Koro

koro

Koro is a culture-specific syndrome from Southeast Asia in which the person has an overpowering belief that his penis (or other genitalia) is shrinking and will shortly disappear. Also known as shrinking penis, the syndrome is listed in the Diagnostic and Statistical Manual of Mental Disorders. In China, it is known as ‘shuk yang.’

For females, the belief focuses on the nipples retracting or shrinking. Though the syndrome is rooted in China and found mostly in Southeast Asia, rare and isolated cases of koro are found in people of non-Chinese ethnicity worldwide. Episodes of epidemics occurred in the endemic nations. In a different cultural setting, mass hysteria of genital-shrinkage have been reported in African nations.

In DSM-IV-TR, koro is listed as one of the entries in the Glossary of Culture-Bound Syndromes of Appendix I. The manual gives koro’s definition as ‘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) will recede into the body and possibly cause death.’ Attempts by numerous authors to sub-group culture-bound syndromes place koro into different classes according to the system of classification, such as the group of ‘specific culture-imposed nosophobia’ (classification with cardinal sign), ‘the genital retraction taxon’ (classification with common factors between syndromes), and the group with ‘culture-related beliefs as causes for the occurrence’ (classification according to how the syndromes might be affected by cultural factors).

Various authors have attempted to distinguish between complete and incomplete forms of koro, as well as cultural and non-cultural forms. Cultural forms are said to involve a cultural belief or myth which plays a role in the genesis and spread of the disease in the community, and are regarded as complete forms, fulfilling all the criteria of the symptom complex. Differentiation into primary koro (as a culture-bound expression) and secondary koro (co-morbid with a CNS disorder or another psychiatric disorder; or drug-induced) has been proposed. Traditional Chinese medicine recognized koro as a sexual disease and classified it into two categories, namely ‘cold conglomeration in liver’ and ‘depletion of kidney’s yang.’

Ideational components of koro anxiety neurosis include fear of impending death, penile dissolution, and loss of sexual power. These cognitions of impending death with retraction and perceived spermatorrhea (a condition of excessive, accidental ejaculation) has a strong cultural link with Chinese traditional beliefs, as demonstrated by the fact that in general, Asians with complaints of genital retraction believe that the condition is fatal, unlike most Westerners. Other ideational themes are intra-abdominal organ shrinkage, sex change to female or eunuch, non-specific physical danger, urinary obstruction, sterility, impending madness, spirit possession, and a feeling of being bewitched.

Extremely anxious sufferers and their family members may resort to physical methods to prevent the believed retraction of the penis. A man may perform manual or mechanical penile traction, or ‘anchoring’ by a loop of string or some clamping device. Similarly, a woman may be seen grabbing her own breast, pulling her nipple, or even having iron pins inserted into the nipple. Physical injury is inevitable, which can be considered as a complication of the syndrome.

Psychosexual conflicts, personality factors, and cultural beliefs are considered as being of etiological significance to koro. Sexual adjustment histories of non-Chinese victims are often significant, such as premorbid sex inadequacy, sexual promiscuity, guilt over masturbation, and impotence. In historical culture-bound cases, reassurance and talks on sexual anatomy are given. Patients are treated with psychotherapy distributed according to symptoms and to etiologically significant points in the past. Prognosis appears to be better in cases with a previously functional personality, a short history and low frequency of attacks, and a relatively uncomplicated sexual life.

In China, traditional treatment based on the causes suggested by cultural beliefs are administrated to the patient. Praying to gods and asking Taoist priests to perform exorcism is common. If a fox spirit is believed to be involved, people may hit gongs or beat the person to drive it out. The person will receive a yang- or yin-augmenting Chinese medicine potion, usually including herbs, animal penises (of tiger, deer and fur seal), pilose antler (stag of deer), or deer tail. Other foods for therapy are pepper soup, ginger soup, and liquor.

Among the Chinese, koro is confined to South China and the lower Yangtze Valley. A 1992 study of self-report questionnaires suggests that in the epidemic area of China, koro victims are mostly Han, male, young, single, poorly educated and fearful of supernatural forces and koro. Since late 1996, a small-scale epidemic of genital shrinking was reported in West African nations. Victims in the African outbreaks often interpreted the experience as genital theft, accusing someone with whom they had contact of ‘stealing’ the organ and the spiritual essence, causing impotence. The perceived motive for theft was associated with local occult belief, the witchcraft of juju, to feed the spiritual agency or to hold the genital for ransom. Social representations about juju constitute consensual realities that propose both a means and motivation for genital-shrinking experience.

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