Moment: How Doctors Profit Off Shame | Dhat Syndrome ft. Dr. Cuterus

Summary

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Podcast Summary

Podcast: Rena Malik, MD Podcast
Episode: Moment: How Doctors Profit Off Shame | Dhat Syndrome ft. Dr. Cuterus
Host: Dr. Rena Malik
Guest: Dr. Taneya Narendra (Dr. Cuterus)
Date: March 12, 2025

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Episode Overview

In this candid and insightful episode, Dr. Rena Malik joins forces with Dr. Taneya Narendra (widely known as Dr. Cuterus) to unpack Dhat Syndrome—a culturally-bound condition prevalent in South Asia. They explore how shame, misinformation, and medical misdiagnosis around sexuality and masturbation can lead to significant psychological harm, especially for young men. The discussion also covers the stigma around sexual health in India, the dangers of alternative medicine practices, and practical advice for building healthy sexual self-awareness and seeking appropriate care.

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Key Discussion Points & Insights

1. What is Dhat Syndrome?

• [00:03] Dr. Narendra explains:
  • Dhat syndrome is a loosely defined collection of mental and physical symptoms (depression, tremors, difficulty concentrating, etc.), culturally linked to masturbation and semen loss.
  • The syndrome’s boundaries are vague: “Anything and everything can be that syndrome.”
• Comparison to female “hysteria”: Historically, both are “catch-all” diagnoses for poorly understood symptoms.
• Critique: This diagnosis is often used by alternative medicine practitioners in India, conflating beliefs with science and legitimizing harmful pseudoscience.

“It’s kind of like the equivalent of what hysteria used to be in the olden times for women. Anything and everything can be that syndrome.”
— Dr. Narendra [00:56]

2. Harmful Effects of Shame and Misinformation

• Mental Health Impact:
  • Instills deep-seated shame around normal sexual behavior, especially masturbation.
  • Example: A young man practicing semen retention became so anxious about nocturnal emissions that he developed physical symptoms (stress, high BP, overeating).
• Cycle of Pseudo-Validation:
  • Both traditional and alternative practitioners perpetuate the belief that “losing semen is bad and it'll lead to ill health.”
  • This can escalate into chronic stress and traumatic health loops.

“He had gotten to the point of no return… he was so entrenched in this idea that losing semen is bad. And that is the essence of that syndrome.”
— Dr. Narendra [02:53]

3. Dangers of Misdiagnosis and Lack of Medical Accountability

• Labeling without Investigation:
  • Dr. Malik warns of the risk where real, potentially life-threatening illnesses go undiagnosed because providers prefer the easy label of “Dhat syndrome” to admitting uncertainty.
  • Result: Delayed or inappropriate care.

“You could have a whole host of different things and people are ignoring them… that person goes misdiagnosed. Maybe they have cancer… really scary.”
— Dr. Malik [03:16]

• Mental Health Spiral:
  • Misdiagnosis based on shame can cause lifelong psychological harm and chronic anxiety.

4. The Indian Healthcare Context: Evidence vs. Alternative Practice

• No Clear Delineation:
  • Patients struggle to differentiate between evidence-based and alternative doctors (“the most famous doctor… might be an alternative medicine practitioner”).
  • The resulting confusion complicates access to trustworthy care.

“There’s no delineation between people who practice evidence based medicine and people who practice alternative medicine… easy to get lost in the conflicting advice.”
— Dr. Narendra [04:58]

5. Practical Advice for Young Men Seeking Sexual Wellness

• First Step: Remove Internalized Shame
  • Reflect on the roots of shame (family, culture, social conditioning) and address these as a foundation for sexual health.
  • “Your brain is your most important sex organ.”
• Masturbation as Self-Discovery:
  • Helpful metaphor: Knowing your body is like “having an instruction manual” for building intimacy with a partner.
• Essential Practices:
  • Regular STI screenings—should be normalized, not stigmatized.
  • Condom use for all sexual activities: “Holy trifecta” of sexual health (STI screening, safe sex, open communication).

“My first advice is always do some inner work to understand, but it’s really essential.”
— Dr. Narendra [06:22]

6. Challenges and Stigma around Sexual Health Care in India

• Judgment in Clinics:
  • Providers often ask “Are you married?” instead of “Are you sexually active?” leading to missed care and judgment, especially for unmarried youth.
• Systemic Barriers:
  • Even finding nonjudgmental providers is difficult, leading to further care avoidance.
• Medical Education Gaps:
  • Stories from an abortion and contraception conference highlight deep-seated moralism in the medical community.

“I kept telling them, you have to speak to your patients and ask them if they're sexually active instead of asking me if they're married.”
— Dr. Narendra [09:21]

• Moral Policing in Medicine:

  • Many doctors resist patient autonomy for unmarried youth (e.g., wanting to call a teenager’s parents for unwanted pregnancy).

• Quote from a mother-doctor:

  “You have to ensure your patient is safe and healthy before you ensure if they’re morally okay, and your definition of morality is different from theirs.”
  — Dr. Narendra relaying her mother’s words [10:16]

• Inadequate Screening Facilities:

  • Limited access to STI screening compounds public health challenges.

7. Hopes for Change and Current Barriers

• Shifting Youth Culture:
  • Indian culture has changed—young people are more open about sex, but medical attitudes lag behind.
• Challenges for Young Doctors:
  • Openness to sexual health is hard to maintain in a judgmental environment.
  • Doctors risk stereotyping patients or being subject to patient backlash—even violence—for broaching sexual health topics.
• Nuanced Conversation Required:
  • Balancing respect, safety, and patient needs requires time and cultural competence.

“Being a patient is hard and being a doctor is hard. If you want to do the right thing.”
— Dr. Malik [13:27]

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Notable Quotes & Memorable Moments

• On cultural confusion:
  “How does somebody who doesn’t come from a background know who to trust? That is the biggest challenge of healthcare in India, in my opinion.”
  — Dr. Narendra [05:25]

• On stigma’s consequences:
  “If you are coming up with an STI, the automatic assumption is that you must be, quote-unquote, promiscuous… there’s so much weight associated with it.”
  — Dr. Narendra [10:34]

• On the generational divide among doctors:
  “Even if [young doctors] want to be open… you’re just surrounded by people telling you no sex is dead.”
  — Dr. Narendra [12:10]

• On the need for safe healthcare spaces:
  “Safe sex is hot sex. If your partner feels safe… they’re gonna be able to be themselves.”
  — Dr. Malik [08:48]

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Timestamps for Key Segments

• Definition & origins of Dhat Syndrome: [00:03 – 01:15]
• Case study: Harm from semen retention myths: [01:15 – 02:53]
• Dangers of misdiagnosis and missed serious illness: [03:09 – 04:00]
• Healthcare confusion in India (evidence vs. alternative): [04:58 – 06:02]
• Advice for young men on sexual health: [06:02 – 08:48]
• Stigma and challenges of STI screening in India: [08:48 – 10:56]
• Medical system’s moral resistance: [10:56 – 12:06]
• Cultural progress vs. entrenched attitudes: [12:06 – 13:27]

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Takeaways

• Dhat syndrome is a harmful, culture-bound diagnosis that enables shame, misdiagnosis, and misinformation.
• Sex-related shame and stigma in healthcare can deeply harm young people—mentally, physically, and emotionally.
• Young men and women need tools for self-reflection, shame resilience, and access to judgment-free care—including regular STI screenings.
• Both patients and practitioners in India face systemic barriers rooted in culture and medicine, hampering progress.
• Addressing sexual health in India requires honest, evidence-based conversations and systemic reform in medical education and public health.

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For more insights like this, subscribe to the Rena Malik, MD Podcast and check out the full conversation with Dr. Cuterus (Dr. Taneya Narendra).

Transcript

[A]

You've mentioned that syndrome a couple times. Can you explain what that is for our audience?

[B]

So the idea is that it is a collective of symptoms you start experiencing when you masturbate. And symptoms range from things like feeling depressed, having tremors in your hands, not being able to concentrate. So it's a range of physical as well as mental symptoms. And why it's very difficult to pin down what these symptoms are, is, is because anything that if you're struggling with anything, it can be labeled as heart syndrome. So, you know, if, if you go to an alternative practitioner and you say that, oh, I'm having a lot of headaches, and they'll tell you, oh, you must have been too much, and you have heart syndrome. So it's, it's, it's kind of like the equivalent of what hysteria used to be in the, in the olden times. For women, anything and everything can be that syndrome. We have so much data to show that it is extremely harmful for the development of young people's minds to have this kind of shame in their bodies and around positive aspects of life, like intimacy, even with themselves, that it's a little bit alarming that we haven't addressed this at a large scale yet. But it's also important to recognize that this is an alternative medicine theory and some of those practices are completely legal in India. So there's a lot of quote unquote scientific validation that people believe is there because they are part of mainstream medicine over here. One of the most heartbreaking cases that I heard about somebody who was labeled to have heart syndrome was this young person who, he was trying to practice semen retention, which is something he learned about on the Internet, which is the idea that if you, like you discussed that if you don't ejaculate, you will somehow develop superpowers and, you know, you, I don't know, get more jacked or whatever. And obviously, if somebody is experiencing the mental health benefits of it, like we mentioned, then if it works for you, go for it. But there is no evidence to say that this actually affects your physical health in any way. And this young person was so obsessed with not masturbating or not ejaculating at all that he started experiencing nocturnal emissions. And he felt so disturbed by it, he felt unhealthy. And he started almost manifesting those unhealthy symptoms in his body because he was always stressed, he was always worried, he became anxious, he developed a little bit of a blood pressure problem, and he was eating too much to sort of self soothe. And I Just had a chat with this young man and I tried to tell him that, you know, this is just a normal part of your development and if it doesn't come out this way, it's going to come out the other way. So don't get yourself so worked up about losing your streak, so to speak. He had gotten to the point of no return. Like he was not able to believe all of the things I was telling him because he was so entrenched in this idea that losing semen is bad. And that is the essence of that syndrome. Losing semen is bad and it'll lead to ill health.

[A]

And I think that the bigger fear for me is that if you have, let's say, headaches or some other manifestation that now people don't know what to do. So they're just labeling you with this issue. And two, they're not getting to the root cause of what's really causing your headaches or causing your symptoms. Like you could have some really serious problem. You could have an aneurysm, you could have, I mean, God knows what, right? You could have a whole host of different things and people are ignoring them. And because they to give you something that is like sometimes we don't know, right? Sometimes it requires more investigation, sometimes you need another opinion. But nobody wants to say I don't know, right? A lot of people have a hard time saying I don't know. And so they may say, well, I don't know, so I'm going to call it that syndrome, right? And then that person goes misdiagnosed. Maybe they have a cancer, maybe they have something really life threatening and they've been misdiagnosed. So that's, that's really scary. And then of course the mental health aspect of it is insane, right? For someone to feel so ill will of themselves because of something their body's gonna do on its own is really sad and really tragic because now that person's never gonna, you know, until their body stops having nocturnal emissions potentially, and they just absorb it themselves. They're not gonna have a feeling of, of wellness, right? They're gonna feel ill forever. And then potentially they're gonna cause other problems because they have so much stress. They're going to just go down this like loop of trauma related health issues which we see so much of, right? And it's so hard to come back from that. It takes a lot of dedicated effort and work. And I imagine that in a place like India it's very hard to get people or practitioners who are actually understand that and Manage that in a way that's appropriate.

[B]

Yeah. And I think it's also that there's no delineation. That's the word. There's no delineation between people who practice evidence based medicine and the people who practice alternative medicine that it's easy to get lost in the conflicting advice you keep getting because one kind of doctor will tell you, you know, this is totally normal and it's totally fine, and the other kind of doctor will tell you, oh no, you're going to go to hell. Or, you know, physical, your physical health is going to go to hell. It can be really perplexing as a, as a person who is not from, say, a medical background or a scientific background to navigate through this maze of conflicting advice. And this really confounds the problem over here because, you know, the most famous doctor that you might know might be an alternative medicine practitioner. So how do you decide what is the correct advice? And how does somebody who doesn't come from a background know who to trust? And I think that is the biggest challenge of healthcare in India, in my opinion.

[A]

Yeah, absolutely. In terms of men who are trying to start exploring their own sexual health, young men, what sort of tips do you have for them in, in being able to do this with confidence and, you know, sort of responsibility?

[B]

I think the number one thing is I'm very big on removing shame around the area of our body. So the number one thing is to tackle the internalized shame we have for whatever reason, be it our family environment, be it our social, cultural environment, be it our community, where we come from, whatever, and kind of doing some inner work to understand why you're feeling so much shame around this. Once you've identified what might be some of the reasons, try and work towards removing those reasons from your life. Because you can keep working on the problem on your own, but until you remove your triggers, you know those issues are going to keep cropping up. So it's kind of weird that my first advice is always do some inner work to understand, but it's, it's really essential. And then once you have an idea around how you feel about sex, because your brain is your most important sex organ, once you have a little bit of an idea, then it's easier to be able to work on yourself and on your desires. One of the easiest things you can do to learn about your own body is masturbation. And how I always think of it is that if you get a table from Ikea and you have to build it on your own versus having an instruction manual, it's easier always to build it with an instruction manual. And when you know and you've explored your desires and your fantasies and your ideas of what sex is supposed to, what you want sex to look like, it's always easier to build that intimacy with your partner versus two people trying to figure out things where they don't both know a lot. Another very important thing is working on the shame again to include regular STI screenings in their life, in their sexual life, in their activity. Because we think that if it's an sti, it's going to show up with some horrid symptoms or you'll have like a massive pimple on your shaft or you'll be really itchy. And while that may be the case in some places, in most cases you don't see any symptoms for NSTI until it really ascends further. It creates more infection in your body and you can see the after effects of the, of how it ravages through your body essentially and removing not just the idea of shame around it, but also including the idea of regularity in there. That every time you have a new partner, you go through a screening and you make sure you're safe. Coupling that with regular condom use for any kind of sexual activity, be it anal, oral or vaginal sex, is fundamental. Holy trifecta, in my opinion.

[A]

No, I agree. I always say safe sex is hot sex. So if your partner feels safe, you know, they're gonna, they're gonna be able to be themselves and not be nervous during the encounter that they might get something right. And then, you know, I think in India, I can only imagine that STI screening is filled with judgment. Maybe that's a misconception on my end. But is that the case? Like, you go and you're like, someone's looking at you like, oh, okay, is that, am I wrong? Tell me I'm wrong.

[B]

Not just that, but also struggling to find a provider who will give it to you. One of the most, one of the things that I lot of hate from the medical community in India from was that I kept telling them, you have to speak to your patients and ask them if they're sexually active instead of asking me if they're married. And people were like, no, this is not appropriate. They shouldn't be having sex at this age if they haven't gotten married. I remember I was at a conference for, it was a contraception and abortion access conference and we had a panel where people were being asked that you have a 19 year old unmarried girl that comes to you with an unwanted pregnancy, what do you do? And I think about six of our seven doctors, six doctors on the stage replied and said, we will call their parents.

[A]

Oh, my God.

[B]

And it was my mother who went up and she was like, actually, no. She's like, she's an adult, so she can make that decision on her own. And people were really angry about it because they were like, you know, you're teaching the wrong models to the young women of the country. And my mother had to sit down with. To a panel of gynecologists, no less, and explained to them that this is what we learn. This is the. This is the literal teaching we get in our medical education, that you have to ensure your patient is safe and you have to ensure your patient is healthy before you ensure if they're morally okay and your definition of morality is different from theirs. So there is so much stigma and judgment associated with the idea of sexual. And if you are coming up with an sti, the automatic assumption is that you must be, quote, unquote, promiscuous. That is why you're needing to come out with, you know, getting tested because you've got an infection, because clearly you're practicing it wrong. You know, there's just so much weight associated with it that it. It's a big deterrent in allowing people to go to access that care in the first place. And when they don't go to access that care in the first place and say they're not judged, there are no avenues. You know, there's such few centers available for getting an STI screen that it's alarming. And we have a major sexual health crisis in the country, and I don't know why it's not being addressed.

[A]

You know, that's really sad. That's really, really tragic. I would hope that by now, I mean, I think we know India has changed a lot since when my parents were kids and grew up in India. And it's very obvious that young people are sexually active. Like, I think people are open about it more so than ever before, right? And I mean, watch Indian movies, like, it's very obvious that, like, things have changed. And so it's shocking to me that people are digging their head in the sand and not, you know, acknowledging this. Do you feel like the younger generation of doctors are being more open? Is it just like the older generation?

[B]

I mean, even if they want to be open, the environment that you train in is really impactful. So even if you want to, you know, be open to this idea, you're just surrounded by people that are telling you no sex is dead. So it has to have some impact. It's very difficult to decipher if this person will be open to communicating about their sexual activity without stereotyping them. So if, say, a person comes to you wearing a sari and they have their head covered, are you going to ask them, are you married? Or are you going to ask them, are you sexually active without stereotyping them based on their attire and the way they speak? It's a very nuanced conversation. And this. This overhaul will take a lot of time, because very often if you're having a person that is coming to you, to your clinic to have a conversation around this, if you ask them, and if they're not married, and if you ask them a question like, are you sexually active? They might get seriously offended. And violence against doctors is a major problem in India, particularly in the part of the country that I live in. So there's no way of predicting if this person will get up and smack you across the face. So. Wow. Yeah, it's a really difficult conversation to have. So challenging these ideas around morality and sex, especially in the clinic, is a very nuanced and a very difficult conversation.

[A]

That sounds like being a patient is hard and being a doctor is hard. If you want to do the right thing, Absolutely. Wow. If you enjoyed this clip from The Rena Malik, M.D. podcast and you want to see more, check out the full episode with Dr. Taneya Narendra right here.