Among women in South Asia, the complaint of
vaginal discharge (often called
leukorrhea) is extraordinarily common. From a biomedical perspective, this symptom suggests that
reproductive tract infection (RTI) is prevalent in the subcontinent; however, several recent studies provide evidence that the prevalence of RTI is relatively low. Women who do not have RTI frequently report the symptom of
vaginal discharge. An anthropological perspective on the cultural meanings of
leukorrhea can shed light on this puzzling phenomenon. According to Ayurvedic concepts of health and illness, 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. Many South Asian women who complain of
vaginal discharge also report a variety of
somatic symptoms such as
dizziness,
backache and weakness. The link between unexplained gynaecological symptoms and mental health concerns has been explored by both psychiatrists and anthropologists in South Asia.
Leukorrhea may represent a culturally shaped "bodily idiom of distress", in which concerns about loss of genital secretions reflect wider issues of social stress. Problems may arise when a symptom with deep cultural meaning is interpreted in a purely biomedical framework. In the syndromic approach to the treatment of
sexually transmitted infections (
STIs), health workers are trained to treat women presumptively based on history and a risk assessment, but without clinical or laboratory confirmation of
infection. A recent evaluation of this approach demonstrates that many women who complain of
vaginal discharge do not have RTI, and are inappropriately treated with
antibiotics. It seems likely that women are over-reporting
vaginal discharge because of its deep cultural meanings, meanings that need to be understood within an anthropological rather than biomedical framework.