KORO:PENILE RETRACTION SYNDROME

A 35 year old patient came with the history of having gone through symptoms of penile retraction.He went through the turmoil for almost 4 hours.He says that he literally had to pull the penile shaft to prevent it from retracting into the body.
He had a particular misconception that if the penis would have totally involuted into the body then he would have died.He said that he heard a few people dying because of this condition.

Genital examination revealed no evidence of penile retraction.Although he was complaining about left testicular tenderness ;it appeared to be due to trauma sustained during the act of mechanical "pulling out".

First we thought the patient to be malingering but there two people with him who happened to be our patients in the past and vouched to have witnessed this condition.
We reassured the patient that such condition doenot exist and he is essentially normal.He was eduacted about his genital anatomy and explained that the penis cannot shrink inside the abdomen.
Later we did a dilgent search on the net.This condition appeared be akin to KORO (this word comes from the Malay-Indonesian word for tortoise) seemed to have been prevalent in China/South East Asia..
Most of the victims complain about episodes of acute attack of genital retraction or genital shrinkage, sometimes both. Each episode usually lasted several hours, though the duration can be as long as two days. There are cases in which koro symptoms persist for years with either chronic and continuous or recurrent history. On top of retraction, other symptoms include a perception of alteration of penis shape, loss of penile muscular tone.
Ideational components of koro include fear of impending death, penile dissolution and loss of sexual power. A man may perform manual or mechanical penile traction, or "anchoring" by a loop of string or some clamping device.
The treatment should be psychotherapy.