attitude towards premarital sex and started thinking that she was losing something sexual education to youngsters. vital. She also complained of weakness and She was counselled about anatomy and "swelling" of the body, for 1-2 days after such physiology of female reproductive system, experience. Within the next 1-2 months, she physiological changes in the body during the act developed aches and pains throughout the body, of sexual intercourse and the role of anxiety in headaches and poor concentration. She would the experience of pain during the act. She was attribute these symptoms to the 'wetness'. She educated about the formation, usefulness and non- started remaining constantly preoccupied with harmful nature of vaginal secretions. She these symptoms and hence anxious. expressed some relief in her symptoms, but The patient got married at the age of 221/2 dropped out of follow-up. years. From the first day of marriage, any thought of sexual intercourse or initiative to this effect by DISCUSSION the husband led to intense anxiety with autonomic symptoms lasting for 15-30 minutes or as long Normal vaginal discharge is due to as sexual intercourse lasted. Though she reported secretions of various glands in the female genital adequate sexual desire, she participated minimally tract and transudation from the vagina. The in the act. She would complain of mild to moderate discharge is white to creamy when fresh and when pain during the initial part of intromission. She dried, leaves a brownish yellow stain on clothing always complained of weakness after the act and (Tindall,1997). It is non offensive in smell and would attribute it to ' wetness' she had during contains of fluids, mucus,epithelial debris, intercourse. After about 3 months of marriage, her electrolytes, proteins and lactic acid. Its quantity complaints of pain and anxiety during intercourse particularly increases during masturbation and decreased considerably but other complaints sexual intercourse due to secretion from the 346 DHAT SYNDROME IN A FEMALE Bartholin's glands. Pathological discharge, on the Dhat Syndrome is a useful diagnostic entity other hand is mucopurulent to frankly in the Indian subcontinent(Bhatia & Malik, 1991). purulent.cream to yellowish in colour, offensive in Its validity now has been established by its smell and microscopy reveals the presence of pus inclusion under "Other specified neurotic cells (Tindall, 1997). disorders" in the ICD-10 (WHO,1992). Vaginal discharge has been referred to be Understanding "Dhat Syndrome" from its used by women as a medium of communication phenomenological aspects with the focus on about health issues particularly sexuality "Dhatus" other than semen alone and hence (Chaturvedi et al., 1993) while describing "Dhatu" irrespective of gender would provide a much better in "Dhat syndrome", Behera & Natraj (1984) had idea about this syndrome. pointed out that the word "Dhatu" appears to have become synonymous with "semen". Originally, in REFERENCES the Indian system of medicine, seven types of "Dhatu" were described (semen being one of Akhtar,S.(1988) Four culture bound those, the most precious). It was believed that psychiatric syndromes in India. International disturbances in any one of these could lead to Journal of Social Psychiatry, 34,70-74. increased susceptibility to physical or mental illnesses (Behera & Natraj, 1984). It appears that Avasthi,A.,Varma,V.K.,Nehra,R. & perhaps due to overemphasis on "semen", focus Das,K.(1992) Construction and standardization of on other bodily fluids regarded as vital was lost. a Sex knowledge and Attitude Questionnaire In the index case, the patient regarded (SKAQ) in simple Hindi for North India population. vaginal secretion as loss of vital fluids and Indian Journal of Psychiatry,34,24-27'. attributed her physical and mental symptoms to it. The patient's conservative background and lack Behera,P.B.& Natraj,G.S.(1984) Dhat of knowledge of normal human reproductive Syndrome: The phenomenology of a culture bound physiology seem to have contributed significantly neurosis of the orient. Indian Journal of Psychiatry, to her belief. Her apprehension of sexual 26(1),76-78. intercourse and resultant anxiety and pain (in the presence of normal sexual desire) appears to be Bhatia,M.S.& Malik,S.C.(1991) Dhat evidence of her conviction of the belief that she Syndrome- a useful diagnostic entity in Indian indeed regarded these fluids as vital (as culture. British Journal of Psychiatry, 159,691- "treasured" fluid was further lost during the act). 695. A part of it was contributed by the previously held beliefs of intercourse being a painful act. Bhatia,M.S.,Choudhary,S.&Shoma,S. Spontaneous relief of pain and anxiety due (1997) Dhat Syndrome- Is it a syndrome of Dhat to the act of intercourse seem to have resulted only? Indian Journal of Human Mental Health,2,SO. due to her relieved apprehension on "exposure". But she continued to hold her earlier held beliefs. Bhatia,M.S.& Choudhary,S.(1998) Dhat What we are arguing here is a case of the Syndrome-culture bound sex neurosis. Indian female counterpart of the typically described "Dhat Journal of Medical Sciences,52,30-35. Syndrome". The patient's socio-demographic background, sexual knowledge and attitude fit into Chaturvedi,S.K.,Chandra,P.S.,lssac,M.,K. a prototype patient of Dhat Syndrome, as did the & Sodarashan,C.Y.(1993) Somatization improvement.
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