Men under 30 are seeking emergency psychiatric care for Koro syndrome, a rare disorder where sufferers believe their genitals are shrinking into their abdomen. Data shows between 42 and 55 percent of men experience anxiety about genital size, but in severe cases this distress transforms into an intense, irrational fear of complete organ retraction.
Despite the belief appearing absurd to outsiders, the fear becomes entirely real to the individual and induces severe anxiety and fear of death.
Unusual emergency cases and folk remedies
In one case, a 26-year-old man sought emergency medical care after experiencing anxiety and fear of death for a month because his penis began retracting into his abdomen. He frequently inspected his genitals and asked his friends to examine them as well. His friends advised him to apply cow dung to his penis to prevent it from vanishing inside his abdominal cavity.
After a week of using cow dung as a folk remedy, the man developed difficulty urinating and his urine became cloudy. Doctors transferred him to a psychiatric ward, prescribed medications, and enrolled him in a psychotherapy program focused on sex education and stress management techniques, which successfully eliminated his obsessive thoughts.
A 22-year-old factory worker who worked in a freezer room sought hospital treatment after experiencing similar symptoms for two years. His genital anxiety was so severe that he could not sleep at night. He resigned from his job because he attributed the genital shrinkage to exposure to cold temperatures.
The factory worker felt an uncontrollable urge to pull his genitals outward manually to relieve his anxiety. Doctors achieved significant symptom relief by providing drug therapy, psychoeducation, relaxation training, mindfulness practices, and deep breathing exercises.
Understanding the causes of Koro syndrome
Medical professionals diagnosed both men with Koro syndrome, an extremely rare condition primarily affecting men under the age of 30. Marina Kalyuzhnaya, a psychiatrist-narcologist and founder of the Doctor Kalyuzhnaya Clinic, told Lenta.ru that the disorder should not be viewed as a mere textbook curiosity.
Kalyuzhnaya explained that such cases represent a classic example of how standard human anxiety assumes a strange form. She stated that humans possess a fundamental and deeply archaic fear of losing vitality, bodily integrity, and male power in a literal sense, and culture provides a ready-made structure to contain that anxiety.
Medical science categorizes Koro syndrome into two distinct types: culture-bound, which is the most common form, and sporadic, which occurs randomly. Sporadic cases are typically recorded in Western nations, while culture-bound cases emerge in Asia and Africa within communities where reproductive capability serves as the main measure of a young man's worth.
Cultural myths and psychogenic epidemics
In China, rapid genital shrinkage is traditionally linked to possession by a fox spirit. In Singapore and Thailand, sufferers attribute organ loss to poisoning, while in Africa, the condition is associated with witchcraft.
In these cultural settings, Koro syndrome often manifests as a mass phenomenon affecting multiple men at the same time. Although it is not an infectious disease, sufferers appear to catch the disorder from one another.
Kalyuzhnaya explained that such outbreaks are spread by an idea rather than a virus. She noted that when a panicking person tells neighbors that their organ is disappearing, anxious neighbors begin listening to their own bodies and detect the same physical sensations, creating a classic psychogenic epidemic.
Risk factors and extreme responses
Doctors divide the risk factors for Koro syndrome into mental and physical categories. Mental factors include schizophrenia, obsessive-compulsive disorder, depression, Alzheimer's disease, and several other mental illnesses. Physical factors include urogenital dysfunction, infertility, intimate area pain, and urogenital fistula.
Before obtaining psychiatric help, many men resort to physical measures to stop the shrinkage. Sufferers frequently clamp their genitals tightly and pull on them, sometimes receiving assistance from confused and anxious relatives. A traditional belief also holds that a wife can reverse the retraction through oral sex.
Folk medicine is widely used in Asian cultures, but not in Europe. Urologist Mark Gadzhiyan wrote that some men take extreme steps by seeking surgical penis enlargement. Gadzhiyan emphasized that surgeons must refuse to perform operations on such patients and instead refer them to the appropriate medical specialist.
Female manifestations and historical cases
Although almost all recorded cases of Koro syndrome involve men, the disorder occasionally affects women. One documented case involved a 25-year-old Hindu woman who claimed her vagina was retracting into her body, despite repeated gynecological examinations finding no physical abnormalities.
Women account for 9.2 percent of culture-bound Koro syndrome cases. The 25-year-old patient constantly touched and checked her genitals to ensure they had not disappeared, causing severe discomfort, rapid heart rate, sweating, and fear of impending harm. She neglected household chores and isolated herself from others before receiving proper therapy that led to recovery.
Dutch physician Pieter Mattheus van Wulfften Palthe first described female Koro syndrome in a 1935 report. He detailed the case of an Indonesian woman in Mandomai village who died because local laws prohibited men from assisting women with genital-related illnesses.
Kalyuzhnaya explained that the low incidence among women occurs because the central symbol of the fear is physically tied to male anatomy, reproductive status, and feelings of power. She noted that the cultural burden surrounding male completeness has historically been heavier, though rare female cases involve perceived shrinkage of the labia or breasts.
Medical treatment and psychiatric care
Treating Koro syndrome involves a combination of medical, psychological, and social interventions. Doctors must first perform physical examinations to rule out actual anatomical abnormalities, such as Peyronie's disease.
Physicians prescribe medications based on the patient's symptoms and any co-occurring mental disorders, using antidepressants, antipsychotics, sedatives, and anti-anxiety drugs. Psychotherapy combined with education plays a vital role, as doctors explain genital anatomy and function, address sexual health topics, and dispel cultural myths.
In rare instances, patients fail to respond to medication and psychotherapy. Medical literature records two chronic cases where remission did not occur for 12 and 15 years despite comprehensive interventions. However, the acute form typically observed during mass epidemics carries a favorable prognosis.
Kalyuzhnaya noted that patients usually arrive at a psychiatrist's office only after several other doctors have failed to help them. A sufferer typically visits a urologist first for a physical exam, then sees a general practitioner regarding heart palpitations and physical anxiety symptoms, while their anxiety intensifies daily.
When a patient finally consults a psychiatrist, Kalyuzhnaya warned that the doctor must never tell them that the condition is merely in their head, because the fear is entirely real to the patient. She stated that the initial priority must be reducing acute anxiety, using medication when necessary, so the patient can communicate calmly before beginning full treatment.
