Somatization misattributed to non-pathological vaginal discharge

doi:10.1016/0022-3999(93)90051-G

Journal of Psychosomatic Research

Volume 37, Issue 6, September 1993, Pages 575-579

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Abstract

Lay explanations and attributional patterns about somatization related to vaginal discharge, a folk illness characterized by undue concern about passing (normal) vaginal discharge and believing that their symptoms are caused by this, were surveyed systematically in 200 consecutive women patients with predominant somatic complaints and 138 normal healthy women. Misattribution was reported 3.5 times more often by women with somatic complaints as compared to the normal women. Sixteen women were absolutely certain that their discharge was totally responsible for their symptoms and illness. Thus, somatization related to vaginal discharge seems to be a frequent undetected problem in women with somatic symptoms.

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Cited by (26)

A qualitative study on psychopathology of dhat syndrome in men: Implications for classification of disorders

2018, Asian Journal of Psychiatry

Citation Excerpt :

It has been described in patients from varied religious backgrounds (Bhatia and Malik, 1991). Studies on female patients report that 32% of psychiatric and 13% of non-psychiatric (gynaecological) outpatients attributed somatic symptoms to non-pathological vaginal discharge (Singh et al., 2001; Chaturvedi et al., 1993; Chaturvedi, 1988). Patients with Dhat syndrome typically present with vague somatic symptoms, weakness, lethargy, anxiety, loss of appetite and sleep, multiple body pains, sexual dysfunction, guilt and many other symptoms (Singh, 1985).

Dhat syndrome is regarded by many as a culture bound syndrome of the Indian sub-continent. However the nosological status, conceptual understanding of the condition as well as the diagnostic guidelines are all mired in controversy.

The current study aims to study the psychopathology of Dhat syndrome in men by using a qualitative approach and to arrive at an operational definition for diagnosing Dhat syndrome.

The qualitative approach consisted of five Focus Group Discussions (FGD) and five Key Individual Interviews (KII) with participants, consisting of patients as well as doctors – both allopathic as well as traditional.

Detailed analysis revealed valuable data regarding the symptoms, causes, treatment measures, socio-cultural context, psychiatric co-morbidity, nature of the disorder and various other phenomenological dimensions. Ideas for future nosological positioning were also specifically looked for. Operational definition and diagnostic guidelines were also arrived at based on the analysis as well as on previous literature.

Although lot of agreement existed among various stakeholders about symptoms and presentation, they varied significantly in their opinion on nature of the condition and treatment. Suggestions for ICD 11 have been made.
The psychological and social contexts of complaints of abnormal vaginal discharge: A study of illness narratives in India

2008, Journal of Psychosomatic Research

Citation Excerpt :

Those studies raised complex questions concerning the reasons why women in such large numbers complain of AVD. Studies in clinical settings have demonstrated associations between gynecological symptoms and social and psychological factors [11,12]; furthermore, a number of qualitative studies have indicated that women often associate their complaints of vaginal discharge with tiredness and other somatic experiences [13,14]. We have recently completed a population-based cohort study of the relationship between psychosocial factors, RTIs, and gynecological morbidity in Goa, India.

Epidemiological studies have reported strong associations between psychosocial adversity and complaints of abnormal vaginal discharge (AVD) in South Asia. We aimed to explore the mechanism of these associations through qualitative research.

We carried out serial in-depth interviews with 42 married women with the complaint of AVD who were purposively selected from a sample of 2494 women recruited into a population-based cohort study in Goa, India. The interviews elicited illness narratives of their complaint, focusing on causal attributions and help-seeking behaviors.

Women explicitly link their personal experiences of social adversity and stress (such as marital problems and heavy workloads) with their complaints of AVD. The complaint of tiredness, a core feature of depressive and somatoform disorders, and complaint of “tension” were commonly associated with AVD through bidirectional causal interpretations. Reproductive events, particularly related to the menstrual cycle and contraception, comprise another set of causal attributions. Many women hold multiple causal attributions. Most women sought health care, both biomedical and traditional, and their narratives indicate reinforcement of their causal attributions by health care providers. However, treatments were often discontinued or changed due to lack of symptomatic relief, side effects, or costs.

Reproductive health policy and practice must explicitly acknowledge and integrate research findings on psychosocial associations of AVD to promote a holistic and evidence-based approach for this common complaint in women in South Asia.
The explanatory models of depression in low income countries: Listening to women in India

2007, Journal of Affective Disorders

Women, and persons facing social and economic disadvantage, are at greater risk for depressive disorders. Our objective was to describe the explanatory models of illness in depressed women, in particular, their idioms of distress, and their views of their social circumstances and how this related to their illness.

We carried out a qualitative investigation nested in a population based cohort study of women's mental and reproductive health in Goa, India. We purposively sampled women who were ever-married and who had been found to be suffering from a depressive disorder on the basis of a structured diagnostic interview. In-depth interviews were carried out about six months apart exploring stressors in women's lives, a typical day in their recent lives, and their illness narratives (idioms of distress, causal models, impact of illness, help-seeking).

35 women consented to participate in the study, 28 completing both interviews. Women gave expression to their problems primarily through somatic complaints, typically a variety of body aches, autonomic symptoms, gynecological symptoms and sleep problems. There was frequent mention of overall “weakness” and tiredness. Economic difficulties and difficulties with interpersonal relationships (particularly related to marital relationships) were the most common causal models. However, women rarely considered biomedical concepts, for example, the notion that they may suffer from an illness or that their complaints were due to a biochemical disturbance in the brain. Despite the lack of a biomedical concept, most of the participants had sought medical help, typically for reproductive and somatic complaints.

We recommend the use of somatic idioms as the defining clinical features, and a broader, psychosocial model for understanding the aetiology and conceptualization of the clinical syndrome of depression for public health interventions and mental health promotion in the Indian context.
The vaginitis monologues: Women's experiences of vaginal complaints in a primary care setting

2003, Social Science and Medicine

Vaginal complaints are a common presenting problem in primary care settings. A disease model has dominated current research and treatment paradigms, with little attention to the illness or experiential dimensions of vaginal complaints. In this paper, we report data from a qualitative study of the experiences of women diagnosed with vaginitis. In semi-structured interviews with 44 women in New York City, United States, we investigated women's interpretations and explanations of their illness, their accounts of its impact on their lives, their experiences with treatment, and the role of vaginal symptoms in communicating distress and anger. We found that women's explanations of vaginal complaints differed strikingly from the current medical model described in the literature on vaginitis. Vaginal symptoms often occasioned extreme anxiety; their impact on social and sexual functioning could be severe. Finally, vaginal symptoms often functioned to express distress and gender conflict. These findings have important implications for the management of the disorder.
Mental health matters too: Gynaecological symptoms and depression in South Asia

1999, Reproductive Health Matters

The intersection of reproductive and mental health, though extensively studied in developed countries, has rarely been researched in developing countries, particularly in South Asia. This article examines the intersection of gynaecological symptoms and depression, focusing on the South Asian region. Depression is one of the most common and most disabling disorders worldwide. This article reviews the evidence of the high prevalence of depression in women in South Asia. Gynaecological symptoms, in terms of self-reported complaints such as vaginal discharge, are among the most commonly cited health problems in women in South Asia. Although much earlier research assumed this symptom to be indicative of reproductive tract infections, recent studies show considerable discordance between symptoms and actual disease. Depression typically presents in the form of medically unexplained physical symptoms. Rates of depression are high in women attending gynaecological clinics and qualitative studies demonstrate a strong relationship between vaginal discharge, weakness, psychosomatic symptoms and psychosocial stress. Part of the aetiology of ‘medically unexplained’ vaginal discharge may be that it is a somatic idiom for depression and psychosocial distress. We therefore call for the development of more flexible models of reproductive health care and research which incorporate both physical symptoms and their psychosocial contexts.

L'intersection de la santé genesique et mentale, bien qu'elle ait été abondamment étudiéé dans les pays développés, a rarement fait l'objet de recherches dans les pays en développement, particulièrement en Asie du Sud. Cet article examine l'intersection des symptomes gynécologiques et de la depression, principalement en Asie du Sud. La depression est Fun des troubles les plus frequents et les plus invalidants dans le monde. L'article montre que la depression est fréquente chez les femmes en Asie du Sud. Les symptômes gynécologiques, du point de vue des troubles signalés par les patientes elles-mêmes, par exemple les pertes vaginales, sont parmi les problèmes de santé les plus souvent cites chez les femmes d'Asie du Sud. Des recherches plus anciennes supposaient que ce symptôme dénotait des infections de l'appareil reproducteur, mais des études récentes montrent des discordances considérables entre les symptomes et la maladie réelle. La depression se présente de manière classique sous la forme de symptomes physiques inexpliqués par la médecine. Les taux de depression sont élevés chez les femmes fréquentant les dispensaires gynécologiques et les etudes qualitatives démontrent une forte relation entre les pertes vaginales, la faiblesse, les symptomes psychosomatiques et les tensions psychosociales. Il est possible qu'une partie de l'étiologie des pertes vaginales “sans explication médicale” soit une expression somatique de la depression et la détresse psychosociale. Nous demandons donc la mise au point de modélos de soins de santé génésique plus souples qui incluent aussi bien les symptômes physiques que leurs contextes psychosociaux.

Poco se ha investigado la intersección de la salud reproductiva con la salud mental en los países en desarrollo, particularmente en el Asia Meridional. Este articulo examina la intersección de los síntomas ginecológicos con la depresión, con enfoque en la región del Asia Meridional. Este artículo revisa los indicios de una alta prevalencia de depresión en mujeres en el Asia Meridional. Los sintomas ginecológicos, tales como el flujo vaginal que son reconocidos por las mujeres mismas, están entre los problemas de salud de la mujer más citados en dicha región. Al contrario de investigaciones anteriores que relacionaron este sintoma con infecciones del aparato reproductor, estudios más recientes revelan una discordancia considerable entre los síntomas y le enfermedad. La depresión típicamente se presenta como sintomas físicos que carecen de una explicatión médica. La incidencia de depresión es alta en mujeres que se atienden en clínicas ginecológicos, y estudios cualitativos demuestran una fuerte relación entre el flujo vaginal, la debilidad, lso síntomas sicosomáticos y la tensión sicosocial. El flujo vaginal podría ser una señal somática de depresión y angustia sicosocial. Podemos, por lo tanto, hacer un llamado a la creación de modelos de atención en salud reproductiva más flexibles que incorporan tanto los síntomas físicos sus contextos sicosociales.
Weeping wombs: Leucorrhea and the chronicity of distress in Gilgit-Baltistan

2023, Anthropology and Medicine

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Somatization misattributed to non-pathological vaginal discharge

Abstract

Psychesthenic syndrome related to leukorrhoea in Indian women

J Psychosom Obstet Gynecol

Dhat Syndrome: a culture bound sex neurosis of the Orient

Arch Sexual Behav

Psychiatry in South East Asia

Br J Psychiatry