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DHAAT - MALE LEUCORRHOEA

Navin Mody
Head for Centre for Health and Sex Education (regd as trust), C/o Holy Cross Hospital).


Analysis of a number of patients complaining of loss of dhatu in urine reveals the peculiar stereotype nature of this pseudo iatrogenic clinical syndrome which is unfortunately fairly common and is perceived as a very serious disorder in our country by patients. Actually the disease is nothing more than a curable ‘neurosis’.

INTRODUCTION

It happens only in India that male patients complain of passing or losing ‘Dhaat’ in urine. [1] The word is used for passing whitish sticky substance in the urine. Few differentiate it from semen while majority of them consider it as a thinned out, water like semen.

CLINICAL FEATURES

Patients vary from young unmarried boys (educated and uneducated alike) to married middle aged male usually hailing from North India, Maharashtra and Bengal. Often they belong to lower or lower middle class society.

A ‘typical’ patient usually complains in a very depressed low voice about passing of ‘Dhaat’ in urine, often 1-2 drops at beginning or post urination. Often he reports that he loses few drops especially while defaecating.

On direct questioning or detailed history taking he would ‘reveal’ that it also comes out on seeing sexual movies/scenes/thoughts or touching or even talking sometimes to person of opposite sex.

Most of them are dead sure that what they have been losing is thinned out semen that is so much vital to life. While others who are not sure about it as semen, too are worried that it might be something precious substance they are losing which would be detrimental to their physical and sexual health.

Further he would blame this dhaat loss to be the sole cause for his generalized body weakness, fatigue at work, sunken eye balls, dark circles around eyes, loss of appetite, yellow urine, mild burning in urine, ‘hot urine’, premature ejaculation, impotence or erectile dysfunctions, angulation of penis, thin bony’ body built, small (reduction) in penile size etc. After narrating above history he would most probably plead you or even touch your feet saying that doctor, please save me"!

Physical examination

It is unnecessary but should be done for patient satisfaction and to detect incidental problems like varicocele, tunicovaginal hydrocele, sore on penis, etc.

The entire symptoms mentioned above is a fairly common and consistent finding in most or almost all the patients and hence should be scientifically considered as ‘syndrome’ - to be precise as a ‘Dhaat syndrome’.

Investigation

The diagnosis is 100% clinical on history taking alone. I’ve never ordered any investigation for my patients.

In my opinion lab investigations should be contraindicated in this ‘disease’ since unintelligent reporting or inference from reports would lead to further unnecessary investigations and treatments. [1]

We have had patients at our centre who had already undergone investigations like cystoscopy and IV urography for some complaints at other hospitals. [1]

Differential Diagnosis : Though diagnosis is easily made on history alone. If you want to be doubly safe go ahead with following office tests.

 a) 3 Glass urine tests
First glass shows ‘threads’ in majority of cases of prostatitis. [2]

b) Look for pus discharge from urethra on ‘milking’ penis, H/o exposure and persistence of burning micturition which is much more in severity than what patient of dhaat syndrome complains is enough to rule out acute gonococcal urethritis (AGU) or non sp. Urethritis (NSU)

DISCUSSION

Semen is associated with a lot of myths in our country, which compounded by ignorance about human sexuality give rise to a number of complaints making a person almost ‘neurotic’. The presentation is so uniform and stereotype in most patients that it is not inappropriate to consider it as a syndrome. I personally prefer to label it as ‘Dhaat Syndrome’ ‘Dhaat - Male leucorrhea’ used by some authors[1] is a synonym.

It is clear from history that the thing that comes out is not semen. Scientifically, it is likely to be secretions of accessory sexual glands[3] namely

a) Bulbourethral or Cowper’s glands
b) Glands of littre

The secretions are often called ‘precome’ precoital fluid. Although these secretions usually precede ejaculation they may contain sperms[4] (which form basis for calling it the semen by some doctors who order microscopy of these secretions!).

Many people still consider advt. as authentic and become vulnerable to exploitation. Besides I have found following to be the cause of this ever alive sexual problem in India :-

TREATMENT

There is no "pill" which can cure the patient. I’ve almost always prescribed tab. Alprazolam 0.25 mg 1 HSOD for one week only just to buy time to give the proper treatment i.e. sex education. It requires a bit of special skill to gradually give sex education to patient so that at the end of sessions he himself should question, which means he does not have any disease" How to do it is out of scope of this paper.

REFERENCES
  1. Kapoor OP. Dhaat - Male leucorrhoea - As seen in modern perspective. Bombay Hospital Journal 1998; 40 (2) : 280.
  2. Baily and love : - short practice of surgery. 1988; 1.
  3. Montague Drogi K. Disorders of male sexual functions, Year Book Publisher. OHIO 67.
  4. Punthaki Dhun Education in human sexuality. FPAI 1993; 253.


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