Koro: A Universally

KORO: A UNIVERSALLY OCCURRING PSYCHOLOGICAL SYNDROME

Koro: A Universally Occurring Psychological Syndrome: An Ethnomedical Perspective

Auriell Frederick
Our Lady Of The Lake College
November, 2012

Koro: A Universally
Abstract
The primary goal of this paper is explore and present a summary of the ethnomedical
aspects of Koro, the psychological syndrome that afflicts individuals with the consuming belief
that ones genitals are retracting inside their body which may or may not result in death. There
have been no recorded cases of this physiological phenomenon. This severe anxiety producing
condition is widely referred to as Koro.. This affliction is described as Suo Yang when recognized
by China, Taiwan, and Singapore. The etiology of this illness can also be traced back to the
Middle Ages of Europe. This syndrome has also been described in Jordan, Africa, Canada, and
Italy. The secondary aim of this paper will seek to identify whether Koro is a culture-bound
syndrome or universal in nature.

Koro: A Universally
Koro has been noted for centuries in Asia but gained notoriety in 1895 when described by
Western anthropologists (Mattelaer and Jilek, 2007). The etiology of the Malay word originates
from the Austronesian group of people including its surrounding coastal Indonesian peoples and
loosely translates to turtles head, and resembles the reptiles behavior with regard to the act of
retracting its head into its body. The International Society of Sexual Medicine described this
psychiatric disorder as an acute state of panic anxiety and classified it as culture specific. The
main concern of individuals suffering from Koro is that their genitalia will shrink inside their
body, possibly into their abdomen which that this can result in sterility and potentially death. On
certain occasions it is thought that death is an inevitable outcome.
The Chinese are particular to the sexual ideology which describes Yin and Yang as the
necessary combination for spiritual harmony and sexual balance. The Daoist philosophy refers to
Yin as the dark energy and Yang as the light energy, both of which are necessary for vitality and
balance. Yin represents the female energy and Yang, the male energy. Such sexual beliefs include
the reasoning that when a disproportionate amount of Yang is lost vitality and death will result
(Tseng, et al., 1988).
The Chinese term for Koro is Suoyang or Sook Yong depending if the dialect is Mandarin
or Cantonese. One emic perspective describes the cause of Suoyang or SookYong as supernatural
rather than natural with negative magical influences from female fox spirits. These mythological
creatures were rumored to be roaming about, transforming themselves into femme fatales with
the primary intention to rob males and females of their Yang organs; protrusions such as the
penis, nipples, testicles, and labia (Mattelaer and Jileck, 2007). The American Journal of
Psychiatry, 1988 reports that, The life pattern and attitudes toward supernatural beings and the
commonly shared folk believe of evil-induced genital retraction were considered for the panic,
while the communitys anxious react and hysterical atmosphere facilitated the intensification and
recurrence of the episodes. Geographic seclusion associated with the localism in fold believes
and practices may have kept the epidemic confined to the region. During a period of which
epidemics were gaining notoriety an attack in South China was directly correlated to the
perpetuation of mass hysteria and intense fear of being harmed or possessed by these meandering
fox spirits. The psychological extension of agitation and excitement of particular peoples is
exhibited in non-Asia cultures as well.

Koro: A Universally
Another folklore explanation for Koro is that indigenous spirits seek the genitals of their
corporeal inhabitants as they are without their own sexual organs. The desire to rob the living
stem from the belief that the procurement of such flesh will allow them come back to life (AlHmoud, 1999).
Chinese culture attempts to ameliorate Suoyang or Sook Yong by fastening various
instruments to the sexual members, applying clamps, pins, chopsticks, and tying string to their
genitalia to prevent retraction, including grasping ones self. The application of pouring cold
water on the afflicted ones head, eating an increased amount of foods high in Yang energy (such
as lime juice, ginseng root, and lean meats), or even receiving fellatio immediately upon
suspecting Koro were thought to reduce or ward of the disease (Faccini, 2009). Sounding
firecrackers, gongs, and various noisemakers were thought to chase the spirits away. Attempts to
pull the sufferers penis from his body are also practiced. If string is not available the stem of
vegetable such as a yam is used to stretch the genitals (Tseng, et al., 1988). Often concerned
family members or individuals within a community will assert measures of assistance without
prior complaint or recognition by the person said to be suffering Koro (Mattelaer and Jilek,
2007).
One study in Tawain, 1972, noted that out of 2,000 individuals only 3% of those afflicted
by this disorder were female (Faccini, 2009). Females affected by Koro were similarly concerned
that their labia and nipples would disappear into their bodies and could suffer the same maladies
and morbidity as their male Taiwanese peers.
Koro epidemics have been common in the 20th century. Documented locations of Koro
epidemics include Singapore and India. In 1982 an epidemic in West Bengal, India was reported
as affecting over 1,000 individuals, all of varying socioeconomic and religious backgrounds.
Those suffering included Moslems, simple material tribespeople and Hindus representing all
castes. The chief complaint of women was fear inversion of nipples and depressing of breasts.
During this time India struggled with heightened interethnic and social tensions which may have
contributed to the collective fear of the rural population would be endangered by invading
inhabitants (Mattelaer and Filek, 2007).

Koro: A Universally
A case study in Jordan was recorded where the patient was in a heightened state of panic
and was extremely anxious that his penis would slowly disappear inside his pelvis. He was
brought to a psychiatric clinic for help by a family member. His only sexual experience was a
recent encounter with a prostitute. His reflected on his experience with embarrassment and
humiliation. Upon examination the clinical findings were unremarkable, including magnetic
resonance imaging and physical examination. His medical history was a singular procedure of
orchidopexy to repair a torn testicle. Though Jordons spiritual belief system included
supernatural demons and spirits they are not thought to steal genitals. Evaluation concluded that
the patient was worried about the surgery caused a decrease in his fertility and disabled his
manhood. He was diagnosed with an anxiety disorder and placed on anti-anxiety medication. At
a three month re-evaluation he was found to be asymptomatic. Upon a ten months evaluation he
continued to be asymptomatic and ceased taking medication (Al-Hmoud, 1999).
Consideration has been given to this psychological disorder (Koro) as whether it is linked
to a body image problem. Body dysmorphic disorder (BDD), also known as dysmorphophobia
was initially described in 1886 by an Italian psychiatrist, Enrico Morselli. Those suffering from
BDD suffer a distorted sense of physical and bodily perception with regard to their own bodies.
Morseli describes BDD as, "The dysmorphophobic, indeed, is a veritably unhappy individual,
who in the midst of his daily affairs, in conversations, while reading, at table, in fact anywhere
and at any hour of the day, is suddenly overcome by the fear of some deformity ... (which) may
reach a very painful intensity, even to the point of weeping and desperation," (Phillips, 2004).
Though Koro has similar features of BDD, Koro generally appears in brief duration often
with accompanying fear of death. Koro also seems to respond well with medication and personal
reassurance. Koro epidemics are documented to occur in hundreds to thousands of individuals
within the period of a couple of weeks to several months time. (Tseng, et al., 1988). BDD is not
purported to occur in epidemiology as Koro is, however, both afflictions do cause certain suffers
to prefer death as an alternative to their perceived realities (Phillips, 2004).
Sporadic cases of Koro in the British, Canadian, German, Jewish, Greek, Vietnam, and
Thailand were also reported by Tseng. Contemporary Western societies do not endorse the
ideology of shrinking genitals but this legend dates to late The Middle Ages in Europe. A mans
member was endangered by magical attack. Witches were fabled to attack males making their

Koro: A Universally
genitals vanish, including their membrane virile. The Malleus Maleficarum, a fifteenth century
European book was created a book for the investigation of witchcraft. Burr notes an excerpt from
the manual, Even when armed with the papal bull, the German Inquisitors found their
preparation incomplete. Soon after their return from Rome they set themselves at the compilation
of a hand-book which should leave no judge an excuse for laxity on exposition of witchcraft and
a code of procedure for the detection and pun-ishment of witches. This, completed in 1486, they
called Malleus Maleficarum, The Witch-Hammer." The manuscript chronicles males who lost
their organs as being hidden with The Devil and witchcraft the culprit. They were said only to
reappear after they placated the witches (Burr, 1998).
A vast collection of evidence of this psychological condition appears word-wide affecting
individuals of numerous countries, socioeconomic backgrounds, and caste systems. Though the
emic causation may vary regionally as there is extreme diversity of religious and spiritual beliefs
and the basic nature of the afflicted groups enculturation, the symptoms are identical with the
exception that death may or may not occur. This conclusion is that Koro is not culture bound
illness but occurs universally.

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References
George L. Burr, ed., The Witch Persecutions in Translations and Reprints from
the Original Sources of European History, 6 vols. (Philadelphia:
University of Pennsylvania History Department, 1898-1912) vol. 3, no.
4, pp. 10-13
Lino Faccini, (2009) The Incredible Case of the Shrinking Penis: A Koro-Like Syndrome in
an Person with Intellectually Disability., Sexuality and Disability - SEX
DISABILITY , vol. 27, no. 3, pp. 173-178, 2009
Al-Hmoud, 1999, Koro-like syndrome in a Jordanian Male, N. East Mediterr
Health J. May;5(3):611-3.
Mattelaer JJ, Jilek W. (September 4,2007). "Koro--the psychological disappearance of the
penis.". History Office of the European Association of Urology.
http://www.ncbi.nlm.nih.gov/pubmed/17727356. Retrieved 15 October, 2012
Katharine A Phillips, 1999, Body dysmorphic disorder: recognizing and treating imagined
ugliness.. World Psychiatry. February; 3(1): 1217.
Tseng, Wen-Shing (2001), Handbook of Cultural Psychiatry, San Diego: Academic press, ISBN
0-12-701632-5

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