| Article Access Statistics|
| Viewed||4158 |
| Printed||48 |
| Emailed||0 |
| PDF Downloaded||340 |
| Comments ||[Add] |
Click on image for details.
|Year : 2014
: 56 | Issue : 4 | Page
|Indian story on semen loss and related Dhat syndrome
Om Prakash1, Sujit Kumar Kar1, TS Sathyanarayana Rao2
1 Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi, India
2 Department of Psychiatry, JSS University, JSS Medical College and Hospital, Mysore, Karnataka, India
Click here for correspondence address and
|Date of Web Publication||8-Dec-2014|
| Abstract|| |
India is a country of many religions and ancient cultures. Indian culture is largely directed by the Vedic culture since time immemorial. Later Indian culture is influenced by Buddhism, Islam, and Christianity. Indian belief system carries the footprints of these cultures. Every culture describes human behaviors and an interpretation of each human behavior is largely influenced by the core cultural belief system. Sexuality is an important domain which is colored by different cultural colors. Like other cultures, Indian culture believes "semen" as the precious body fluid which needs to be preserved. Most Indian beliefs consider loss of semen as a threat to the individual. Ancient Indian literature present semen loss as a negative health related event. Dhat syndrome (related to semen loss) is a culture-bound syndrome seen in the natives of Indian subcontinent. This article gathers the Indian concepts related to semen loss. It also outlines belief systems behind problems of Dhat syndrome.
Keywords: Belief, culture, Dhat syndrome, India, semen
|How to cite this article:|
Prakash O, Kar SK, Sathyanarayana Rao T S. Indian story on semen loss and related Dhat syndrome. Indian J Psychiatry 2014;56:377-82
| Introduction|| |
Culture influences human behavior inherited from the society since generations. Its role in shaping the behavior pattern of a particular group of persons sharing same values is irrefutable. India is a country of racial, cultural, linguistic, and religious diversities. India is considered to have conservative social norms with respect to sexuality. Indian culture has a lot of influence on belief towards different aspects of sexuality. Different aspects of sexuality are less discussed in public as well as in education system. , A barrier still exists before openness toward sexuality. Due to this, a lot of misbeliefs and misconcepts exist toward sexuality in India. Cultural myths in relation to semen loss can induce physical and psychological symptoms in men which are together as a syndrome termed as Dhat syndrome. 
'Dhat syndrome', term first used in scientific literature by renowned Indian psychiatrist Prof. N. N. Wig, described as a specific syndrome nurtured as a result of culture-related beliefs.  This syndrome is a conglomeration of multiple psychosomatic symptoms, including sexual symptoms in the absence of physical illnesses. In stressful situations, an individual's focus of attention may shift to bodily symptoms like passage of white semen like substances in urine. The individual, who carries a strong cultural belief that semen is a highly precious and vital element in the body, may attribute the symptoms to loss of semen. 
Indian studies ,,, found depression, anxiety, somatization, and hypochondriacal symptoms as common phenomenon, while erectile dysfunction and premature ejaculation as common associations with Dhat syndrome. Most common symptoms of the patients with Dhat syndrome are weakness, fatigue, palpitation, and insomnia. , Dhat syndrome is commonly seen in young, newly married males of low socio-economic status of rural background. They usually belong to families with traditional sexual attitude.  Dhat syndrome can be treated by resolving sexual myths, relaxation exercise, reassurance, supportive psychotherapy, anxiolytics, and antidepressants. , Recently, cognitive behavioral intervention is also suggested for patients with Dhat syndrome. 
| Historical perspectives of indian sexuality and semen loss|| |
Indian concepts on sexuality and semen loss are in constant state of evolution. There remained a continuous change in beliefs and revolution of thoughts in Indian psyche. These changes are due to several reasons like:
- Exchange of knowledge due to migration
- Mixing of different religions, cultures, and races
- Influence of foreign invaders
- Evolution of science and its impact on culture
- Modernization and globalization.
Indian history is the reservoir of various religions and cultures. Every religion and culture laid down its concepts and beliefs in different forms ranging from arts, scripture, paintings, to various literatures. Out of different ancient literatures Vedas are the most ancient ones. They are divided into four parts-Rig-Veda, Sam-Veda, Yajur-Veda, and Atharva-Veda. The Vedas describe about philosophy, culture, religion and life above all these things.  An important ancient literature which describes about behavioral aspect of human beings is "Manu Samhita". There is a description of 330 millions of Gods and Goddesses in Hindu religion. In Hindu religion, "Kama Deva" and "Rati Devi" are considered as God and Goddess of Sex, respectively.
In Hindu mythology and Vedic culture, there is a vivid description about "Brahmacharya", which means "strictly following or adopting the path to reach brahma (God)". In this path, the individual needs to conserve his semen which adds to his strength and takes him closer to the supreme soul. Loss of semen is considered as the biggest obstacle in the path of "Brahmacharya". In the ancient Indian Epic 'Ramayana', Lord Rama's younger brother Laxmana had maintained "Brahmacharya" during his stay with his brother during his 14 years stay in the forest for which he was very powerful (due to preservation of semen) and able to destroy the evil powers. In the same epic, there is a description of "Hanumana", who had also followed the path of "Brahmacharya" and hence considered most powerful.
Ancient Indian textbooks contain a detailed description of sexuality. Vedas, Upanishads, Puranas, Gita, and other religious literatures emphasize the importance of "Brahmacharya".  There are also stories related to normal and abnormal sexuality in these literatures. Some of the literatures like Kamasutra of Vatsayan, Ratishastra, and Kalyanamalla's Ananga Ranga, etc., exclusively focused on sexuality. Ayurveda, Charak Samhita, and Susruta Samhita also describe the value of semen and consequences of semen loss. Ayurveda mentions sexuality and treatment of related issues as a separate subsection as "Vajikarana". , Most ancient literature describes the preciousness of semen. As loss of semen in any other means (nocturnal emission, masturbation and prostitution) was considered as wastage, early marriages were largely promoted to prevent this wastage.
Wall sculptures of Khajuraho, Ajanta, and Sun temple of Konark carries the footprints of sexual eroticism of the ancient era. These erotic sculptures were created in temple walls which was easily accessible by common people helping sex education.
After 10 th century AD, India is attacked and invaded by Afghans, Arabians, and Mughals. During this period, Indian culture was largely influenced by the Islamic thoughts.  Islamic beliefs on semen loss, masturbation and sexuality affected traditional Indian belief system.
After 16 th century AD, incursion of British, French, Dutch, and other foreign invaders brought a lot of changes in Indian culture.  Westernization of Indian culture also affected the beliefs on semen loss and male sexuality. During this period Indian belief system was largely influenced by western thoughts and maximum diversification of cultural beliefs occurred in this period.
In the post independent era, there was a psychiatric movement in India leading to change in the belief system. The beliefs related to semen loss, masturbation became medicalized. This process of medicalization of semen loss is still continuing, though it has started since many decades still a lot of things to be done to solve the myths.
| Concepts of semen loss and dhat syndrome|| |
Vedic and Hindu concepts
"Dhat" is derived from the word "dhatu". The word "Dhatu" is a Sanskrit word which means "Metal" or "Elixir". ,, There is description of seven "Dhatus" [Chyle (Rasa), Blood (Rakta), Flesh (Maans), Fat (Meda), Bone (Asthi), Marrow (Majja), Semen (Veerya)], out of which most important is "Shukra Dhatu (semen)". In Sanskrit, semen is quoted as "Sukra" or "Veerya" . Ancient Vedic literature, believes "Sukra" as the force of life. 
There is description about normal semen in Charaka Samhita and Susruta Samhita as:
(normal semen is crystal like oily, slimy, thick, non-corrosive and sweet with honey-like smell). 
Ancient Hindu mythology believes "Dharma", "Artha", "Kama", and "Moksha" as the basic supports of life. The word "Kama" stands for sexual life. As per Charaka Samhita, excessive indulgence in sexual activities, obstructing ejaculation of semen, sexual intercourse with impassionate women, black magic and overpowering sexual urges may lead to decline in sexual performance. It also emphasizes on dietary, age-related, injury and prolonged illness as other causes of sexual decline.  Charaka Samhita mentions it as below:
Charaka Samhita has depiction of semen loss or loss of semen-like substances in the urine in different names like-Shukrameha (semen in urine), Suklameha (white substance in urine) and Sitameha (sweet and cold urine).  Charaka Samhita also mentions that suppression of natural urges (defecation and urination) are abnormal as it may hamper the natural flow of semen and ejaculation of this obstructed semen lead to tiredness (called as 'Avasadi') which is mentioned  as:
Ayurveda, the most ancient medical literature also gives descriptions about semen loss. Ayurveda mentioned 'semen is derived from marrow which is formed from flesh and blood in stepwise manner'. , Blood is formed from food. Therefore, semen is derived from food in a multistep process of purification and filtration. During each step of this process there occurs forty times condensation and ultimately one drop of semen is formed from 40 drops of bone marrow.  Due to these reasons, semen is considered as highly precious body fluid. It is also mentioned that semen attributes to physical beauty, physical strength (energy) and mental strength (intelligence and memory). Loss of semen leads to loss of happiness, loss of memory and loss of vigor.
Charaka Samhita and Susruta Samhita have also descriptions about semen and semen loss.  Charaka Samhita mentions the significance of semen and also depicts about different medications to boost it up.  As per Charaka Samhita, obstruction of semen (Veeryavarodha) by suppressing the erotic impulses gives rise to loss of libido in long run.  Similarly, loss of semen is described as "Sukra Kshya". Both obstruction of semen and loss of semen over time give rise to impotence (Clibya/Klaibya).  Ayurveda mentions about substances and foods that lead to increase in libido (Aphrodisiacs) and also highlights the foods and behaviors to be avoided in order to prevent loss of semen and impotency. 
Impotency due to loss of semen is mentioned as "Shukra-Kshayaj Klaibya" which can be factually translated as "semen loss related impotency"which is depicted in Charaka Samhita is as below  :
Indian cultural attitude toward semen loss was also depicted in the famous book "Kama Sutra" by Vatsayana (300 A.D.) and it also emphasizes the vital role of semen in keeping the individual healthy. Due to this strong cultural belief semen loss is accompanied with fear and anxiety.  Ayurveda also puts restriction in sexual intercourse during the lifetime of an individual and emphasizes that one should not in frequent sexual intercourses with advancing age as it leads to loss of semen causing decline in vigor and vitality. It is also mentioned that loss of semen predisposes the individual to various diseases and even death. 
Islamic description on sexual dysfunction is quiet similar. In Urdu sexual dysfunction resulting from semen loss (Masturbation or prostitution), premature ejaculation, and impotency is described together as "Mardana Kamzori".  In Islamic textbooks, masturbation (istimna) means self-stimulation of the sexual organ till one achieves emission of semen or orgasm. Masturbation is forbidden in Shi'ah fiqh. Masturbation is considered as a shameful (in Urdu-Haya) offence in Quran. "The believers are. those who protect their sexual organs except from their spouses. Therefore, whosoever seeks more beyond that [in sexual gratification], then they are the transgressors." (Quran; 23:5-6).  Islam believes, formation of semen continues after puberty (Bulugh) and the excess amount of semen formed comes out as nocturnal emission (Ihtlam). Quran depicts that sexual urges develop in an individual after attainment of puberty and suppression of it is harmful so it need to be satisfied through marriage. Another belief why semen loss due to masturbation is more harmful is unlike sexual intercourse, there occurs minimal use of tactile, visual, olfactory, or auditory senses for arousal and it is the psychic stimulation that produces excitement. This psychic excitement results in emotional disturbances and depression. 
Religion and culture strongly affects the public belief system, which applies to Islamic religion also. In Muslims, the sexual myths and beliefs related to semen loss and masturbation are carried forward over generations through traditional healers and being altered in every step. Beliefs related to loss of semen challenge the sexual strength and masculinity in Muslim male-dominated society. 
There is no clearly defined depiction about semen loss in the Buddhist culture. However, the religion strongly discourages sexual promiscuity even raises finger against all sorts of sexual activities and this very reason may be because of fear of semen loss. It is considered by many lay people that 100 drops of blood make one drop of semen.  Masturbation is believed as a destructive sexual practice. Buddhist ethics had recommended a stringent sexual practice and condemns homosexuality, masturbation, sexual acts with inappropriate persons in inappropriate places in inappropriate postures in inappropriate times. 
Loss of semen, even the slightest is considered as a sinful offence. Nocturnal emission is also seen in a defaming view in early Buddhism and it is considered as an obstacle in the path of spiritual progress of monks.  However, Vinayapitaka believe that involuntary loss of semen may it be as nocturnal emission or during defecation and micturition, is not an offence as there minimal involvement of psyche (mind) in these processes. As per this, semen gets released from its original source. There is difference in beliefs regarding the original source of semen, some believe that the original source of semen is at the waist where as another group of Buddhists believe it is not so and the whole body contains semen (Vinayapitaka, 3:112).  Buddhists also believe that semen is the source of energy and is formed from purification of food due these beliefs monks retain their semen (seeds) to have long energetic life. ,
Christianity spread in India during last six centuries. Christian beliefs are derived from western thoughts (brought by British, Dutch, French, and Portuguese traders, later rulers). Biblical depictions are the treasures of Christian belief system. St. Paul was the first person in Christianity who commented on marriage and sexuality. He discouraged sexuality and emphasized to scarify the bodily pleasure. As per St. Augustine, every act of sex reminds the ancient original sin of Adam and Eve, which is carried forward over generations hence he discouraged sexual intercourse coining it a shameful act. 
Orthodox Christians believe masturbation related semen loss as abnormal and consider it as a sin as it hampers the normal procreation by the process of sexual intercourse.  As per Saint Augustine, nocturnal emission is not as sinful as masturbation due to its occurrence in a state of diminished consciousness and involuntariness.  Bible cites nocturnal emission as unhygienic and impure. "When you are encamped against your enemies, then you shall keep yourself from every evil thing. If any man among you becomes unclean because of a nocturnal emission, then he shall go outside the camp. He shall not come inside the camp, but when evening comes, he shall bathe himself in water, and as the sun sets, he may come inside the camp." - Deuteronomy 23:9-11. 
Other popular beliefs
There are some popular beliefs in peoples of different regions of the country regarding semen loss. Majority of such beliefs are culturally colored but altered over generations. In one of the Indian state of Odisha, semen loss is described as "dhatu padiba" or "dhatu kshyaya" which is definite male health concern. , It implicate to thinning of semen and whitish discharge in urine (believed as semen in urine).
Majority of Indian males describe the nocturnal (physiological) ejaculations as pathological and denote it by the name "Swapndosh" .  This word is the assortment of two words "Swapn" means dream and "dosh" means fault. It implicate that the unfulfilled sexual urges of an immoral man gets fulfilled by this means but as it is not culturally sanctioned, it is considered as cult.  Similarly, loss of semen by masturbation is usually described as "hasth-maithun". In Indian context, a popular, strongly held belief about masturbation exists that masturbation is a "bad habit". People think masturbation as an illegal and unnatural way of erotic arousal which leads to loss of semen which in turn leads to thinning of semen and other physical and psychological consequences.  Many people also confuse semen with pre-ejaculatory fluid of normal sexual arousal and attribute their concern to it.  Accessibility to pornographic literature and movies also influences the individual's perception about semen and sexuality which results in physical as well as psychological hazards. ,
| Indian research on beliefs|| |
Malhotra and Wig, in their study (1975)  tried to analyze the culturally colored Indian belief system related to semen loss, on a sample of 175 males and found different beliefs like, semen loss can be cured:
- If people avoid masturbation
- If people avoid bad company or literature with sexual content
- If they marry
- If they modify/change their dietary habit.
Several Indian studies conducted to analyze the belief systems of men regarding semen loss and revealed that most men believe that loss of semen results not only in sexual problems but also non-sexual symptoms. ,,
Prakash and Meena  tried to explain Indian belief through the basis of the anatomy and physiology of penis. They proposed that patients with Dhat syndrome believe that whatever blood is collected in cavernous spaces during erection, probably converts into semen. Hence, with every sexual activity they lose blood, as blood is their source of energy, they lose energy everyday becoming more weak and lethargic.
Traditional healers are highly involved in the publicity, mitigation, distortion and dissemination of the message related to "semen loss anxiety and somatization" in India.  With advancement of science, they have also started spreading the myths through media to multimedia.
| Conclusions|| |
Ancient thoughts and beliefs were structured by the learned and able laureates of that era. Their depictions were definitely valid to educate people and giving shape to sexuality from animosity to humanistic. Indian concepts on semen loss and sexuality are in evolution. Indian culture has a great impact on the perception about semen loss and sexuality. The beliefs are transferred from generation to generation imbibing new thoughts and concepts in due course of time. Whatever strong beliefs possessed by people at present is in an altered form due to hybridization of multiple cultural beliefs, self-made thoughts of traditional healers and modern scientific knowledge. But these beliefs are in a process of change and needs to move in a positive direction.
It is indispensable to know the cultural aspects before approaching the persons with problems related to semen loss (Dhat syndrome) as result of their culturally influenced beliefs. Understanding the culturally imbibed belief systems is important for mental health professionals while treating their clients.
| References|| |
Prakash O, Rao TS. Sexuality research in India: An update. Indian J Psychiatry 2010;52:S260-3.
Avasthi A, Grover S, Kaur R, Prakash O, Kulhara P. Impact of nonorganic erectile dysfunction on spouses: A study from India. J Sex Med 2010;7:3666-74.
Prakash O. Lessons for postgraduate trainees about Dhat syndrome. Indian J Psychiatry 2007;49:208-10.
Wig NN. Problems of mental health in India. J Clin Soc Psychiatry 1960;17:48-53.
Ranjith G, Mohan R. Dhat syndrome as a functional somatic syndrome: Developing a sociosomatic model. Psychiatry 2006;69:142-50.
Chadda RK. Dhat syndrome: Is it a distinct clinical entity? A study of illness behaviour characteristics. Acta Psychiatr Scand 1995;91:136-9.
Chadda RK, Ahuja N. Dhat syndrome. A sex neurosis of the Indian subcontinent. Br J Psychiatr 1990;156:577-9.
Bhatia MS, Malik SC. Dhat syndrome - A useful diagnostic entity in Indian culture. Br J Psychiatry 1991;159:691-5.
Behere PB, Natraj GS. Dhat syndrome: The phenomenology of a culture bound sex neurosis of the orient. Indian J Psychiatry 1984;26:76-8.
Bhatia MS, Bohra N, Malik SC. 'Dhat' syndrome - a useful clinical entity. Indian J Dermatol 1989;34:32-41.
Avasthi A, Kaur R, Prakash O, Banerjee A, Kumar L, Kulhara P. Sexual behavior of married young women: A preliminary study from north India. Indian J Community Med 2008;33:163-7.
Dhikav V, Aggarwal N, Gupta S, Jadhavi R, Singh K. Depression in Dhat syndrome. J Sex Med 2008;5:841-4.
Avasthi A, Gupta N. Manual for standardized management of single males with sexual disorders. Marital and Psychosexual Clinic: Chandigarh; 1997.
Salam KP, Sharma MP, Prakash O. Development of cognitive-behavioral therapy intervention for patients with Dhat syndrome. Indian J Psychiatry 2012;54:367-74.
Asha MR, Hithamani G, Rashmi R, Basavaraj KH, Jagannath Rao KS, Sathyanarayana Rao TS. History, mystery and chemistry of eroticism: Emphasis on sexual health and dysfunction. Indian J Psychiatry 2009;51:141-9.
Burton R, Arbuthnot FF. Translated "The Kamasutra of Vatsyayana". New York: Putnam; 1984. p. 223.
Sumathipala A, Siribaddana SH, Bhugra D. Culture-bound syndromes: The story of dhat syndrome. Br J Psychiatry 2004;184:200-9.
In: Shushruta S, editor. Vaidya Yadavji Tikamji Acharya. Bombay: Nirnaya Sagar Press; 1938.
Money J, Prakasam KS, Joshi VN. Semen-conservation doctrine from ancient ayurvedic to modern sexology theory. Am J Psychother 1991;45:9-13.
Dudhmal A, Mokashi M, Sawant B, Thakur S, Bakre S, Herlekar. Klaibya: Ayurvedic concept of erectile dysfunction. National J Ayur Altern Med 2012;1:157-62.
Bhugra D, Buchanan A. Impotence in ancient Indian texts. Sex Marital Ther 1989;4:87-92.
Akhtar S. Four culture-bound psychiatric syndromes in India. Int J Soc Psychiatry 1988;34:70-4.
Avasthi A, Grover S, Jhirwal OP. Dhat Syndrome: A culture-bound sex related disorder in indian subcontinent. In: Gupta S, Kumar B, editors. Sexually Transmitted Infections. 2 nd
ed. New Delhi: Elsevier; 2012. p. 1225-30.
Byadgi PS. Concept of immunity in Ayurveda. J Appl Pharma Sci 2011;1:21-4.
Hirsh A. Post-coital sperm retrieval could lead to the wider approval of assisted conception by some religions. Hum Reprod 1996;11:245-7.
Rizvi SM. Marriage and Morals in Islam. Islamic Education and Information Centre. Ontario;
Khan N. Dhat syndrome in relation to demographic characteristics. Indian J Psychiatry 2005;47:54-7.
Kuruppuarachchi KA, Wijeratne LT. The continuing story of dhat syndrome. Br J Psychiatry 2004;185:260.
Available from: http://www.berzinarchives.com/web/en/archives/approaching_buddhism/world_today/issues_buddhist_sexual_ethics.html [Last accessed on 2012 Dec 15].
Faure B. The Red Thread: Buddhist Approaches to Sexuality. Princeton: Princeton University Press; 1998. p. 86.
Powers J. A bull of a man: Images of masculinity, sex, and the body in Indian Buddhism Cambridge: Harvard University Press;
Olson C. The different paths of Buddhism: A narrative-historical introduction. New Brunswick: Rutgers University Press;
The Western Sexual Morality. Available from: http://www.al-islam.org/m_morals/chap1.htm [Last accessed on 2012 Dec 15].
Available from: http://www.experiencefestival.com/a/Nocturnal_emission/id/1998917 [Last accessed on 2012 Dec 15].
Collumbien M, Hawkes S. Missing men's messages: Does the reproductive health approach respond to men's sexual health needs? Cult Health Sex 2000;2:135-50.
Khan SI, Hudson-Rodd N, Saggers S, Bhuiyan MI, Bhuiya A, Karim SA, et al
. 'Semen contains vitality and heredity, not germs': Seminal discourse in the AIDS era. J Health Popul Nutr 2006;24:426-37.
Verma RK, Sharma S, Rangaiyan KG, Singh R, Pelto PJ. Beliefs concerning sexual health problems and treatment seeking among men in an Indian slum community. Cult Health Sex 2003;3:165-73.
Lakhani A, Gandhi K, Collumbien M. Addressing semen loss concerns: Towards culturally appropriate HIV/AIDS interventions in Gujarat, India. Reprod Health Matters 2001;9:49-59.
Malhotra HK, Wig NN. Dhat syndrome: A culture-bound sex neurosis in the Orient. Arch Sex Behav 1975;4:519-28.
Verma RK, Rangaiyan KG, Singh R, Sharma S, Pelto PJ. A study of male sexual health problems in a Mumbai slum population. Cult Health Sex 2001;3:339-52.
Bhatia MS, Choudhary S. Dhat symptoms - Culture bound sex neurosis. Indian J Med Sci 1998;52:30-5.
Prakash O, Meena K. Association between Dhat and loss of energy: A possible psychopathology and psychotherapy. Med Hypotheses 2008;70:898-9.
Paris A. Dhat syndrome: A review. Transcult Psychiatr Rev 1992;29:109-18.
Dr. Om Prakash
Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi - 110 095
Source of Support: None, Conflict of Interest: None