Evaluation of the efficacy of novel treatment strategy to treat Dhat syndrome: a pilot study.

Abstract

Background: Dhat Syndrome is difficult to treat due to the unwavering belief of the patients about the harmful effects of semen loss. We hypothesized that this belief can be overcome by objective demonstration of zero health benefit of zero semen loss using reversible anejaculation property of silodosin.

Aim: To prospectively evaluate the efficacy of objective demonstration of zero health benefits of zero semen loss as treatment strategy to alter the mental construct of the Dhat syndrome patients using a randomized double blind placebo controlled two arm switchover study design.

Methods: The patients with complaints of Dhat syndrome were recruited post-confirmation of the diagnosis by Dhat Syndrome Evaluation Questionnaire (DSEQ). After excluding participants based on exclusion criteria, participants' anxiety and perceived physical fitness was assessed using Hamilton Anxiety Rating Scale (HARS) and Perceived Physical Fitness Scale (PPFS) respectively. They were randomized into two groups with Group 1 receiving placebo and Group 2 receiving silodosin 8 mg respectively with counseling being common for both. After 2 months, and a drug wash out period of 7 days, the participants were switched and interventions continued for another two months. In the end, Dhat symptomatology with DSEQ, anxiety with HARS and perceived physical fitness with PPFS were assessed and compared with initial assessment and discussed with the participants in a one to one session. Main outcome measure: The post-intervention change in Dhat Syndrome symptomatology in our study participants.

Results: A total of 32 adult males grouped as 1 (N = 18, mean age 28.9 ± 4.8 years) and 2 (N = 14, mean age 27.4 ± 4.3 years) participated in the study with none and 59% reporting semen loss while on silodosin and placebo respectively. The PPFS showed no statistically significant difference irrespective of the type of treatment in our participants and approximately 2/3rds of the participants reported relief from Dhat symptomatology and significant reduction in anxiety related to semen loss.

Clinical implications: Objective demonstration of zero health benefits of total prevention of semen loss to the patients of Dhat syndrome directly contradicts the unwavering belief about the harmful effects of semen loss in these patients thus altering their mental constructs.

Strengths and limitations: Prospective randomization design and objective demonstration of zero health benefits of zero semen loss are the strengths and the small sample size is the limitation of the study.

Conclusions: The alteration of the mental construct of the Dhat syndrome patients using novel treatment strategy was successful in majority of our study participants.