The obese young man appeared mortally petrified. “Doctor, please save me. My penis is shrinking. At this rate it will disappear altogether,” he sobbed. His parents were equally distraught. They were begging the doctor to save their son’s life. The man is suffering from a psychological disorder: Koro syndrome. Koro means head of a turtle in Malay.
Koro is a culture-specific syndrome in which the affected individuals have an overpowering belief that their genitalia are retracting and will disappear, despite the lack of any longstanding changes to the organs. Koro is also known as shrinking penis, and it is listed in the Diagnostic and Statistical Manual of Mental Disorders.
This condition is also called Genital Retraction Syndrome (GRS), penis panic, etc; and is characterised by the belief that the shrinking penis will eventually be absorbed into the body and cause death. Women who suffer from this syndrome believe that their breasts and vaginal lips are shrinking and being sucked into the body.
The vanishing penis belief has a long and distinguished history. It was first mentioned in the ancient Chinese text The Yellow Emperor’s Classic of Internal Medicine of 300 BC.
A penis panic is sometimes a mass hysteria. This hysteria has occurred around the world, most notably in Africa and Asia. A well-documented ‘penis panic’ mass hysteria occurred in Singapore in 1967. Hospitals were inundated with people worried that their penises were shrinking.
This psychological disorder is associated with occult belief such as witchcraft and guilt associated with masturbation.
Men who are extremely obese will find it difficult to locate their penises buried under layers of fat. This fear or anxiety is mostly found in countries such as India, China and Japan. Among the Chinese, koro is confined to south China and the lower Yangtze Valley. A 1992 study 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.
In the western hemisphere, genital shrinkage is reported but not all the other typical koro symptoms, such as fear of death. The incomplete forms of koro are the non-cultural forms, while the complete form with acute anxiety is the classical culture-bound type.
Most patients report acute anxiety attacks due to perceived genital retraction or genital shrinkage, despite a lack of any visible and longstanding biological changes in the genitalia. Longstanding refers to changes that are sustained and do not appear reversible, unlike the effect of cold temperatures that cause retraction. These changes may trigger a koro attack, although the effects of temperature are objectively reversible. Episodes usually last several hours, and as long as two days. There are cases in which koro symptoms persist for years, indicating a potential co-morbidity with body dysmorphic disorder (obsession with imaginary defects in their appearance). Other symptoms include a perception of alteration of penis shape and loss of penile muscle tone. Some patients may complain of genital paraesthesia (an abnormal sensation, typically tingling or prickling) or genital shortening. Among women, the fear is about nipple retraction, generally into the breast as a whole.
Psychological components of koro anxiety include fear of impending death, penile dissolution and loss of sexual power. Feelings of impending death along with retraction and perceived wastage of semen have a strong cultural link with Chinese traditional beliefs. This is demonstrated by the fact that Asians generally believe koro symptoms are fatal. Other presenting 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 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. These may cause physical injury, even death.
Psychosexual conflicts, personality factors, and cultural beliefs are considered to be the causes of this condition. Sexual adjustment histories of non-Chinese victims are often significant, such as premorbid sex inadequacy, promiscuity, guilt over masturbation and impotence.In typical culture-bound cases, reassurance and sexual anatomy education are required. Patients are treated with psychotherapy according to symptoms.
A few reminders to the panic-stricken:
The penis will not shrink once it has grown to its adult size.
Penis has no bone. It has only spongy tissue. Its size depends on the amount of blood staying in the tissue spaces and it varies from time to time. Penis can be stretched when necessary (during erection) and can be compressed during nonsexual situations.Life depends on overall general health and not just on the penis.