Academic journal article Journal of Health Population and Nutrition

'Semen Contains Vitality and Heredity, Not Germs': Seminal Discourse in the AIDS Era

Academic journal article Journal of Health Population and Nutrition

'Semen Contains Vitality and Heredity, Not Germs': Seminal Discourse in the AIDS Era

Article excerpt

INTRODUCTION

Dominating perspectives of public health often ignore cultural meanings of sexual health concerns, such as semen loss, and mainly work to prevent sexually transmitted infections (STIs)/HIV in the framework of disease and death. Traditional health practitioners deal with psychosexual health concerns of men but their treatments are often considered inappropriate by dominant doctrines of biomedical science. Ultimately, men are trapped and puzzled about how to get access to appropriate information and treatment options.

In the changing paradigm of reproductive and sexual health, non-STI sexual health concerns of men cannot be ignored as their 'personal' or 'psychological' problems. The sociocultural meanings of non-STI sexual health problems of men have received little attention with some notable exceptions in South Asia and elsewhere (1-5) In South Asian countries, researchers have demonstrated that men are worried about semen loss and other non-STI sexual health problems (1,2, 4-9). Studies revealed similar concerns of non-STI sexual health anxieties among European and American male populations (3,10). 'Western' biomedical scientists have investigated psychosexual problems in clinical settings (11,12) but have ignored the social aspects of these problems (13).

In the Indian state of Orissa, a major male concern reported was dhatu padiba, the passage of 'white discharge' (perceived as semen) through urination and defaecation due to 'thinning of semen' (1). About two-thirds of Muslim slum dwellers in Mumbai, India, reported wasting of semen in the form of 'white discharge' through nocturnal emission, urination, or defaecation (5). These men believed that reduced quantity and thinning of semen led to kamjori (sexual weakness), a serious health problem.

A population-based survey of prevalence of STIs conducted in Matlab, a rural area of Bangladesh, revealed a low prevalence of STIs among men but the prevalence of psychosexual problems was comparatively higher (1). The survey reported that 17% of men suffered from psychosexual problems, including premature ejaculation, impotence, 'dissatisfaction' with sexual intercourse, difficulties in maintaining an erection, and nocturnal emissions. During the first year of the establishment of male sexual health clinics at Matlab, 41.5% of adult men attended the clinic with psychosexual problems reflecting similarities to that of the Indian context (14).

As in other South Asian countries, in Bangladesh, neither the public nor the private modern health sector accords importance to non-STI sexual health concerns of men, and consequently they have not been incorporated into service priorities. This results in missed opportunities to access men practising risky behaviours and to render appropriate services to improve the quality of sexual and reproductive health of men (and women).

This paper offers deeper meanings of semen loss and related concerns of Bangladeshi men and analyzes findings in the broader context of a sociocultural and masculinity framework with an expectation that policy planners and programme managers will re-visit the current paradigm and re-design STI interventions to interact with culture-bound concerns of men about semen loss.

The context: men, semen, and sociomedical history

The importance of semen is deeply rooted in the historical and sociocultural belief system of the Indian subcontinent. Results of studies of the Indian context suggest that men consider that semen loss often leads to both sexual and non-sexual health problems (2,4-7,15-22). The complaint of 'whitish discharge' as semen has questionable scientific corroboration (23). Researchers have described it as a culture-bound syndrome, specifically named as dhat syndrome in the Indian sub-continent (6,7,15,16,20-22). The dhat syndrome has been incorporated in Annex 2 (Culture-specific disorders) of the ICD-10 Diagnostic Criteria for Research (24). …

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