Is Semen Loss Syndrome a Psychological or Physical Illness? A Case for Conflict of Interest
A 24-year-old male, unmarried, agricultural worker by occupation and without any drug habits had come with complaint of erectile dysfunction and depressive symptoms secondary to that. These complaints started around 4 months back, when his father was looking for a bride. Prior to this, he reported never having had sexual ideas and his friends tried to give him advice on how to show sexual prowess to a woman on her first night. That night when he went to sleep he felt some shadow crawling over his body and he had spontaneous ejaculation. This was first time such thing had happened to him. His father reassured him that night. Next two nights also he had spontaneous ejaculation at night and this terrified the patient that all his semen may have drained out and consequently, his ability to impregnate a woman and his energy to carry out physical work had been depleted significantly. His friends had advised him to masturbate and told him to continue the technique to get semen out at least once a month. To his dismay, he found that he was unable to do as there was ‘no rigidity’ in the penis. When questioned about the nature and importance of semen, he said that semen is important for producing children and having a family but added that he had no idea where it came from. He consulted a Siddha practitioner for his problems and was told that if semen was not coming out through its proper channel, it would fill other body fluids and also come out in the saliva. That doctor took sample of saliva in small bottles and told the patient that after testing he had come to the conclusion that they are containing sperms. Along with this presumed ‘imbalance in bodily fluids’, he had developed depressive symptoms secondary to semen loss when he presented to us and had attempted suicide once during this period.\nAfter evaluation, he was admitted as a case of severe depressive disorder. During ward stay and with various treatments there was improvement in biological functions and consultations also revealed acute gastritis for which he was treated adequately. He continued to believe that semen is coming out through saliva. By its taste and smell he was able to confirm what the previous Siddha doctor had told him. Few weeks later, he observed that the size of his penis had shrunken and corroborated this observation by taking his measurements. He began to worry about how he was going to live without his own family and how he would become a laughing stock among people for losing his ‘maleness’ or ability to impregnate a woman. He also worried about earning his livelihood by farming due to accompanying weakness.\nDuring assessment we found that he has hypolibidinal state prior to onset of these problems. There were no local pathology and sex hormone study and thyroid function tests did not show any abnormalities.