Article

Socio-cultural, psychosexual and biomedical factors associated with genital symptoms experienced by men in rural India

London School of Hygiene and Tropical Medicine, UK.
Tropical Medicine & International Health (Impact Factor: 2.33). 04/2008; 13(3):384-95. DOI: 10.1111/j.1365-3156.2008.02013.x
Source: PubMed

ABSTRACT

Biomedical, anthropological and psychiatric frameworks have been used to research different elements of men’s sexual health – sexually transmitted infections, psychosexual concerns and psychological distress – but rarely within the same study. We combined these in a study in rural north India. In Tehri Garhwal and Agra districts, we explored male perceptions of genital and sexual symptoms through focus group discussions and then conducted a clinic-based survey of 366 symptomatic men who presented at rural private provider clinics. Men’s urine specimens were tested for gonorrhoea and chlamydia infection using polymerase chain reaction techniques. Researchers screened them for probable psychological distress by administering the General Health Questionnaire (12- items). Results revealed that local and traditional notions of health influenced men’s symptom perceptions, with semen loss their predominant concern. Dhat, commonly perceived as an involuntary semen loss, corresponded most closely with the symptom of urethral discharge, but was attributed mainly to non-infectious causes. It could also manifest as a syndrome with physical weakness and mental lethargy. FGD participants lacked correct and complete information on reproductive health. Around 75% of the symptomatic men presented with dhat, but only 5.5% tested positive for gonorrhoea or chlamydia. Application of syndromic sexually transmitted infection (STI) guidelines in these settings could result in over diagnosis and over treatment with antibiotics. In contrast, there was a significant association between dhat and probable psychological distress as detected by the GHQ (Adjusted OR, GHQ case positive: 2.66, 95% CI: 1.51–4.68). Our study confirms the existence of a dhat syndrome in rural India, which is culturally influenced and reflects heightened psychosexual concerns as well as mental distress states. Comprehensive health services for men should include assessments of their psychosexual needs and be supported by reproductive/sexual health education. STI treatment guidelines for urethral symptoms should be revised and be based on epidemiological data.
Des cadres d’études biomédicaux, anthropologiques et psychiatriques ont été utilisés pour rechercher différents éléments en matière de santé sexuelle des hommes: infections sexuellement transmises, préoccupations psychosexuelles et détresse psychologique. Mais ces cadres ont été rarement combinés au sein de la même étude. Nous les avons combiné dans une étude en zone rurale dans le nord de l’Inde. Dans les districts de Tehri Garhwal et Agra nous avons exploré les perceptions des hommes sur les organes génitaux et les symptômes sexuels par le biais de discussion focalisée de groupe (DFG). Puis avons procédéà une enquête clinique sur 366 hommes symptomatiques qui se sont présentés dans des cliniques rurales de pourvoyeurs de soins privés. Des échantillons d’urine ont été testés pour les infections gonorrhéennes et chlamydiennes à l’aide de techniques de la réaction en chaîne de la polymérase. Ces individus ont été consultés par les chercheurs pour de probables détresses psychologiques par le biais du Questionnaire de Santé Générale (QSG) basé sur 12 points. Les résultats ont révélé que les notions traditionnelles locales et de collectivités sur la santé influencent les perceptions des hommes sur les symptômes, avec les pertes de sperme étant la préoccupation prédominante. Le “dhat”, communément perçu comme une perte involontaire de sperme, correspondait le plus étroitement au symptôme de décharge urétrale, mais était imputé principalement à des causes non infectieuses. Il se manifesterait également comme un syndrome incluant la faiblesse physique et la léthargie mentale. Les participants au DFG n’ont pas généré des informations correctes et complètes sur la santé reproductive. Environ 75% des hommes symptomatiques présentaient le dhat, mais seuls 5,5% avaient des résultats positifs pour la gonorrhée ou le chlamydia. L’application des directives syndromiques pour les IST dans ces endroits pourrait entraîner un surdiagnostic et un surtraitement avec des antibiotiques. En revanche, il existait une association significative entre le dhat et la probable détresse psychologique tel que détectée par le QSG (OR ajusté, cas positif QSG: 2,66; IC95%: 1,51–4,68). Notre étude confirme l’existence du syndrome du dhat dans l’Inde rurale, qui est culturellement influencé et reflète des préoccupations psychosexuelles accrues ainsi que des états de détresse mentale. Les services détaillés de santé pour les hommes devraient inclure des évaluations sur leurs besoins psychosexuels et être appuyés par une éducation sur la santé reproductive/sexuelle. Les directives de traitement des IST basées sur les symptômes urétraux devraient être révisées et basées sur des données épidémiologiques.
Se han utilizado marcos biomédicos, antropológicos y psiquiátricos para investigar sobre los diferentes elementos de la salud sexual masculina – infecciones de transmisión sexual, preocupaciones psicosexuales y distrés psicológico, pero raramente dentro del mismo estudio. Las hemos combinado en un estudio en una zona rural del norte de India. En los distritos Tehri Garhwal y Agra hemos explorado las percepciones masculinas sobre los síntomas genitales y sexuales mediante discusiones focalizadas en grupo (DFG) y luego conducidas en un estudio basado en una clínica de 366 hombres sintomáticos que se presentaron en clínicas rurales privadas. Se examinaron los especimenes de orina de los hombres para infección por gonorrea y clamidia mediante técnicas basadas en PCR. Los investigadores evaluaron un posible distrés psicológico mediante administración de un Cuestionario General de Salud (12-items). Los resultados revelaron que las nociones locales y tradicionales de salud influenciaban las percepciones de los síntomas de los hombres, siendo una pérdida de semen su principal preocupación. Dhat, comúnmente percibido como una pérdida involuntaria de semen, correspondía de forma más cercana con el síntoma de descarga uretral, pero era principalmente atribuida a causas no infecciosas. También podía manifestarse como un síndrome incluyendo debilidad física y letargo mental. Los participantes de DFG no tenían información completa ni correcta sobre salud reproductiva. Alrededor del 75% de los hombres sintomáticos presentaban dhat, pero solo un 5.5% eran positivos para gonorrea o clamidia. El aplicar las guías de vigilancia sindrómica de ETS en estos lugares podría resultar en el sobre diagnóstico y sobre tratamiento con antibióticos. En contraste, había una asociación significativa entre dhat y un probable distrés psicológico detectado por las DFG (Adjusted OR, GHQ caso positivo: 2.66, 95% CI: 1.51–4.68). Nuestro estudio confirma la existencia del síndrome de dhat en India rural, la cual está culturalmente influenciada y refleja un aumento en preocupaciones psicosexuales al igual que estados de distrés mental. Unos servicios sanitarios completos para hombres deberían incluir evaluaciones de sus necesidades psicosexuales y ser apoyados con una ecuación sexual y reproductiva. Las guías de tratamiento de los síntomas uretrales de ETS deberían revisarse y basarse en datos epidemiológicos.

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    • "Possible symptoms of STI (genital sores and painful urination) were associated with CMD. A qualitative study among rural Indian men found that genital symptoms (most commonly abnormal discharge) had associations with 'bad habits' such as drinking alcohol and watching pornographic films and that these went against Indian virtues of purity and self-control (Gautham et al. 2008). These conceptualisations may be associated with thoughts and feelings of guilt, shame and self-blame that are characteristics of depression. "
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    ABSTRACT: page/terms-and-conditions This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
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