Chronic koro-like symptoms – two case reports

A 30-year-old unmarried, male, clerk presented with the persistent fear that his penis was shrinking gradually for last 12 years. He stated that due to the shrinkage he remained weak, anxious and sleepless. He continuously brooded over it. He got panicky whenever he saw his penis, as he felt that it is shrinking back, and remained perturbed for days together after that. Due to this he consciously avoided to see or contact his penis, even in bathroom. He explained that it was due to his nocturnal emissions and a couple of masturbatory acts in middle adolescence. He was extremely religious and attended religious institutions (like that of Satsang and Brahmakumaris). He considered penis as sacred and its gradual shrinkage as an omen of his ultimate destruction and death. He believed that this was due to sinful (anti-religious) incidences of nocturnal emission and masturbatory acts. He had decided not to marry in order to avoid any possible retraction. He remained preoccupied with these thoughts, avoided company, and interaction with females. He requested for medicines that would stop further retraction.

He had been given anxiolytics, sedatives, antidepressants and anti-psychotics at various point of time by many practitioners and had been counselled. His symptoms persisted with intermittent exacerbations without much relief.

Unlike obsession his thoughts were never resisted. His belief had influenced his behaviour and way of life, was shakeable, and appeared more like overvalued ideas. His mood state was predominantly anxious with occasional panic attacks associated with somatic equivalents. He did not have any other major psychiatric syndrome.

A 41-year-old unmarried, unemployed male from a business family, presented with the complaints of gradual retraction of penis and scrotum into the abdomen. He had frequent panic attacks feeling that the end had come. The symptoms had persisted more than 15 years with a waxing and waning course. During exacerbations he spent most of his time measuring the penis by a scale and pulling it in order to bring it out of abdomen. He tied a string around it and attached it to a hook above to prevent its shrinkage during night. There was a history of excessive sexual indulgence in the early twenties with prostitutes and he had suffered repeatedly from sexually transmitted diseases characterised by discharges (probably gonorrhoea) and ulcers (probably syphilis). He was adequately treated for that. He did not have remorse or guilt over those happenings. He continued visiting prostitutes occasionally and described no inadequacy in sex. He engaged his partner in fellatio in order to bring the penis out. He refused marriage, as he feared that his life was at stake due to this shrinkage as he had had many experiences of nearing death due to that. He did not have regular work and was mostly dependent on the family.

He had been treated with anxiolytics and occasionally with antipsychotic medications with minimal benefit. He had received psycho-education. He frequently engaged in doctor shopping and tried to see doctors before the appointment day expressing concern over his symptoms. He often used medicines from other fields of medicine (homeopathy, Ayurveda, unani) to prevent the retraction.