A man enters a commercial tricycle to return home after a gruelling day at the market. He sits calmly at the back, minding his business and like most millennials, flicking through his phone. After a few minutes, the driver stops at a junction to pick up another passenger. The passenger, a man with dreadlocks in his mid-twenties, sits at the back, as far away from the other man as possible. Down the road, the driver spots another passenger and since the tricycle seat can accommodate three people, he pulls over and takes the third passenger. They are now crammed up like sardines in the vehicle.
Passenger number 2 drops first. He leans over to alight from the Keke NAPEP and brushes against passenger number 1. He pays the driver in a denomination larger than the transport fare. The driver adjusts his parked vehicle to rummage through his deep trousers, looking for change.
Suddenly passenger number 1 starts to scream.
He jumps out of the Keke screaming obscenities at passenger number 2 and the driver. He appears agitated and nobody can make sense of what is amiss. Bystanders gather around the tricycle trying to make sense of the commotion. In between curses and screaming, passenger number one says ‘his penis is missing’. That he felt it shrink the moment passenger number 2 brushed against him.
Immediately, mob action is activated. The crowd descend on passenger 2 demanding an explanation. Amidst the commotion, a policeman emerges and disperses the crowd. Both passengers 1 and 2 are taken to the police station. The driver zooms off in relief.
At the station, the policeman calls a doctor friend to come and examine passenger 1. The policeman, excited at the chance to make some money, actually reports the case to his superior and asks both passengers to write their statements. In his words ‘we are trying to get to the bottom of the case of missing genitals in this country’.
Of course, the doctor finds nothing. Both passengers have their genitals intact. No disappearance, no shrinking, no nothing. Just a bunch of anxious men panicking over nothing.
For a long time now, Nigerians have started a foolish rumour about people (usually men) missing their genitals after a handshake or contact with another person with malicious intent and supernatural powers. When the stories started to trickle in, I waived it off as mass hysteria. Most doctors will tell you for free, that one of the common complaints in the clinic is ‘shrinking of the penis’. As a young medical officer, I remember reaching out to senior colleagues the first time a patient met me with this complaint. Green as I was, I actually thought it was a biological problem until my colleagues in psychiatry educated me on body dysmorphic syndrome, anxiety attacks and mass hysteria.
Who would have thought that anxiety attacks could manifest in the form of missing penises?
Gaskiya, we were not taught this in medical school. Either that, or I missed the class.
Anyway, since then, I have learnt a lot about the so called ‘Koro’ illness.
The koro syndrome is a triad of deep-seated fear of penile shrinkage, its disappearance into the abdomen and consequent death. The disorder, which is considered culture related, is endemic in South-East Asia and China, where it occurs in both epidemic and sporadic form. In modern psychiatry, it is considered a culture-bound syndrome (CBS). The syndrome, which may be triggered by acute anxiety, often assumes panic dimensions. The patient experiences profuse sweating, palpitations, dizziness or vertigo, tingling sensations and feeling of numbness throughout the body. His insuperable fear impels him to perform preventive manoeuvres, such as holding his penis, pulling it outward and showing it to others for reassurance.
In the majority of cases, the attack is transient, lasting from minutes to days. Sexual inadequacy may pre-exist or appear as a sequela of the attack. In the female counterpart of the syndrome, occurring but rarely, the woman is afraid that her breasts or labia are shrinking. Most cases of Koro in Asia occur in epidemic form.
As far as could be ascertained, there have been five major outbreaks were documented in the literature since 1967 in Asia. The epidemics were reported to be triggered by popular rumours or mass media communications. The process of contagion develops under, and is propagated by, socio-cultural stress, political situations, and commonly shared beliefs. Individual psychopathology was also seen to play an important role. The epidemic manifestations of Koro have also been described as mass hysteria or epidemic psychosis.
Furthermore, the Koro syndrome was also reported to be associated with heroin withdrawal, drug abuse, alcohol hepatitis, avitaminosis, urinary tract infection, febrile episodes and cerebral malaria. Attention to the physical condition may result in resolution of the koro symptomatology. In 1954, Devereux stated that patients with gonorrhoeal urethritis and urinary tract infection often complain of a transient shortening of the penis due to reflex spasms.
Now it has come to Nigeria.
Like China, ours also comes in seasons. A few years will pass without a significant outcry and then suddenly, without warning, people start screaming about missing genitals. Innocent people will be beaten and prosecuted without reason, properties burnt, and resources wasted. Similar to Asia, I believe, this mass hysteria occurs due to a combination of socio-economic stress, political situations and our fanatical infatuation with blaming everything on our ‘enemies’. In addition, there is also a heavy dose of collective foolishness.
Because how do you explain the fact that educated people also fall for this foolishness? If the person who is complaining of missing genitals has an anxiety disorder or is suffering from a panic attack- what about you, the observer? How can you believe it? How can you be staring at something and believe it when somebody tells you its not there? Or that it is shrinking? What is wrong with us? Is it something in the water? President Tinubu’s government? Removal of subsidy? Inflation? What?
Medically, during these ‘outbreaks’, the treatment approaches can be divided into three main avenues. Firstly, preventive measures as prescribed by the culturally embedded myths. This simply means to address the cause of the problem correcting myths and misconceptions in the society. Similar to what we do in vaccine hesitancy, mass health education and promotion programs are encouraged across the country.
The second treatment is a bit more technical. This involves manipulatory strategies (pulling the penis outward, fastening of clamps and strings to the penis) performed by the patient himself, and or family members so as to demonstrate the presence of the genital. Oyinbo people say ‘seeing is believing’. The patient is taught to do this manoeuvre whenever he starts to have anxiety over shrinking or absent genitals.
Thirdly is the modern medical conception, which takes into consideration the possibility of Koro as a psychiatric disorder, or an organic illness, elicited by a psychological trigger, or any combination of these. Accordingly, physical examination, laboratory tests, radiologic imaging and psychiatric evaluation will afford appropriate treatment planning. The treatment may include psycho-pharmacological medication (benzodiazepines, neuroleptics, antidepressants), cognitive behavioural therapy and even physical modalities such as electroconvulsive therapy.
The crux of this Koro issue is the fear associated with it. People need to note that in most cases it is largely a psychological issue that can be managed medically. Koro syndrome is considered a culture-bound phenomenon, meaning it is influenced mainly by cultural factors.
More importantly, we need to apply our collective common sense.