Drs Rajesh and Jacob's suggestion of a dichotomy between form and content is an interesting one. We acknowledge that some patients’ explanations for their distress may be linked to their perception of semen loss or dhat. Drs Rajesh and Jacob highlight that contemporary themes are incorporated into psychopathology, and we agree. However, it is interesting to note that patients with dhat appear to latch on to a more traditional explanation. The ‘disappearance’ of similar complaints in the West may be related to changes in socio-economic conditions. The distinction between form and content of a number of psychopathological symptoms is well worth studying and ripe for further research. We think the suggestion that management is the same, irrespective of the diagnostic labels is simplistic – the cultural explanations of distress and their understanding is paramount in delivering services that will be acceptable and in providing treatments that will be adhered to by patients.