I read Sumathipala et al's (Reference Sumathipala, Siribaddana and Bhugra2004) review on dhat syndrome with interest. The authors’ contention is that dhat syndrome is not culture-bound. My argument is although dhat is globally prevalent, the specificity of the culture (Ayurvedic concept) and certain psychosocial features being pathogenic in the development of dhat syndrome in the south Asian context cannot be ignored and the essence of the cultural perspective of ‘semen loss anxiety’ in different geographical areas has been misunderstood.

According to the traditional Indian Ayurvedic system of medicine, genital secretions are considered a highly purified form of dhatu, or bodily substance, and loss of this precious substance is thought to result in progressive weakness or even death. In south Asia, the complaint of loss of genital secretions is regarded with concern by both men and women. The cultural and biomedical meanings of the complaint of leucorrhoea in south Asian women (Reference KarenKaren, 2001) demonstrate that the complaint of vaginal discharge accompanied by a host of somatic symptoms could not fit a particular biomedical diagnostic category, and is understood within the ethno-medical context of Ayurveda.

As noted by Malhotra & Wig (Reference Malhotra and Wig1975), Asian culture condemns all types of orgasm because they involve semen loss and are therefore ‘dangerous’. In contrast, the Judaeo-Christian cultures of the 18th and 19th centuries in Europe considered most types of sexual activities outside marriage to be ‘sinful’.

The so-called culture-bound syndromes have been the focus of the debate between adherents of biopsychological universalism (universal human psychopathology) and adherents of an ethnological cultural relativism (typical aspects of a particular culture). Culture-bound syndrome is not always bound (Reference Westermeyer and JancaWestermeyer & Janca, 1997) but heavily related to certain cultural traits or cultural factors that can be found in different geographical areas, or across ethnicity or cultural units or systems, which share the common cultural view, attitude or elements attributed to the formation of the specific syndromes. Based on this new understanding, the term should be changed to ‘culture-related specific syndrome’ to reflect its nature accurately (Reference Tseng and McDermottTseng & McDermott, 1981).