Koro Syndrome: Causes And Management

Introduction

Koro syndrome is commonly known as Genital Retraction Syndrome, a culture-bound delusional condition in which individuals have an oppressive belief that their sexual organs are retracting and will vanish. Koro is also known as a shrinking penis and is mentioned in the Diagnostic and Statistical Manual of Mental Disorders. The syndrome occurs worldwide in most cases in Africa, Asia, Europe, and the U.S. Koro refers to the “head of a turtle” in Malay, where just like the head of the turtle, the male sex organ will retract soon and be abolished.

What Is The Koro Syndrome?

Koro syndrome was first recognized in ancient China and explained as the apprehension of the genitals shrinking and retracting to vanish within the body and mass hysteria over genital shrinkage anxiety. The sufferer first encounters a tingling sensation in the genitals, tracked by a rapid-onset panic attack leading to a sudden and pervasive fear that the genitals are fading and is terminated by an imminent fear of death.

The male population is mostly affected by this syndrome, whereas females rarely suffer from a variation of koro in which they believe their nipples are retracting. Interestingly, koro often occurs as an epidemic where multiple patients are documented simultaneously within a specific geographic location.

What Is the Clinical Presentation of the Koro Syndrome?

Pain, tingling, and other physical symptoms are expected in Koro but are also indicative of an underlying physiological process. As koro is a cultural-bounded psychological condition, it is mainly associated with the following:

• Acute anxiety or panic attacks.

• An apprehension of shrinkage of the penis.

• Impotence.

• Loss of masculinity and sexual control.

• Feeling powerless.

• Infertility.

Genital retraction syndrome is a neuropsychiatric condition with a clinical course of culture-bound koro syndrome, usually self-limited. Still, in some cases, it can be transient, chronic, or recurrent, lasting from days to weeks, months, or even years.

What Are The Body Dysmorphic Disorders?

Body dysmorphic disorder (BDD) occurs within the body images like:

• Koro Syndrome: A specific condition where the heightened perception that one’s genitals will diminish in size invaginates and retracts into the abdomen, eventually leading to death. Mainly associated with shame and apprehension of punishment from others due to having a small penis and a sense of masculine inadequacy. The compensatory mechanisms ensure the existence of the penis by masturbation or grasping the sex organs.

• Counter-Koro Syndrome or Roko Syndrome: A distinct form of BDD directly contrasting to Koro related to paranoia about penile enlargement. The patient with Roko is characterized by the delusion that one’s penis is expanding enormously and that it will result in its excessive protrusion from the abdomen and consequential fear of frequent and perceptible erections. It is related to feelings of regret about having a large penis and erections that may be visible at inappropriate times with rejection of masculinity, as a coping mechanism to obscure the penis at the wrong places by taping and wearing a protective guard.

• Priapism: Organic or psychogenic syndrome a prolonged penile erection that endures for more than four hours beyond sexual provocation and orgasm or is unrelated to sexual impulse. Ischemic priapism is a non-sexual, persistent erection marked by little or no blood flow and irregular cavernous blood gases. Stuttering, or intermittent, is a condition of ischemic priapism that self-resolves spontaneously.

What Are the Causes Of Koro Syndrome?

Koro is a cultural expression of several states, including anxiety neurosis, conversion disorder, depersonalization disorder, atypical psychotic disorder, and body image disorder. The pathogenesis of Koro is poorly comprehended.

In koro-like cases or Sporadic Koro, the clinical presentation appears to be related to the underlying disorder like:

Associated with a primary or neuropsychiatric disorder.

• Drug abuse like cannabis abuse and heroin withdrawal.

• Brain tumor, which is a growth of cells in the brain.

• Recurrent, unprovoked focal seizures that start in the temporal region of the brain characterize the chronic nervous system condition known as temporal lobe epilepsy.

• An obstruction in a blood vessel in the brain that may burst, decreasing blood flow to a portion of the brain, is what causes a stroke, a brain attack.

• An anxiety disorder called phobic disorder is characterized by a recurring, overwhelming fear of something or someone. Typically, phobias cause a sudden onset of fear and last for more than six months.

• Schizophrenia is a chronic brain disorder that includes delusions, hallucinations, disorganized speech, trouble with thinking, and lack of motivation.

Body image is a crucial segment of one’s self-concept. The genital organs are specifically related to one’s gender individuality, and odd perceptions of one’s genital organs can cause body dysmorphic disorder (a body integrity identity disorder). The brain mechanisms contributing to the subjective perception of penis retraction are yet to be determined. Still, Koro has been compared to Capgras and Othello syndromes as a right frontotemporal impairment where the right hemisphere is concerned with the ability to relate to the internal and external world, self-monitoring, and other behavioral dysfunctions. The left hemisphere interprets the world based on false evidence, causing an individual to make fallacious decisions.

What Are the Treatment Modalities of the Koro Syndrome?

Reassurance and lectures on sexual anatomy are given in circumstances tied to past cultures. Psychotherapy is administered to patients in accordance with their symptoms and etiologically significant previous events. In instances with a previously functional personality, a brief history and low frequency of episodes, and a reasonably simple sexual life, the prognosis seems to be better. Careful diagnostic workup, which may involve looking for underlying sexual conflict, is typical for sporadic Western instances. The psychiatric illness identified informs the choice of psychotherapeutic therapy.

Indigenous Treatment:

In China, patients receive traditional care that is based on the causes that cultural beliefs imply. It is normal to offer prayers to the gods and request exorcisms from Taoist priests. If they feel one is present, people may beat or strike gongs to drive away a fox ghost. To balance the internal conditions, the patient will receive a yang- or yin-augmenting Chinese medication, which often consists of herbs, pilose antler (stag of deer), deer tail, tiger penis, deer penis, or fur seal penis. Other therapeutic meals include pepper soup, ginger soup, and alcohol.

It is necessary to rule out physical causes for the koro symptoms, and it is essential to visit the urologist if one experiences these symptoms to address the urogenital pathology.

• In treatment with Haloperidol, the classic symptoms of koro vanished within three weeks.

• Symptomatic reliefs associated with infertility and anxiety.

• Standard antipsychotic and antidepressant treatment has a beneficial effect in most cases.

• Electroconvulsive therapy is used to treat sporadic koro cases of schizophrenia.

Conclusion

Koro can be seen in all cultures, and there is a splendid heterogeneity among non-western patients. However, socio-cultural context and associated comorbidities will likely impact the evolution of classic Koro or Koro-like conditions and must be considered when making a diagnostic formulation. More research is needed to establish how generously to classify Koro syndrome and incorporate cultural influences into diagnostic practices.