Cultural and biomedical meanings of the complaint of leukorrhea in South Asian women

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.