Koro syndrome (Genital Retraction Syndrome)

        Koro syndrome (Genital Retraction                           Syndrome)

   Koro syndrome is a psychiatric disorder characterized by anxiety and a deep fear of the shrinking of the penis and /or retraction of the genitals into the abdominal until they disappear. Far koro syndrome sufferers, it is believed when the genitals do disappear you will die. 

  Koro is a characterized by acute anxiety and a deep-seated fear of shrinkage of the penis and its ultimate retraction into the abdomen, which will cause death. The concurrence of the Koro(genital retraction) syndrome with a pathological condition of the urogenital system has rarely been described. We report a case of Koro associated with infertility.  

  First identified in ancient China, Koro almost always follows an identical pattern. The suffer first experiences a tingling sensation in the followed by a rapid- onset panic attack. This quickly leads to a sudden and pervasive fear that the genitals are disappearing. In Asia, this is almost always accompanied by an imminent fear of death, although this element is often missing from reports in other parts of the world. The suffers normally asks friends or relatives to physically manipulate his genitals stop them retracting, which sometimes leads to injury. The anxiety subsides quickly when a culturally acceptable treatment is used, from exorcism to potions. 

Causes of Genital Retraction Syndrome:

 Koro has been described as a panic disorder that around the genitals. It appears to be heavily influenced by cultural beliefs, which might explain why epidemics are common. For example, in some West Africa outbreaks, the suffers believed that, rather than retracting into their bodies, their genitals were being stolen for occult reasons. During the "Burning Times" of medieval Europe, witches were held responsible for genital retractions in the local population. The symptoms subsided when the witches were appeased. 

 Personal and cultural morals, religious doctrine and current mental health status often play in individual cases. A 2008 study in the journal of German Psychology found that many sufferers reported a recent sexual encounter that made them uncomfortable, such as an extramarital affair. Some had a history of preoccupation with their genitals. Some reported a high level of fear, guilt or shame. Other were immature and lacked sexual confidence. Still, others had an existing mental health disorder or a history of substance abuse. Although the specifics vary for each case, it appears that the highest risk for Koro exists in people who are already experiencing fear, or guilt. 

   Koro syndrome is largely observed in young Asian men. Many of these young men are usually uninformed about physiological puberty. They are also deprived of proper sex information that explains their physical development. Individuals who suffer from the koro syndrome believe their penis shrinking is a warning sign of their imminent death.

Koro Syndrome is mainly found in Asian countries. Scientists are unsure whether it is due to a native cultural tendency towards a type of anxiety or if the syndrome began as a rumor that has been taken literally. A few doctors have noted koro syndrome has become increasingly popular in Western countries, however, in Western countries, koro syndrome was linked to additional psychological conditions.

People who suffered from koro in the U.S. were also diagnosed with mental illnesses such as schizophrenia, anxiety disorder or body dysmorphic disorder. While in Asian countries individuals who suffer from the condition are otherwise healthy.

In a study, conducted by German researchers, it was observed patients who suffer from alternative mental illnesses, once their mental disorder was treated, more times than not their fear of genital retraction diminished. German researchers also believe the koro syndrome may exist more often than reported. They noted many patients may be reluctant to report their symptoms due to feelings of shame. 

Classification:

     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).

   A typical episode will occur when a man goes to urinate in the cold or while emotionally upset (often due to guilt over masturbation or frequenting prostitutes, while concerned about his sexual performance, or after a fight with his wife) and observes that his penis is becoming smaller, a condition known medically as hyperinvolution. Remembering the dangers of a shrinking penis, the man grabs his genitals before they can retract into his body, and calls for help. If no one is around to help he holds onto his penis, the individual may use mechanical devices to keep the penis from retracting, including cords, chopsticks, clamps, or small weights. While there are no substantiated reports of the condition itself resulting in any physical damage to the individual, many sufferers have unfortunately inflicted harm upon themselves in frantic attempts to stretch the penis to prevent further shrinkage. It is not unusual for those with koro to resort to using mechanical devices such as clamps or weights.

Diagnosis:

   Several criteria are typically used to make a diagnosis of koro: penile (or breast) retraction, anxiety related to the retraction, fear of death as a result of retraction, and use of mechanical means to prevent full retraction. Cases that do not meet all the requirements are generally classified as koro-like symptoms or given a diagnosis of partial koro syndrome. It has been argued that the criteria are sufficient but not necessary to make a diagnosis of koro. 

Signs and symptoms:

      Most of the victims complain about episodes of an acute attack of genital retraction or genital shrinkage, sometimes both. Each episode usually last several hours, though the duration can be as long as two days. Victims of koro worry compulsively over what they view as sexual excess. They also lack confidence in their own sexual capacity and thus their sense of virility. This sexual anxiety leads to the body-image distortion syndrome that accompanies depersonalization. But in koro, unlike other states of depersonalization where the person realizes that they are simply “spaced out” because of stress, this person (with koro) has the limited insight of his condition, yet he does not suffer wide-spread emotional disturbances.  Ethnographic psychologists consider koro to be closely related to the panic attacks precipitated by sexual anxiety.

Treatments :

   Indigenous treatments for koro vary dramatically and are often influenced by current events. For example, an outbreak might be blamed on an invading force or an individual rival. Defeating the foe is sometimes the recommended treatment in these situations. In other cases, indigenous treatment might include an exorcism, rest, herbal treatments, or other healing practices. Some research shows that antipsychotics are sometimes helpful in reducing symptoms.

If you're suffering from koro, talk therapy may help you learn new and healthier ways of relating to your body.

  Because it's common for people with this fear to have other conditions, Western mental health professionals often perform a full workup to determine exactly which factors are in play. In many cases, treating the underlying condition also causes the koro symptoms to subside.

    It's also important to rule out physical causes for the koro symptoms. Pain, tingling and other physical symptoms are common in koro but could also indicate an underlying physiological condition. It's a good idea to visit the urologist if you're experiencing these symptoms.

The goal of the treatment is to help the patient in healthy functioning of his daily routine. A combination of medication and cognitive-behavioral therapy (CBT) was chosen.

The following rubrics were selected for repertorisation:

MIND-DELUSIONS-genitals-shrunken, are

MIND-DELUSIONS-worthless; he is

MIND-ANXIETY-conscience; anxiety of

MIND-THOUGHTS-persistent

BBCR- pg. No: 649

Genitalia- Male organs- Penis- Shrunken: ag-c, alo, bell. 

Cara:

Mind, Delusions, body, body parts, parts shrunken: Sabad, nux-m.