In these past few weeks, whether you get your news from traditional media sources or social media, you are likely to have heard or read stories of missing penises. What started as sporadic events in Kasoa, have now spread to other vicinities in Accra with one such case being reported in Ashaiman, which is quite literally, at the polar opposite end of Kasoa.

This has led to much anxiety in some and a sense of wonder in others. “How does someone’s penis get stolen by another?” “What is the purpose of this theft?” “How does the genital region look after the penis has been stolen?” And then there are those who wonder, “How is it even possible for another person’s penis to be stolen?”

Certainly, for some of us, especially the much ‘ridiculed’ 30plus (30 years and above) folks, this is not the first time we’re hearing of such occurrences. I remember how as a wee little boy in lower primary, a friend came to school one day to tell us the “penis thieves” were back in town and when we were out in crowded public spaces, to keep our hands in our pockets. This rather simple act, he said, could ward off thieves. At the time, I too asked some of the questions listed above and these were the answers I got:

• That, for the other person to be able to steal the victim’s penis, there had to be physical contact. This, they explained, was the reason it usually happened in crowded spaces since people naturally bumped into others in crowded/enclosed environments.
• That the stolen penis was used for all manner of rituals, from wealth rituals to fertility rituals and according to some, to things as base as penis enlargement rituals. They said when people bought penis enlargement herbal concoctions, the supposed subsequent increase in girth and length was due to some kind of spiritual transfer of someone’s stolen manhood.
• That the genital area looked like the genital area of dolls.

And finally;

• That it took some special kind of spiritual powers. These powers, they claimed were commonly possessed by some of the migrant workers from Niger, Somalia, Burkina Faso and the likes who are typically referred to as “abokis/abokyis”

This phenomenon is termed Koro, and recently in Nigeria, a newspaper article reported on it. At the time, I had no idea that in a matter of a few short months, we were going to see a re-emergence of cases here in Ghana as well. I suppose it is not only jollof, hi-life and afrobeats we share in common with our Nigerian brothers.

What then does Koro entail? This condition first appears in literature in China, where it is referred to as suo-yang, somewhere in 300BCE. It was managed through exorcisms and the use of herbal potions as it was believed to be a spiritual phenomenon. The name Koro, etymologically, comes from Malay and means the head of a tortoise, in allusion to how the head of the tortoise retracts into its shell. Cases have mostly been recorded in Asia and Africa with some subtle differences. After all, this is a culture-specific disorder. While in Asia, many view this as a shrinking penis disorder which can lead to fatalities and is usually associated with infidelity and sleeping with another person’s partner, in Africa, it is reported as a penis theft and is usually not regarded as fatal.

Read also: Awutu Senya Municipal Council warns against spreading missing genitals falsehoods

The question that now begs to be fully answered is, what then is Koro? In the International Classification of Diseases, 10^th Revision (ICD-10), Koro appears, together with other conditions loosely grouped together as culture-specific disorders, in the Annex, specifically Annex 2.

These culture-specific disorders have varied characteristics but share two principal features:

(1) they are not easily accommodated by the categories in established and internationally used psychiatric classifications

(2) they were first described in, and subsequently closely or exclusively associated with, a particular population or cultural area.

These syndromes have also been referred to as culture-bound or culture-reactive, and also as ethnic or exotic psychoses. Some are rare, while others may be comparatively common; many are acute and transient, which makes their systematic study particularly difficult.

The status of these disorders, however, is not without controversy. There is raging debate amongst psychiatrist as to why they should be given a category of their own, instead of putting them under already existing diagnostic psychiatric classifications such as anxiety disorders and reactions to stress. They argue that every psychiatric condition is expressed in a cultural context and so to create a specific category for these so-called culture-specific disorders is unnecessary. This explains why in the more recent ICD-11 Diagnostic Manual, the WHO dropped this classification.

However, this condition may be classified under the newly included bodily distress disorder (6C20) and specifically as bodily distress disorder, unspecified (6C20.Z), which has been described as the presence of bodily symptoms that are distressing to the individual and excessive attention directed toward the symptoms.

Excessive attention is not alleviated by appropriate clinical examination and investigations and appropriate reassurance. Likewise, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) replaced the classification, culture-bound syndrome, found in the DSM-IV with culture-specific disorders or cultural concepts of distress.

In this new classification, Koro was dropped from the culture-specific disorders and reclassified under other obsessive-compulsive and related disorders.

This panic anxiety state which mainly affects men has been reported over the years in different parts of West Africa. In Nigeria, the earliest recorded cases date back to 1975 and were recorded by the psychiatrist, Dr. Sunday Ilechukwu, in Kaduna. In this case, two men were brought to the doctor accompanied by policemen, with one claiming the other had stolen his penis. When the doctor proceeded to examine him and showed him that his penis was in fact still there and intact, the victim exclaimed that it must have just appeared as it was not there previously. Why this seemingly sudden reversal? Well, Koro is usually acute and transient and the acute panic-anxiety state usually only lasts a few hours, although there are some reported cases that have lasted days and even in perpetuity in patients that have a co-morbid body dysmorphic disorder.

 According to a paper written by Vivian Afi Dzokoto and Glen Adams, between 1997 and 2003, there was an outbreak of such cases in several West African countries.

It is reported to have first started in late 1996 in Nigeria or Cameroon and by January 1997, had reached Ghana, from where it continued to Cote D’Ivoire and finally to Senegal by August that year.

There was a total number of about 56 cases reported by the media in this time frame in these countries. Ghana had about 40 cases. It is, however, likely that there were far more cases than those reported since usually, those cases reported by the media also involved mob violence meted out to the supposed thieves.

These episodes tended to be brief and transient and whenever an independent assessment of the region was done, either by the police or by medical personnel, it proved that indeed the penis was intact. When confronted with this new information, the individuals usually expressed surprise and insisted that it must have just reappeared as it was not there moments prior to that.

In fact, in this recent epidemic being reported in Accra, one of the cases has ended up in court with the victim being remanded into police custody by the court for raising a false alarm.

This is because upon being sent to the hospital by the police for assessment, it was revealed that his penis was in fact, intact. All the other cases that have so far been reported in Accra have all seemingly had their penises returned by the supposed thief, which is rather curious because if really, such theft had taken place, wouldn’t it stand to reason that there would be some victims who would not be able to accurately identify the thieves and therefore be left without a penis?

Some also claimed that even though the penis was there, it had reduced in size, a claim which cannot be independently verified. It must also be pointed out that the male genitalia normally varies in size during the course of the day. Weather conditions and emotional states can lead to a ‘shrinkage’.

Typically, cold weather and anxious states shorten the length of the penis but with a reversal of these states, the penis returns to its normal size. Since usually, at the time of victims’ claims, independent verification is usually deferred by the mob who are usually more focused on meting out retributive justice on the alleged perpetrators, it cannot be ruled out that these people might have experienced a reversible shrinkage in the size of their penis.

While most of the recorded cases of Koro are primarily in men, women have also been said to experience similar panic-anxiety states in relation to the loss of their genitals.

In women, the experience is usually said to be centred around their breasts. The affected person tends to believe that their nipples are inverting and entering their breasts or that their breasts are somehow reducing in size. There has also been mention of some women who believe their vagina to be sealed.

It is reported that in the 1970s in Nigeria when the cases of Koro were first reported, while the men could be seen with their hands in their pockets or visibly holding on to their crotches to avoid the theft of their penis, the women folded their arms on their chest in order to prevent their breasts from being stolen.

Again, while in men certain conditions can lead to reversible changes in the size of penile length and girth, in women as well, certain medical conditions can lead to inverted nipples and it can therefore not be totally ruled out that a woman could be speaking the truth when she says her nipples are inverted. However, this would be due to a wide range of medical conditions and not spiritual theft.

Various attempts have been made to explain this phenomenon. The psychopathology is quite clear on the fact that, it is an anxiety disorder manifested in a culturally specific way.

However, on what the possible social triggers could be that lead to such mass hysteria, we have to rely on the social sciences account. For instance, in 1997 Sackey identified in “The Vanishing Sexual Organ Phenomenon in the Context of Ghanaian Religious Beliefs” that the outbreak of cases in Ghana could have been precipitated by political and economic tensions.

She identified the election cycle of 1996 as the political stressor and the economic challenges faced by most which had been further exacerbated by the overindulgent spending which usually characterised the celebration of Christmas and New Year’s festivities.

This explanation quite interestingly fits current social conditions in the country – rising cost of living, Christmas, New Year and Easter festivities having been celebrated not too long ago, massive youth unemployment and an ongoing political campaign season with an impending general election on the horizon. Could these possibly explain why we are seeing a resurgence of this epidemic?