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OPINION
Year : 2021  |  Volume : 19  |  Issue : 2  |  Page : 117-118

Shrinking and psychological disappearance of the penis: A salient psychocultural issue in Nigeria


Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy

Date of Submission24-Jan-2021
Date of Decision10-Feb-2021
Date of Acceptance15-Feb-2021
Date of Web Publication15-Apr-2021

Correspondence Address:
Dr. Chidiebere Emmanuel Okechukwu
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_10_21

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  Abstract 


Koro syndrome is a psychiatric disorder characterized, by severe anxiety, with grievances of a shrinking penis in men and fear of its retraction into the abdomen and consequent death. Koro is also identified as genital retraction syndrome or shrinking penis syndrome, and it was recognized in the diagnostic and statistical manual of mental disorders, fourth edition in the section of culture-bound syndromes. There are numerous reported cases of penis loss in Nigeria, the suspicion associated with penile retraction usually transforms into a severe panic attack concerning fear of loss of potency and virility in men. Psychosocial factors, cultural belief, religious doctrine, strong confidence in the mystical powers of voodoo, and present mental condition of an individual often act as stimulus in the reported cases of male genital retraction and mysterious penis theft in West Africa. Moreover, in Nigeria, it is often believed that individual genitals were stolen for ritual and occultic purposes. Patients with Koro can be treated using psychotherapy with reference to the underlying symptoms and mental disorder.

Keywords: Andrology, Koro, male genital, Nigeria, panic disorder, psychiatry, psychotic disorders


How to cite this article:
Okechukwu CE. Shrinking and psychological disappearance of the penis: A salient psychocultural issue in Nigeria. Curr Med Issues 2021;19:117-8

How to cite this URL:
Okechukwu CE. Shrinking and psychological disappearance of the penis: A salient psychocultural issue in Nigeria. Curr Med Issues [serial online] 2021 [cited 2021 Jun 19];19:117-8. Available from: https://www.cmijournal.org/text.asp?2021/19/2/117/313807




  Introduction Top


Psychological disappearance of the penis, also known as Koro syndrome has been reported in Asia and Africa.[1] Koro syndrome is a psychiatric disorder characterized, by severe anxiety, with grievances of a shrinking penis in men and fear of its retraction into the abdomen and consequent death.[2] Although Koro is associated with panic attacks, it is essential for urologists who specialize in men's sexual and reproductive health to have a comprehensive knowledge of this syndrome for effective clinical diagnosis and referral to psychiatrists for final diagnosis and treatment. Koro can also be described as culture-specific syndrome in which the concerned person has an overwhelming belief that his external male genital organ is retracting and will disappear, notwithstanding the absence of any established changes to his organ.[2] Koro is also identified as shrinking penis syndrome, and it was recognized in the diagnostic and statistical manual of mental disorders, fourth edition in the section of culture-bound syndromes.[2] Koro can also be described as genital retraction syndrome and is characterized by the belief that the shrinking penis will finally be grasped into the body, which will eventually lead to death.[3]

There are reported cases in which Koro symptoms continue for years, signifying a possible comorbidity with penile dysmorphic disorder, also known as small-penis syndrome, which is a form of body dysmorphic disorder that signifies a lingering obsession and concern over one's penis size that is within the normal range.[4] In Nigeria Koro is related with mysterious, and occultic belief such as witchcraft and African juju/voodoo.[1],[5] However, most men who are morbidly obese often have buried penises, due to excess fat deposition within the genital region.[3] Some of the symptoms of Koro include a feeling of adjustment in the penis shape, organ reduction, urinary hindrance, infertility, loss of penile muscles, and itching sensation within the genital region.[1],[2],[3]


  Psychosocial Features of Koro Top


Major psychological features of Koro are penile disappearance, anxiety over imminent death, diminished erotic ability, imminent madness, bewitchment, and possession by evil spirit.[1],[5] In West Africa, most individuals with Koro and their family members usually seek for spiritual help through a voodoo doctor.[5] Koro has a strong psychosocial, religious, and cultural connection.[5],[6] However, belief in the disappearance of the penis is significantly associated with psychosexual contradictions, personality influences, and cultural beliefs.[1]


  Some Reported Cases of Koro in Nigeria Top


Psychological disappearance of the penis and mysterious penis theft, have been extensively reported in West African countries, alleged “penis thieves” are often beaten to stupor, and most times they are lynched to death, most especially in Nigeria.[7] There are numerous reported cases of penis loss in Nigeria, the suspicion associated with penile retraction usually transforms into a severe panic attack concerning fear of loss of potency and virility in men.[8] In Nigeria, the participants usually claim that their male external genital organ had disappeared.[8] The inception of psychological disappearance of the penis is characterized by cue, flash, check and alarm, the cue is typically a touch, most often a handshake from a stranger.[8] The flash is a terrible and fearful consciousness frequently defined as a tremor, shock, stomach cramp, and scrotal spasm, followed by an individual's reluctance to reach for his penis to check whether it is intact.[8] With the belief that his male genital organ had disappeared, the person usually makes a loud noise depicting the alarm, calling the attention of the general public for help.[8] Psychological disappearance of the penis and mysterious penis theft is usually recognized as a mystical incidence in West Africa in which an affected individual is stripped of his male organ for occultic purposes, and the falsely accused genital organ thief often receives harsh treatment from the masses.[8] Clinical presented cases of Koro depict patients who have mental disorder, most patients are described as worried, fearful, and agonized.[8] On March 11, 2020, a Nigerian news outlet, reported an incident in which a motor spare parts dealer in Bayelsa State, Nigeria was accused of mysteriously stealing someone's penis, and he was nearly beaten to death by an angry mob, who attacked him following a false penis theft alarm raised against him by a laundry operator who he handed his garments in Yenagoa, Bayelsa State.[9] On April 12, 2001, the British Broadcasting Corporation news Africa reported a case in Osun state Nigeria where an angry mob killed 12 people accused of stealing people's penis for occultic purposes because an individual raised an alarm that his penis had disappeared.[10] Similar incidents occur widely in other West African countries, where there are numerous reported cases of genital retraction syndrome and accusations of penis theft.[11] Patients with Koro can be treated using psychotherapy with regard to the underlying symptoms and mental disorder.[6] However, there is shortage of psychiatrists in Nigeria, and this seems to limit effective mental health-care service delivery in the most populated African country.[12]


  Conclusion Top


Koro can be described as a panic disorder that is associated with belief in male genital retraction, whereas the male genital is still intact. Psychosocial factors, cultural belief, religious doctrine, strong confidence in the mystical powers of voodoo, and present mental condition of an individual often act as stimulus in the reported cases of male genital retraction and mysterious penis theft in West Africa. Moreover, in Nigeria, it is often believed that individual genitals were stolen for ritual and occultic purposes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mattelaer JJ, Jilek W. Koro – The psychological disappearance of the penis. J Sex Med 2007;4:1509-15.  Back to cited text no. 1
    
2.
Ntouros E, Ntoumanis A, Bozikas VP, Donias S, Giouzepas I, Garyfalos G. Koro-like symptoms in two Greek men. BMJ Case Rep. 2010;2010:bcr08.2008.0679.  Back to cited text no. 2
    
3.
Dan A, Mondal T, Chakraborty K, Chaudhuri A, Biswas A. Clinical course and treatment outcome of Koro: A follow up study from a Koro epidemic reported from West Bengal, India. Asian J Psychiatr 2017;26:14-20.  Back to cited text no. 3
    
4.
Okechukwu CE, Deb AA, Emara S, Abbas SA. Penile dysmorphic disorder: A secret obsession in men. Urol Sci 2020;31:85-6.  Back to cited text no. 4
  [Full text]  
5.
Ventriglio A, Bonfitto I, Ricci F, Cuoco F, Bhavsar V. Delusion, possession and religion. Nord J Psychiatry 2018;72:S13-5.  Back to cited text no. 5
    
6.
Chowdhury AN, Brahma A. Update on Koro research methodology. Indian J Psychiatry 2020;62:102-4.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Dzokoto VA, Adams G. Understanding genital-shrinking epidemics in West Africa: Koro, juju, or mass psychogenic illness? Cult Med Psychiatry 2005;29:53-78.  Back to cited text no. 7
    
8.
Ilechukwu ST. Magical penis loss in Nigeria: Report of a recent epidemic of a Koro-like syndrome. Transcult Psychiatry Res Rev 1992;29:91-108.  Back to cited text no. 8
    
9.
Daily Trust. Available from: https://dailytrust.com/how-mob-attacked-me-over-penis-theft-allegation. [Last accessed on 2020 Nov 10].  Back to cited text no. 9
    
10.
BBC News Africa. Available from: http://news.bbc.co.uk/2/hi/africa/1274235.stm. [Last accessed on 2020 Nov 10].  Back to cited text no. 10
    
11.
Mather C. Accusations of genital theft: A case from northern Ghana. Cult Med Psychiatry 2005;29:33-52.  Back to cited text no. 11
    
12.
Okechukwu CE. Shortage of psychiatrists: A barrier to effective mental health-care delivery in Nigeria. Int J Noncommun Dis 2020;5:22-3.  Back to cited text no. 12
    




 

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