"KORO-A GENITAL RETRACTION SYNDROME EPIDEMIC IN NORTH BENGAL"




DEFINITION & NOMENCLATURE:------

"Koro" is a Genital Retraction Syndrome where a person thinks that his/her external genitilia (Penis/Testicles or Vulva / nipple of Breast ) will shrink, retract and disappear with or without fear of Death.

It occurs more in male than female patients.The earliest Chinese refrence is seen in'Yellow Emperor's classic of Internal Medicine' dated 300 BC,Western reference to the term koro is found in B.F. Matthes' Dictionary of Beginese Language (1874) of South Sulawesi ,Indinesia. The word is also used in Makassarese Language,meaning "to shrink"; the full dialect for it is garring koro. In Malaysian Language,keruk is the probable linguistic link of koro which means "to shrink". The term shuk yang or shook yong or suo yang (Chinese),Jinjina bemar (Assamese,India),Rok-joo(Thai) are coined for this diseas all in regional language, means "the shrinkage of penis".Actual word "KORO"originated from Malaysian word Tortoise (which is another name for "Penis" in slander language)as Tortoise has a habit of retracting their head resembling (like a PENIS)in to body,so people probably used that example to express this disease.

PSYCHOSOCIAL CLASSIFICATION

Koro has been described as"Culture Bound Syndrome"(which means it occurs in person with certain cultures where these cultural beliefs or myths generate and spread this classical form of disease,it is seen endemic with outbreaks or epidemics as in China,South East Asia, Malaysia, Indonesia (migrated people from China with classical )and certain part of Africa,Thailand,Singapore,India (non chinese local peoples as both classical and non cultural form ) and Western countries like Britain,America, France, Canada, Jordan (sporadic non cultural or secondary Koro where only shrinkage without any fear of death associatedwith CNS disorder,drug induced or under another psychiatric diorder) in mental disorder book and has been subgrouped as'Specific Culture-imposed nosophobia'or 'The genital retraction Taxon' or 'Cultural related beliefs as causes of occurrence'.

PREDISPOSING FACTORS & CAUSES

Psychosocial cultural belief which predispose "koro" a punishment of personal guilt of sex with other ladies/prostitutes(than Spouse/Wife),masturbation/Impotence or Sexual inadequacy (many such ancient folk stories are rampant in Chinese culture or theory of loss of yang humor (The Yan & Ying theory)or semen which is condsidered as vital energy,excess loss of this by frequent Ejaculation(depicted in Taosim which strongly inflence chinese medical thought) may lead to death.Witch Craft or evildoers or Fox spirit or ghost stories and folklore novels or KALA JADU (Assam & Bengal) are prevalent in China where it has been described that these spirits cause genitilia to retract in abdomen,making them physically and sexually weak and utimately dead.in South China and in south asian and Africa and even in India where this disease is prevalent,people have strong belief in such stories and play. Mass hysteria that Contaminated pork with swine fever cause epidemic of Koro in singapore in 1967.In Africa,Black magic was behind this and in Nigeria and ghana,there was panic that penis has disappeared by touch of a stranger.

But in isolated 03 cases in America, patients suffering from anxiety and worries about Penis suffered it after smoking Cannabis which may increase worries and anxiety as its side effect.In Britian and other western part it was due to depression resulting from psychological disorder,phobia for AIDS,brain tumor,schizophrenia etc.,but never a social or folk beliefs based on prevalent ancient stories and dramas.Ethnographic psychologist (who study different cultures) consider koro to be closely related to panic attacks caused by either social belief based on prevalent stories or myth or rumors of food poisioning or evil doers or as punishment to evil doing in form of self perceived or believed sexual offence resulting in retraction or shrinkage of genitialia with or without fear of death.Attacks of koro are often set off when men are in situations that would normally cause the male genitals to shrink slightly,such as emotional distress or cold temperatures.as Scrotum and penis more responds for shrinkage on exposure to mental stress and cold temperature they affect more than female.But tensed and psychological disturbed or introverted sexually freezed or tense female may suffer too complaining of retraction of Nipples and of vulva or disappearance of vulva under tight thighes under severe stress and strain.

SIGN & SYMPTOMS: Koro exist in two forms.Classical or True or Primary Koro where patients under a social belif or rumor or myth complains of shrinkage of Penis or testicles or both in Male and of Vulva or Nipples of breast / breast or both in female folowed by retraction of them in abdomen with physical and sexual weakness with or without fear of death.Mostly present as acute attack lasting for hours to maximum duration of 02 days.But some may show symptoms for years as chronic cases or recurrent cases ,some instead of shrinkage of genitilia complain genital shortening,alteration of penis size,loss of muscular strength,genital paraesthesia with no complain of retraction or breast mass in female with altered breast size and hidden or distorted nipples.Feature of sexual dissolution,loss of sexual or physical power,weakness,urinary obstruction,sterility may be seen.Psychologically Pateint suffer from anxiety neurosis may include fear of death,non specific physical danger,impending madness,spirit possession and feeling of being bewithched or under cover of black magic with feeling to sex change to eother female or vice versa or turning Enuch.

But in secondary or unclassical form of Koro as seen in western world only retraction of penis or loss of penile strength is coplained where person has got intense anxiety for penis with a strong psychosocial disease or under any organic brain disease or under influence of drug or intoxication.

While there are no substantiated reports of the condition itself resulting in any physical damage to the individual, many sufferers have unfortunately inflicted harm upon themselves or physical damage in frantic attempts to stretch the penis or Breast to prevent further shrinkage. It is not unusual for those with koro themselves or wthrough their family members and social sympathisers to resort to using devices such as clamps or weights or pegs or by aloop of string for retraction of penis as mechanical traction device.female either herself or ladies around her grab breast,pull nipples out or insert iron pins in nipple so that it cannot go inside.

Chanting of local religious songs and puja or religious celebration to please God/Goddess through local preachers and pandits or programmes for their blessing or correct any unknown mistake conducted in their past celebration or work out by local witch hunters by putting wood fire and smoking to remove bad blessing or evils or black witch from society or beating or killing of socalled wrong or evildoers suspected in society or villages is done.In North bengal people are putting lime water over both ears and nose ,keep Kush grass or pure water of a temple or river to keep these bad evils from them .some also cover their genitilia and breast so much under clothe as nothing happens to these organs.

DIAGNOSIS: it is easily done when epidemics occur as strong social belief or myth or rumor based on past prevalent stories and drama of witch hunt or as a punishment of some sexual wrong doing or intake of contaminated food or prsence of some diseases with typical full blown symptoms of penile/Testicle shrinkage or retraction in abdomen in patient of introversion suffering from anxiety or psychological disorder or under religiuos and social belifs and faith in myths or evil doers with or without sexual and physical weakness and fear of death.Injuries are secondary to measures taken by patients or relatives to prevent injuries.

TREATMENT:---

As the disease involves social beliefs and psychological insult so both Medical and Indigenous treatment should be given otherwise complete eradication may not be possible.As no defect is found in genitilia and breast to nothing is done for this if injuries inflicted by patient or relatives as mechanical manipulation to prevent retraction of genitilia or nipples then local injuries are dealt both surgically and medically.

in Cultural bound cases,lectures should be organised through healers of society by educating them with anatomy and physiology of Genitilia with audio visual or practical demonstration either as alone or to whole society utilising local media,radio /Tv/poster/leaflets and picturing small booklets,Individualy affect person psychosocial analysis is done and therapy for underlying disease is started.Inwestern type sexual conflict is identified and patient treated for any psychological or organic disease diagnosed.

indigenous medicines by local healers may be also advised to win the belief of people,praying to Gods and submitting to socalled social healers and witch hunters may be allowed to control epidemic spread but side to side strong counselling and health education should be provided individually ,by NGO or by Government health agency and social reforming departments.In china people hit gongs or bells to drive out witches .They use chinese a yang or yin augmenting medicine including herbs,animal penises (of tiger,deer,and fur seal )pilose anter(stag of deer) or deer tail.Pepper soup ,ginger soup,Louki or cucumber soup or liquor is also drunk to cure the diesease,in north Bengal people are using lime water application over both ears and nose and kush grass and holy water keeping to keep awya bad evils.

Dr.D.R.Nakipuria



09434143550

**Author is a naco trained HIV and sex specialist