User:Clg1124/koro

Koro
Koro is 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. The syndrome is reported in south and east Asia, where it is known by a variety of local terms, such as shook-yang and suo-yang (Chinese), jhinjhini bimari (Assam), and rokjoo (Thailand). It is occasionally found in the West. Koro occurs in localized epidemic form in east Asian areas at times. This diagnosis is included in the Chinese Classification of Mental Disorders, Second Edition (CCMD-2).

Koro can affect men, women, and children between the ages of 8-45. Occurence by age groups is as follows: 10-14 years old-26%, 15-19 years old-32%, 20-24 years old-23%, 25-29 years old-7%,6-9 years old-3%.8 It can occur as an epidemic, affecting hundreds at once, or it can be sporadic, occurring in a variety of places and people. It has little cultural affect and is associated with psychiatric or medical disorders.3 It is based solely on subjective accounts and varies from person to person, making it hard to distinguish fact from fiction.

History and Origin
"Koro may have originated as early as 2,200 years ago and is first mentioned in the Huangdi Neiching, the Yellow Emperor’s Classic of Internal Medicine".1 In 10 A.D in China, it was viewed as punishment for impotence, sexual regression, and anxiety. The Malay word for Koro has many proposed origins. Two of these potential origins, "keruk" and "kuro", translate into "to shrink" and "tortoise" respectively. The term "kuro" seems most logical "given that the "head of a tortoise" is old Malay slang for the glans penis" and a tortoise retracts its head in its shell.3 In Chinese medicine, they believe in yin and yang and that a balance between the two is essential. An excess of yang in men causes great disturbances. There are five viscera, including the heart, lungs, liver, spleen, and kidney, that store but not eliminate specific assigned functions.3 The kidney serves as the main sexual function and is believed to be the storage place for sperm. Sperm is believed to be easily depleted by sexual indulgence. If a man has too much sex, his kidney will be damaged and it will cause retraction of the penis. 1 The Taoist philosophy of koro is that the penis is the main reproductive organ and can only be replaced while having sex. This replaces the ching or sexual energy by absorbing the females sexual energy of yin. If he cannot keep the organ's energy he will die. 7 When a person believes they have koro, they often cry for help and others will try and help them. Death often occurs during this because they will do whatever they think will help that person. 8

The liver is also believed to be involved in the shrinkage of the penis. The liver becomes numb and shrinkage occurs, causing the person to cough, have abdominal pain, and impotence. This is caused by illness due to cold. Grief moves inner self, causing harm to the mind and leads to madness, amnesia, lack of sperm, and muscle spasms. Death is believed to happen when the bones of the chest are depressed, hair color is poor, and during Autumn.

Many believe that a man must only ejaculate when his wife is most likely to get pregnant so they can have a healthy baby. 8

Koro was once viewed as a reproductive organ disorder, but now it is seen as a psychosomatic disorder. There have been many observations of koro and many different groups have come to different conclusions. The psychoanalysts first introduced this into the western world in 1874. It was believed to only include symptoms of shrinkage and limited to the native people. In 1895, it was brought into western literature. In 1930, the need for a more psychoanalytical view became apparent. The first English case of koro was in 1948 and was brought on by a fear of castration. Biomedicine thought of koro as a pathological behavior and cognition problem which lead to anxiety neurosis. In 1965, a 15 point review with koro was developed. It was seen as a depersonalization disorder and an acute hysterical panic reaction. In the 1960s and 1970s, the western world began to see koro as related to drugs and medical disorders such as stroke and HIV. They came up with several reasons why people develop koro. These included body image, sexual neurosis, psychogenic reaction, castration anxiety, fear of social stability, and panic disorder. They performed CT scans to look for changes in the brain and the penile platysmograph. They treated koro with citaprolam and flouoxamine. The sociological view of the possible causes included war, racism, and contaminated food. Men lose these when they die, and their ghosts return as beautiful women called hu-li-jing to steal the genitalia of the living. They also thought that others who witness the behaviors of the affected may lead them to do the same things. Stress also plays a major role in the development of koro 3.

Causes
There are many different beliefs on how koro happens. It can be caused by contaminated food, theft from sorcerers, black magic, drugs, depression, anxiety, psychosis, shaking hands with strangers,1 economic hardships, stressed populations, government reforms, and genetics.

In Singapore, they believed that pork from poisoned swine was the cause. An outbreak occurred and all were warned of the contaminated pork. Of the people affected, only 44% believed it was the contaminated pork while others believed it was caused by a sexual encounter. Most of the affected men were single and had only a primary or secondary education. Most did not believe any of this or experienced symptoms until the media reported the incidents. 3 In China, they believe in a spirit known to them as hu-li-jing, the genital-thieving fox spirit.3 They believe that the hu-li-jing would take the sexual organs of the living in order to stay alive. They have also thought that the spirits would work in pairs: one would steal the organs and the other would give medicine for the replacement.1 Strangers can be the most dangerous cause of all of these others. Men go to great measures to keep their penis from retracting into the body, such as attaching strings and clamps. Women will insert iron pens through the nipples to keep them from retracting. 8

In America, koro is caused by bipolar or schizophrenia disorders, drugs such as cannabis or heroin, and depression. In one case of Cannabis-induced koro, the male experienced a recurring dissatisfaction with the size of his penis and said it was bent. Although the man did not experience a fear of death, he did have great anxiety.6 He had heard that spending time in the bathtub would help decrease his anxiety. In another account, a man was feeling a numbness in his penis and dissatisfaction with its size. He grew up in a community that put an over-emphasis on penis size, and he had always felt this way.6 He took 5mg of diazepam, drank 2 beers, and his fears went away. Both of these men had heard about koro in a class, and then later developed the signs and symptoms. This led them to decrease the times per week they used drugs.

Signs and Symptoms
There are many different symptoms that can occur. The symptoms can be experienced differently by each person and one person may experience all of them. Anxiety occurs in 90%, shrinkage in 74%, retraction in 60%, palpitation in 40%, <10% experience shortness of breath, collapse, nausea, blurred vision, and bodily spasm.1 There is a triad of symptoms that must be experienced in order to have a koro diagnosis. 4These are retraction, belief that it will cause death, and fear. Women experience different symptoms like vaginal sealing, retraction of labia,8 shrinkage of breasts, retraction of nipples, and disappearance of genitals.5 The most common complaint in women is retraction of the nipples or shrinkage of the breasts. 7.7% experience retraction of breasts and 12.8% experience breast shrinking.7

Treatments
Treatments vary in each culture. Some cases are treated with western medicine, but others go to village chiefs for help. A man in Jordan was diagnosed with koro during a time in which he was preoccupied with a misconception about fertility and sexual potency following a testicular operation as a child and sex with a prostitute as an adult.2 In Jordan, they believe that ghosts of the dead take the penis so they can come back to life. 2 The treatment for him was imipramine 25mg/day, alprazolam 1mg/day, along with psychotherapy/behavioral therapy. This particular male was asymptomatic in 3 months, and at 10 months he was back to normal and taking no medications. Many people have sexual inadequacies, and treatment is directed at getting to the root of the sexual conflicts the person may have. 9

In other cases, establishing the validity of theft is the most effective treatment for the person experiencing koro. The person may have medical personnel or police to check the condition of the genitals. If the cause is shaking hands with a stranger, a chief may decide to shake hands with the one being accused of genital stealing. 1 If genitals disappear or shrink, then he is guilty and will be punished. The punishment is to be beaten until the sexual organs are replaced in the victim the same way that they were taken.1 If the fox spirit is the one accused, then an exorcism is needed and medicine is administered to cure the person.8