What is Dhat Syndrome and its Treatment?

Dhat syndrome is a condition found in the cultures of the Indian subcontinent in which male patients report 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. Male patients think that they suffer from premature ejaculation or impotence, and believe that they are passing semen in their urine.
Somatic symptoms like weakness, easy fatiguability, palpitations, insomnia, low mood, guilt and anxiety are often present. Males sometimes report a subjective feeling that their penises have shortened. These symptoms are usually associated with an anxious and dysphoric mood state.
The patients who presented with symptoms of Dhat syndrome were mostly young, recently married, belonging to average or low socioeconomic status (perhaps a student, laborer or farmer by occupation), from rural area and from family with conservative attitudes towards sex.
Patients having Dhat syndrome can be further divided into three categories.
1.    Dhat alone – Patients attributed their symptoms to semen loss; presenting symptoms – hypochondriacal, depressive or anxiety symptoms
2.    Dhat with comorbid depression and anxiety – Dhat was seen as an accompanying symptom
3.    Dhat with sexual dysfunction– Erectile dysfunction (22-62%) and premature ejaculation (22-44%) were the most commonly associated psychosexual dysfunctions; while depressive neurosis (40-42%), anxiety neurosis (21-38%), somatoform/hypochondriasis (32-40%) were the most reported psychiatric disorders in the patients having diagnosis of Dhat syndrome.
Young males are most often affected, though similar symptoms have been reported in females with excessive vaginal discharge or leucorrhea, which is also considered a “vital fluid”.
The word “Dhat” derives from the Sanskrit language word dhatu, meaning “metal,” “elixir” or “constituent part of the body” which is considered to be “the most concentrated, perfect and powerful bodily substance, and its preservation guarantees health and longevity.”
Since then, myth prevalent among people of the Indian subcontinent is that “it takes 40 days for 40 drops of food to be converted to one drop of blood, 40 drops of blood to make one drop of bone marrow and 40 drops of bone marrow form one drop of semen.”
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.
Knowledge & Attitude to Dhat Syndrome
Regarding composition, majority of patients believed that Dhat consisted of semen, followed by pus, sugar, concentrated urine, infection or “not sure.” Majority considered masturbation and/or excessive indulgence in sexual activities as important causative factor, followed by venereal diseases, urinary tract infections, overeating, constipation or worm infestation, disturbed sleep or genetic factors.
Majority got the information about Dhat syndrome from friends, colleagues or relatives. Fear of semen loss and its cure are propagated by vaids and hakims and advertised everywhere on walls, on television, in newspapers and on roadside hoardings in most of the northern Indian cities. Most of the patients prefer to visit STD clinics, urologists and physicians rather than approach psychiatrists.

There are many patients in whom whitish or yellow semen like or water like secretions are discharged in urine during defecation, urination or other time. This type complaint has been found in many boys or men. The various causes of such problems are:
Causes Of Dhat or Spermatorrhoea

1) Dhat secretion in urine
1.) Spermatorrhoea
2.) Retrograde Ejaculation: In this semen goes in bladder in place of, coming out through penile opening. The cause of retrograde ejaculation can be due to diabetics, some psychiatric drugs & pelvic surgeries. Thus for treatment the cause should be tried to find out by detail history, investigation. Once diagnosis is made treatment can be possible.
3.) Pyuria
4.) Crystalluria
5.) Leucocytouria
6.) Cowper's gland over activity / or infections
7.) Prostatitis
8.) Significant proteinuria
9.) Chylliuria
10.) Nephrotic syndrome
11.) Candidal balanitis
12.) Non gonococcal urethritis
13.) Idiopathic 
14.) Venereophobia

Symptoms Of Dhat Syndrome

Nothing more leads to anxiety in any man other than semen loss which can be through wet dreams and masturbation. There are loads of symptoms attached
Appetite Loss
Lack of physical strength
Poor Concentration

Though initially it was thought that we have this syndrome in men only, however, later it was found that even women might have this syndrome.
The overall anxiety related to loss of semen it can be tracked back to thousands of years as it is present in the Ayurvedic texts as well. Where it mentioned as that even a single drop of semen, could destabilise the whole body

First step in proper treatment of Dhat like secretions is accurate diagnosis of cause of his problem. So we first try to find out cause. We take detailed history, thorough sex counseling and physical examination. After that depending on likelihood of particular, cause relevant tests are done at our centre. Thus you may consult us at our centre & at same time you may get all test done also. The time taken in getting all the reports ready is 24 hours. So if you are from out of Delhi, you may come here for two days for proper diagnosis of your problem. 

Onset: Sudden/gradual, Response to previous therapy, Libido, Stress (physical or mental), H/O precipitation by some infection or unprotected sexual intercourse, Sec. Sexual Characters, Other symptoms suggestive of any infections. 

We examine whether Sexual Development is adequate or subnormal. For this testis size is measured by orchidometer (if patient is outstation then by ultrasound of testis). Then other systems are examined. Signs of urinary tract infection, any sexually transmitted diseases are examined.

At our centre we have all the facility for complete investigation of cause of Dhat problem . So we perform following tests, step by step depending on their need based on history & examination. 
The various diagnostic tests needed/performed are as follows: - 
Biochemistry tests, phosphorus, Usg., C/S, & other relevant tests.
Management of Dhat Syndrome
Understanding of Dhat syndrome by Modern Medicine fails to impress most patients. Only AYURVEDIC MEDICINES HAVE PERMANENT CURE FOR DHAT SYNDROME.WE AT Dr.S.K.Jain’s Burlington Clinic (P) Ltd Lucknow  in valueable guidance of Dr.Saransh Jain Have Permanent Cure.Wig suggested emphatic listening, a nonconfrontational approach, reassurance and correction of erroneous beliefs, along with the use of placebo, anti-anxiety and antidepressant drugs, wherever required. Other group advocated psychoeducation and culturally informed cognitive behavioral therapy. Good response was reported with anti-anxiety and antidepressant drugs as compared to psychotherapy. Depressive symptoms of this syndrome showed effective response to selective serotonin reuptake inhibitors along with regular counseling.
The available intervention studies suggest that the management of Dhat syndrome involves sex education, relaxation therapy and medications. Sex education primarily focuses on anatomy and physiology of sexual organs and their functioning with reference to masturbation, semen, nocturnal emissions. It also involves functioning with genitourinary system independent of gastrointestinal tract, etc. Relaxation therapy mainly consists of Jacobson’s Progressive Muscular Relaxation Technique, which can be combined with biofeedback (so as to facilitate objective evidence and mastering of anxiety by the patient).

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