Fear of your genitals retracting into your body?

            Koro, also known as genital retraction syndrome is a culture bound depersonalization syndrome in which the affected person believes their genitals are getting retracted into their body causing extreme panic, consisting of the penis shrinking.

According to the DSM-IV TR:

“Koro is a term, probably of Malaysian origin that refers to an episode of sudden and intense anxiety that the penis (or in females, the vulva, and nipples or rare cases the ears, nose and tongue) will recede into the body and possibly cause death. The syndrome is reported in south and East Asia, where it is known by a variety of local terms, such as Shuk yang, Shook Yong, and suo yang (Chinese) jinjinia bemar (Assam);or Rok–joo (Thailand). It is occasionally found in the west. Koro at times occurs in localized epidemic form in East Asian areas. This diagnosis is included in the Chinese classification of mental disorders, second edition (CCMD-2).”

Victims of Koro worry compulsively; feel guilt and anxiety out of sexual excess (real or imagined). This causes a panic-like state. The Koro affected person usually has limited insight. “The Koro encounter is usually a very dramatic one; believing that the condition is critical, the victim becomes very anxious, doing whatever he/she can to stop the sex organ from further retracting.” This does not only affect the victim, but the family members too because they too start to believe that the affected area are retracting, sometimes even helping out. (Those of a different sex are not allowed to touch the sexual organs of a victim)” The Koro attack is of short duration, and usually does not recur. Koro usually affects younger Chinese males ages 21 to 40. “As far back as 700 years ago in China, people believed that health was the result of an equilibrium between the yang (male) and the yin (female). During masturbation or nocturnal emissions and unhealthy loss of (yang) took place putting the individual in an unbalanced condition.” They usually are going through some kind of conflict or maladjustment. They are usually immature, unintelligent and dependent. Men who are extremely obese will find it difficult to locate their penises. Other characteristics are, lack of sexual hygiene, fear of inadequate sexual performance, imbalance of yang and yin, guilt about masturbation, belief that losing semen is dangerous to a men’s health, inappropriate sex (ex. rape, sex out of wedlock, pedophilia, sex with prostitutes) and phobia of catching aids. Koro is characterized by three cardinal symptoms: 1) a belief or delusion of retraction of the penis into the abdomen 2) Intense panic with physical signs of anxiety 3) The use of mechanical means to prevent penile retraction. Koro patients also show significant sexual conflicts on psychiatric evaluation.

“Koro was first introduced to western science as a malady of the southern Sulawesi people (Indonesia) and until recently was thought to be restricted to southern Chinese immigrants in Hong Kong and South East Asia.” In Malay the word Koro means head of turtle; hence the resemblance between the head of the turtle and penis. “In certain parts of the world, especially in Chinese societies, Koro epidemics have been so serious that thousands of people have been affected within a short period of time. Some reported cases of Koro have gone as far as to resort to extreme physical measures to prevent the believed retraction of the penis. Cases have also been reported where men have used apparatuses such as hooks, needles, and fishing line to prevent the disappearance of the penis. There have also been reported cases of outbreaks in mass hysteria, and rare cases that involve women.” News of an epidemic in a neighboring island can trigger another wave of epidemic.

“However, since 1952 there have been 24 cases of Koro reported in non-Chinese and non-Indonesian patient. In most of these patients the syndrome was generally incomplete as defined by the three cardinal symptoms, with the patients usually manifesting the belief or delusion of retraction of the penis associated with retraction of the penis associated with anxiety.”  For example, according to the Yoruba of Nigeria there is a belief that penis has been stolen by a male witch so he can have sex with victims wife, or that bewitchment causes male impotence. “Koro was thought to occur secondary to violations “real or fantasized of the folklore rule-systems concerning sexual behavior.”

Koro has been successfully treated with Cognitive behavioral therapy and/or a course of alprazolam and imipramine (which are used to treat anxiety disorders). Home remedies for Koro include fellatio from the affected persons partner because it is said that it keeps the penis from vanishing. Crushed Rhino horn because it is said that rhino horn helps fertility. Other preventative measures for Koro, are getting the family involved in holding the penis. The affected person believes that by holding his penis it wont get sucked into the body, but doing so would be impossibly tiring. This is where the family comes into play, they take turns holding the affected persons penis preventing it from retracting. “Injury to the sex organ is almost inevitable, although the extent of the injury varies, bruises, bleeding and infection as a result of the rescue effort are commonplace. In extreme cases there may be permanent damage to the organ.

A commonly used assessment for Koro-like symptoms is the Socio-Sexual Knowledge and Attitudes Assessment (SSKAAT-R). This is an assessment tool used to evaluate sexual knowledge. “The approach to this symptom should encompass a careful diagnostic workup with a search for underlying sexual conflicts. The choice of psychotherapeutic treatment should be based on the underlying psychiatric pathology found.” Insight oriented therapy for sexual conflicts has appeared to be helpful.  Another assessment usually given is the Life Problems Questionnaire. It assesses the existence of psychological, social and health problems affecting the respondent’s life.  Finally, the Folk Belief Questionnaire assesses the degree in which the person believes in Koro-related folklore. According to Mo et al. (1987),

A Fortune-teller warned that the second half of 1984 would be a disastrous year in which Souyang would be widespread in Hainan. Because people were poorly educated and afraid of supernatural forces, they were strongly influenced by the fortune-teller’s prediction. As a result, the community expected Koro and a self-fulfilling prophecy ensued (p.77)

This has shown that there is Sometimes a predisposal to the belief. For example in the Chinese folklore a fox spirit is capable of turning into a beautiful woman, and extract peoples vital energy. Most of the affected people had heard about this before being affected. Treatment for this person becomes a mix of exorcism and medicine because the person truly believes they are possessed.

I could not imagine how crazy this must be to either experience or to observe. Has anyone encountered a person going through this?

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