The koro syndrome it is a psychological disorder in which the patient believes that his genitals are shrinking or retracting towards the abdomen and that they will soon disappear. It is more frequent in men, who are convinced that their penis is getting smaller and smaller and that it could even invaginate inside their bodies, causing death..
In the cases of women with this syndrome, they believe that their nipples are shrinking or that their vulva is about to disappear, even though clearly nothing strange or abnormal is happening with their genitalia..
Patients with this syndrome feel very anxious and often have obsessive thoughts and compulsive behaviors: they try to stretch or enlarge their penis or nipples with different elements that could harm them.
Koro syndrome is also known as genital retraction syndrome and is more common in Asian countries. Mass hysteria has been documented around this syndrome, which could be "spread" from one person to another in certain cultures..
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There are basically two types of Koro syndrome.
The primary Koro, which would have a cultural origin and that occurs in individuals who do not suffer from other mental disorders, and the secondary Koro, which appears in people who suffer from diseases such as schizophrenia, body dysmorphic disorder or anxiety disorders.
It is frequent in countries such as India, China and Japan, as its cause is strongly linked to cultural beliefs of that region of the world..
Most of the men in whom this disorder appears are single, with few studies, little sexual education and deep beliefs in supernatural phenomena, such as spells and incantations..
In these cases, the patient presents symptoms of great fear and anxiety. In addition to believing that his genitals are shrinking and could soon disappear, he thinks that he could die from this..
Many patients indicate that the problem with their genitals started after having sexual contact with a prostitute, or that it could be related to masturbation or nocturnal pollutions.
This shows the close relationship of this syndrome with cultural beliefs and the lack of adequate sexual education..
Koro syndrome cases that occur outside endemic countries, that is, outside Southeast Asia, are "incomplete" cases of the syndrome, which is generally caused by another underlying mental disorder.
In cases of secondary Koro, the patient also believes that his genitals are shrinking and that they could disappear, but he does not think that he could die from it and the associated anxiety is not as severe as in primary Koro.
Patients with Koro syndrome suffer from anxiety attacks because they are tormented by the idea that their genitals are shrinking, even though it is not possible to verify that permanent changes are actually happening in their sexual organs.
That is, the penis or other genital regions could contract temporarily due to the effect of low temperatures for example, but it is a totally reversible effect, which should not trigger anxiety symptoms in a person, unless he suffers from Koro syndrome.
According to literature reviews that refer to Koro case studies, anxiety attacks usually subside after a few hours, although they could last up to a couple of days.
In other cases, the symptoms of Koro may persist longer and establish chronic, increasing the chances that the syndrome occurs in conjunction with other metal diseases, such as body dysmorphic disorder..
Other symptoms may include an alteration in the perception of the shape of the penis, loss of muscle tone in the penis and paresthesia in the genital area (abnormal or strange sensations, tingling, tingling, etc.).
The patient also feels afraid of dying, that his penis will disappear completely or of having erectile dysfunctions in the future..
The sensation of near death and genital retraction is typical of cases of primary Koro, which appear mainly in Southeast Asia.
Other beliefs that the patient may present in Koro syndrome include the fear of becoming a eunuch, of becoming a woman, of becoming sterile, that their urinary tract is blocked, they believe that they are possessed by an evil spirit or that they are victims of a spell.
Patients with extreme anxiety can resort to physical methods to avoid retraction of the penis, anchoring it with different devices that could cause damage..
For women, their breasts or nipples may be stretched trying to prevent shrinkage, and some may even have iron rings placed on the nipple, which could also lead to injury..
As already mentioned, psychosexual conflicts, certain personality factors and cultural beliefs are the main causes of Koro syndrome..
In patients with this condition not found in Southeast Asia, antecedents such as sexual promiscuity, feelings of guilt after masturbation, sexual impotence, etc. are frequently found..
To make the diagnosis, a complete medical review must be carried out, including psychosexual aspects and psychiatric history of the patient.
The doctor should investigate whether the patient is concerned about their appearance or body image, to rule out body dysmorphic disorder..
It is also important to inquire about the patient's beliefs and values, or what they think about their genitalia or sexual life..
And of course, you also have to rule out any real injury or alteration that could be happening to the genitals. There may be injuries inflicted by the patient himself, in an attempt to avoid retraction of his penis, which helps guide the diagnosis.
In summary, if the patient declares that his genitals are shrinking although no physical abnormalities are found, if he presents a picture of great anxiety, thinks that he may die and uses mechanisms to avoid retraction, then it is primary Koro.
If any of these symptoms are missing but others are present, then it may be secondary Koro or incomplete Koro, which is usually the one that appears in western countries.
In the cases of Koro associated with cultural beliefs, treatment is based on psychological therapy and can be prevented by providing information on anatomy and adequate sexual education..
In western Koro cases, look for sexual conflicts and mental illnesses that may be the cause of the symptoms. The psychological and psychiatric treatment to be followed will depend on the patient's situation..
Cases of massive hysteria of Koro syndrome have been reported, that is, groups of people in whom the symptoms appear, who apparently have "caught" each other.
For example, a single low-income mill worker in West Bengal was treated in the area's psychiatric service, as the patient reported that for two or three days his penis had been shrinking and entering his abdomen , a fact that was weakening him. I could not sleep because of anxiety and repeatedly thought about this idea.
He said he did not use any type of drugs and in his medical history no psychiatric history was found. The patient believed that his symptoms were due to nocturnal pollution and masturbation.
To avoid retraction of his genitalia, he submerged himself in a nearby pond, staying there overnight, for 14 or 16 hours, which caused a respiratory infection..
This fact was known by his co-workers and inhabitants of the area. Two days later, six other workers at the same mill reported similar symptoms and decided to imitate their co-worker's behavior..
The doctors then decided to stay alert and perform group therapy for the workers, with which the outbreak subsided after five or six days.
But a few days later another worker from the place, a 53-year-old divorced, who had been absent during those days, went to the emergency service declaring that his penis was getting smaller. Upon returning to the village, he had heard about the symptoms of his companions, who had gone into the ice water to relieve themselves.
Although this patient drank alcohol from time to time, he stated that he had been sober for the past two weeks and no psychiatric history was found in his medical history.
With this case, the outbreak was reactivated and 11 more cases appeared among the mill workers. The 53-year-old patient's nephew also developed Koro syndrome a few days after his uncle.
After a new medical intervention, the outbreak was controlled after six or seven days.
While the underlying mechanisms are still not very well understood, this massive behavior could be explained by mirror neuron theory..
This is a special type of neurons that have been found in the human brain and other primates, and would be responsible for "observing" the behavior of other individuals of the species and imitate their behavior.
These neurons could play a very important role in learning by imitation, but then their function would be inhibited to prevent the person from going around imitating everything that others do.
However, in cases of massive Koro, the inhibition of these neurons would fail and in this way the syndrome could spread from person to person..
In certain regions of China, Koro is considered endemic and there were large outbreaks in 1948, 1955, 1966 and 1974, coinciding with times of great uncertainty and social tension in the country..
In 1984 and 1985 there was a Koro epidemic that lasted more than a year and affected more than 3,000 people in different cities. To end the outbreak, a mental health campaign was carried out and since then, there have been no more epidemics in China.
Social and economic improvements in the country surely also helped reduce the outbreaks.
In 1967 there was another major case of massive Koro in Singapore, which lasted approximately ten days. Certain media outlets reported that some people had had Koro symptoms after eating pork that had received the swine flu vaccine..
These rumors soon spread and a short time later a hospital in the region treated 97 cases of Koro syndrome in a single day..
The government and medical authorities stopped the outbreak by making public announcements on TV and in newspapers about the falsity of published information..
In the 70s and 80s, cases of genital retraction were also reported in Nigeria and other African countries and until 1996 small outbreaks were still detected.
The African victims interpret the symptoms as a “theft” of their genitals: a person with whom they had sexual relations would have “taken away” their organ and their spiritual essence, causing them sexual impotence.
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