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One of the most novel and striking undesirable to cannabis illustrates the role of cultural factors in drug responses. At least two individuals who smoked high doses of marijuana the first time that they tried the drug experienced Koro (Chowdhury & Bera), which means “turtles head”. It is an acute state of anxiety associated with a strong fear of death. It also includes the alarming perception that one’s penis has retracted into the abdomen. Any man who holds his member dear can understand the terror that must accompany this delusion. Thankfully the disorder remains extremely rare. Oddly most cases are limited to Asian countries, where the idea that anxiety might lead to penis loss is considered more tenable. In China, the disorder is known as shook yang (shrinking penis). The two cases associated with marijuana intoxication appeared in West Bengal, India, where a Koro epidemic had occurred in 1982 (Franzini & Grossberg, 1995).
The first reported case of marijuana – induced Koro involved a 27 year old Hindu, who took 30 large inhalations of cannabis the first time he used the drug. He later had odd sensations in his legs and reached down to touch them. To his horror, he found that his penis had seemingly disappeared inside his abdomen. Understandably, he screamed for help. His friends came, grabbed his penis, and put him in a nearby pond for over two hours until he realised his genitals were normal. The second case involved a distant cousin of the first. This 26 year old man lived in a nearby village. He had heard of his cousin’s case but did not know that the symptoms appeared after using cannabis. On his first exposure to the drug he felt an odd, empty space in his abdomen that he thought he could fill via deep breathing. He suddenly had the haunting sensation that each breath caused further and further retraction of his penis. He, too, cried for help. His friends placed him in a pond for half an hour until he felt his genitals had returned to normal.
Explanations of this odd malady remain difficult to prove. The phenomenon remains so rare that systematic studies have been impossible. Nevertheless, given the documented increases in anxiety that can accompany marijuana intoxication, these cases may represent a cultural interpretation of panic. Both men lived near the location of a Koro epidemic. They may have learned vicariously that panic and penile retraction can occur together. Thus in their first exposure to cannabis, anxiety and other symptoms may have led them to think of this reaction to panic. Once this expectation was activated, the reaction may have become self-fulfilling. Worry about penile retraction may have exaggerated anxiety, which in turn may have heightened the worry about penile retraction. The simple treatment (spending time in a pond) suggests that perhaps any distraction that might alleviate anxiety could decrease Koro.


Understanding Marijuana: Mitch Earleywine
Pg 115/116