Last Updated on February 25, 2023 by Mike Robinson

What is Koro Syndrome?

Koro syndrome is a mental disorder in which the patient believes his genital organs are shrinking or retracting into his abdomen and will soon vanish. Men are more likely to have it. They think their penis is getting smaller and could even grow inside their bodies, which would kill them.

In cases of women with this syndrome, they believe that their nipples are shrinking or that their vagina is about to disappear, even though nothing strange or abnormal is happening with their genitals. Patients with this syndrome feel very anxious and often have obsessive thoughts and compulsive behaviors: they try to stretch or enlarge their penises 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. Cases of massive hysteria have been documented around this syndrome, which could “spread” from one person to another in certain cultures.

Types of Koro Syndrome

There are two main types of koro syndrome. Primary koro results from culture and happens to people who don’t have other mental disorders. Secondary koro is a result of diseases like schizophrenia, body dysmorphic disorder, or anxiety disorders and happens to people who don’t have primary koro.

Characteristics of Primary Koro

It is prevalent in countries like India, China, and Japan due to its close ties to local cultural beliefs. Most men with this disorder are single, have little sexual education, and strongly believe in paranormal events like spells. The patient displays symptoms of extreme anxiety and fear in these circumstances. He fears that this will cause him to pass away and that his genitalia are shrinking and may soon vanish.

Many patients assert that masturbation may cause their genital problems or that they may have begun after having sex with a prostitute. This demonstrates how closely this syndrome is to cultural beliefs and sex education needs.

Characteristics of Secondary Koro

Cases of Koro syndrome that happen outside of Southeast Asia, where it is common, are “incomplete” cases of the syndrome. Another mental disorder usually causes these cases. In secondary koro, the person also thinks his genitals are shrinking and could disappear. However, he doesn’t believe he will die from it, and the anxiety that comes with it isn’t as bad as in primary koro.

Signs and Symptoms of Koro Syndrome

Although the penile or other genital regions could contract temporarily due to low temperatures, it is not permanent. Therefore, it should not trigger anxiety symptoms unless the person suffers from Koro syndrome.

Research from cases of koro shows that anxiety attacks usually subside after a few hours in most cases. However, they could last up to a couple of days. In other cases, koro symptoms can persist for longer and become chronic. This increases the likelihood that the syndrome occurs with other mental diseases, such as body dysmorphic disorder.

In addition to the presumed retraction of the penis, other symptoms may include a change in how the penile muscles look, a loss of muscle tone in the penile muscles, and paresthesia in the genital area (abnormal or strange sensations, tingling, etc.). The patient also fears dying, his penis disappearing altogether, or having erectile dysfunction in the future.

Other beliefs that the patient may present with in Koro syndrome include the fear of becoming a woman, of being sterile, of their urinary tract becoming blocked, of being possessed by an evil spirit, or of being the victim of a spell.

Highly anxious patients may resort to physical methods to prevent retraction of the penile implants, anchoring them with different devices that could cause damage. In the case of women, the breasts or nipples may be stretched to prevent shrinkage, and even some jewelry rings are on the nipple, which could also cause injuries.

What Sauses Koro Syndrome?

As mentioned, psychosexual conflicts, certain personality factors, and cultural beliefs are the leading causes of Koro syndrome.  In patients with this condition who are not from Southeast Asia, there are often activities such as sexual promiscuity, feelings of guilt after masturbation, or sexual impotence.

 Mass Hysteria Cases of Koro Syndrome

There have been reports of massive hysteria of Koro syndrome, that is, groups of people in which the symptoms appear and who apparently would have “contacted” each other.

For example, a worker in a West Bengal mill, single and low-income, was treated at the psychiatry service in the area. The man reported that his penis was shrinking into his abdomen for two or three days.

He said he did not use any drug, and in his clinical history, he had no psychiatric antecedents. The patient believed his symptoms were due to his nightlife and masturbation.

So that his genitalia wouldn’t shrink, he jumped into a nearby pond and stayed there all night for 14 or 16 hours. This gave him a respiratory infection. People he worked with and people who lived in the area knew this. Two days later, six other people who worked at the same mill had the same symptoms and decided to act like their co-workers. The doctors then decided to stay on high alert and give group therapy to the workers. 

After five or six days, the outbreak went away. But a few days later, a divorced 53-year-old worker who had been absent during those days went to the emergency room saying that his penis was shrinking. When he returned to the village, he discovered that his friends had been sick and had gone into the cold water to relieve themselves. Even though this patient drank alcohol sometimes, he said he hadn’t had any in two weeks, and his medical history showed no psychiatric problems.

The outbreak was activated again with this case, 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 under control after six or seven days.

The Brain and Koro Syndrome

While the underlying mechanisms are still poorly understood, the theory of mirror neurons could explain this massive behavior. This is a particular type of neuron in the human brain and the brains of other primates. It is responsible for “observing” the behavior of other individuals of the species and imitating their behavior.

These neurons could play a crucial role in learning by imitation. Their function would still be less able to prevent the person from imitating everything others do. However, in cases of massive koro, the inhibition of these neurons would fail. Therefore, the syndrome could spread from person to person.

Diagnosing Koro Syndrome

To make the diagnosis, there must be a complete medical review, including psychosexual aspects and the patient’s psychiatric history. The doctor should investigate if the patient is concerned about their appearance or body image to rule out body dysmorphic disorder.

It is also important to inquire about the beliefs and values of the patient or what he thinks about his genitals or his sexual life. We must also rule out any injury or changes that might happen to the genitals.

In summary, if the patient declares that his genitals are shrinking with no evidence of physical abnormalities, shows severe anxiety, believes that he can die, and uses devices to avoid retraction, it is primary koro. If any of these symptoms are missing, but others are present, they may be secondary or incomplete. This version is usually the one that appears in Western countries.

Treatment Options

In cases of koro associated with cultural beliefs, symptoms disappear with psychological therapy. Reoccurrence of symptoms is preventable by providing information on anatomy and adequate sex education.

In Western Kore cases, they should look for sexual conflicts and mental illnesses that may cause the symptoms. The psychological and psychiatric treatment will depend on the patient’s situation.

Also Read: What Is Cognitive Restructuring and How Is It Applied?

Koro syndrome is rare, but its symptoms, the references that patients make, and how it can be “contagious” are fascinating.