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Joshi S, Tripathi A, Agarwal S, Singh N, Gupta B, Nischal A, Kar SK. Phenomenology, disability and sexual functioning in female Dhat syndrome: a study of tertiary care gynaecology outpatients. Gen Psychiatr 2022; 35:e100863. [PMCID: PMC9562279 DOI: 10.1136/gpsych-2022-100863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Background Dhat 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 the syndrome complain of passing vaginal discharge and can be excessively concerned and preoccupied with it, often attributing various physical symptoms to the loss of vaginal fluids. Aims This study aimed to assess the sociodemographic and clinical profiles of female patients with Dhat syndrome and their perceived stress, disability and sexual functioning. Methods Sociodemographic details of 70 females with non-pathological vaginal discharge were evaluated with a semistructured sociodemographic assessment. The phenomenology of the vaginal discharge was assessed with the Scale for Assessment of Female Dhat Syndrome Questionnaire. Anxiety and depressive symptoms were measured with the Hospital Anxiety and Depression Scale. Perceived stress in the past month and disability caused by the illness were assessed with the Perceived Stress Scale and the World Health Organization Disability Assessment Scale. In addition, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Level 2 Somatic Symptoms Scale was administered to rate the severity of somatic symptoms, and sexual functioning was evaluated using the Female Sexual Function Index (FSFI) scale for women who had had sexual intercourse in the past month. Results The mean age of onset vaginal discharge was 23.0 (6.6) years. Biological factors, such as urinary tract infection, were the commonly attributed cause of the loss of vaginal fluids. Psychiatric comorbidity and perceived moderate stress in the past month were found in 38.6% and 68.6% of female patients with Dhat syndrome, respectively. Disability scores tended to be low. Among the females having had sexual intercourse in the past month, 48.3% had FSFI scores indicative of a female sexual disorder. Conclusions The clinical presentation of women with non-pathological vaginal discharge is similar to that of males with Dhat syndrome. It requires comprehensive assessment and management that targets the biological, social and psychological factors and cultural issues.
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Affiliation(s)
- Shubha Joshi
- Department of Geriatric Mental Health, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Smriti Agarwal
- Department of Gynaecology and Obstetrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nisha Singh
- Department of Gynaecology and Obstetrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bandna Gupta
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Anil Nischal
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
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Mehra A, Kathirvel S, Gainder S, Avasthi A, Grover S. Female Dhat syndrome in primary care setting. Ind Psychiatry J 2021; 30:278-284. [PMID: 35017812 PMCID: PMC8709513 DOI: 10.4103/ipj.ipj_76_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 04/11/2021] [Accepted: 06/10/2021] [Indexed: 11/04/2022] Open
Abstract
AIM The study aimed to evaluate the females presenting with the complaint of nonpathological vaginal discharge to a general gynecology outpatient service in a rural community clinic from the perspective of female Dhat syndrome. METHODOLOGY Sixty-nine females considered to have nonpathological vaginal discharge after detailed gynecological evaluation, including required investigations, attending a rural community clinic were assessed for their belief about the vaginal discharge. The study subjects were also evaluated on the proposed criteria of female Dhat syndrome by using a semi-structured interview. RESULTS The mean age of onset of vaginal discharge was 36.1 (standard deviation - 8.5) years. Most of the females considered the loss of vaginal fluid as loss of a vital fluid from the body. Consumption of warm foods and drinks (75.8%) was the most common reason reported for vaginal discharge followed by eating unbalanced food/inappropriate food (73.5%). A majorty of the subjects considered vaginal discharge responsible for bodily weakness (87.0%), backache (71.0%) and stomache (66.7%). About two-third of the participants considered the taking energizing medications like vitamins/tonics/tablets and treatment from a gynecologist the treatment for vaginal discharge. CONCLUSIONS Significant proportion of females with non-pathological vaginal discharge have a belief that they are losing a vital fluid of the body. The subject attributes their symptoms to factors such as consumption of warm foods and drinks, and eating unbalanced food/inappropriate food. Accordingly, assessment and management of women with Dhat syndrome require addressing these important issues.
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Affiliation(s)
- Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Soundappan Kathirvel
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalini Gainder
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Psychaesthenic Syndrome: A Review on its Implication in Female Sexual Arousal. JOURNAL OF PSYCHOSEXUAL HEALTH 2019. [DOI: 10.1177/2631831818821542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: Psychaesthenic syndrome in the recent classification of DSM-5 comes under ‘Cultural Concepts of Distress.’ This can be the equivalent of Dhat syndrome in males. There is a paucity of literature regarding psychaesthenic syndrome. In this paper, we have tried to review the available literature regarding psychiatric and sexual comorbidities of psychaesthenic syndrome. Our paper also aims to ascertain the role and implication of psychaesthenic syndrome in female sexual arousal. Methods: PubMed, Google Scholar, and other databases were used to conduct the search. Research published in English was included. We searched the databases using the terms ‘psychaesthenic syndrome,’ ‘female Dhat syndrome,’ ‘nonpathological white discharge per vagina (NPWDPV),’ ‘leucorrhea,’ ‘female sexual disorders,’ etc. Results: For this review, we could find around 65 papers pertaining to the subject. These focused on the presence and effect of psychiatric disorders on sexual functioning. The effect of psychaesthenic syndrome on sexual functioning was also explored. The discomfort caused by NPWDPV may itself lead to decreased interest in sex. As inhibited sexual desire and sexual arousal disorder are estimated to be among the most common sexual disorders in women, it is probable that difficulty in sexual arousal is one of the major perceived effects of psychaesthenic syndrome. It has been found that depression often leads to difficulty in sexual arousal, amongst other sexual dysfunctions. Thus, there is an indirect causation of female sexual arousal disorder in psychaesthenic syndrome if depression is the manifestation of the syndrome. Conclusion: Very few studies have been done regarding the role of psychaesthenic syndrome in female sexual arousal till now. We are in the process of a major population-based study to delineate the epidemiological aspects, clinical features, management, and prevention aspects related to psychaesthenic syndrome. This review presents the available literature, issues of concern, and methods to manage NPWDPV.
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Kar SK, Singh A. Where Lies the Fault in Diagnosing Dhat Syndrome among Females? Understanding through a Case Study. Indian J Psychol Med 2017; 39:506-508. [PMID: 28852249 PMCID: PMC5560003 DOI: 10.4103/0253-7176.211742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Dhat syndrome is a culture-bound syndrome of South-East Asia, common in young men. However, similar entity has also been described in female patients who attribute their symptoms to nonpathological or physiological vaginal discharge. The current diagnostic system for psychiatric illnesses does not encompass Dhat syndrome in females, and so these group of patients receive alternative diagnoses such as somatoform disorder or depression. As a result of which the focus of unique Dhat syndrome-centered management gets weakened, affecting the clinical outcome. This case study focuses on the diagnostic dilemmas related to Dhat syndrome in females and pitfalls in the current diagnostic system.
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Affiliation(s)
- Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Amit Singh
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
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Avasthi A, Grover S, Sathyanarayana Rao TS. Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian J Psychiatry 2017; 59:S91-S115. [PMID: 28216788 PMCID: PMC5310110 DOI: 10.4103/0019-5545.196977] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ajit Avasthi
- Department of Psychiatry, PGIMER, Chandigarh, India
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Abstract
Sexual problems that are psychological in origin, rather than physiological, are called psychosexual disorders. Multiple factors, such as general health of the patient, chronic illnesses, psychiatric/psychological disorders, and socio-cultural factors, alone or in combination can be attributed to the development of psychosexual dysfunctions. The symptoms of these disorders vary for each individual and differ with gender. These disorders may be categorized as sexual dysfunction, paraphilias, and gender identity disorders. Dermatologists are sometimes consulted for sexual dysfunctions in their routine practice by the patients visiting sexually transmitted infections (STI) clinics because a majority of the patients believe that these problems are caused by dysfunctions in the sex organs, and because people are hesitant to go to sexuality clinics and psychiatrists for such problems. Sometimes these patients are referred from other specialties such as urology or gynecology; most often, we attempt to search for STIs or other dermatoses on the genitalia and refer them back. We often underestimate the prevalence of sexual concerns of the patients or feel uncomfortable discussing matters of sexuality with them. Dermatologists should understand basic sexual medicine and ask patients for sexual problems. They should be trained to manage such patients accordingly. In this review, we will be focusing on sexual dysfunctions, their etiopathogenesis, and management from a dermatologist's perspective.
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Affiliation(s)
- Tarun Narang
- Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh, India
| | - Garima
- Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh, India
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Grover S, Avasthi A, Gupta S, Hazari N, Malhotra N. Do female patients with nonpathological vaginal discharge need the same evaluation as for Dhat syndrome in males? Indian J Psychiatry 2016; 58:61-9. [PMID: 26985107 PMCID: PMC4776585 DOI: 10.4103/0019-5545.174376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIM The aim of this study was to evaluate the concept of female Dhat syndrome characterized by the complaint of nonpathological vaginal discharge in association with somatic, anxiety, and depressive symptoms. MATERIALS AND METHODS A total of 26 female subjects with nonpathological vaginal discharge along with depressive and somatic complaints were assessed on a self-rated questionnaire modified from Comprehensive Questionnaire for Assessment of Dhat Syndrome designed for males. They were also assessed for psychiatric comorbidity as per ICD-10. RESULTS All female subjects received an ICD-10 psychiatric diagnosis, with somatoform/dissociative disorder (57.7%) being the most common. The mean age of onset of vaginal discharge was 24.6 (standard deviation - 7.0) years, noted every day or for 2-3 times per week by more than two-third of the participants. Two-fifth (61.5%) of the women described it as a milky discharge. The most common reason reported for passage of vaginal discharge was that of urinary infection or problems of urinary tract infections (42.3%) followed by vaginal infection/disease (34.6%). More than half (53.8%) of the subjects considered vaginal discharge to be responsible for weakness in the body, weakness in stamina and thinness of physique, while slightly more than two-third (69.2%) of them reported bodily weakness and sleep disturbances. Overall the clinical picture in females was similar to male patients with Dhat syndrome on most of the account. CONCLUSIONS Subgroup of patients with vaginal discharge attribute their somatic and mental symptoms to the passage of whitish vaginal discharge and are distressed due to the same. The clinical picture is similar to Dhat syndrome in males. There is a need to recognize female variant of Dhat syndrome as a culture-bound syndrome. Identification of the same may help in managing this subgroup of patients seeking help from the gynecologists for their nonpathological vaginal discharge or from mental health professionals for their symptoms of common mental disorders.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Gupta
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Hazari
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kar SK, Sarkar S. Dhat syndrome: Evolution of concept, current understanding, and need of an integrated approach. J Hum Reprod Sci 2015; 8:130-4. [PMID: 26538854 PMCID: PMC4601170 DOI: 10.4103/0974-1208.165143] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Dhat syndrome has often been construed as a culture-bound sexual neurosis of the Indian subcontinent. Symptoms similar to that of Dhat syndrome has been described in other cultures across different time periods. The present paper looks at the evolution of the concept of Dhat syndrome in India. The review also takes an overview of the current understanding of this syndrome in terms of nosological status as a distinct entity and its “culture-bound” status. The narrative finally attempts to discuss the integrated approach for the treatment of this disorder.
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Affiliation(s)
- Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Siddharth Sarkar
- Department of Psychiatry, Sree Balaji Medical College and Hospital, Chrompet, Chennai, Tamil Nadu, India
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Affiliation(s)
- Indira Sharma
- Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Abhishek Pathak
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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