Pig medicine book pdf

Please forward this error screen to 188. The condition can be diagnosed through psychological assessment along with physical examination to rule out genuine disorders of the genitalia pig medicine book pdf could be causing true retraction. Glossary of Culture-Bound Syndromes of Appendix I.

Attempts have been made by numerous authors to place koro into different classes. Various authors have attempted to distinguish between complete and incomplete forms of koro, along with cultural and non-cultural forms. Cultural forms are said to involve a cultural belief or myth which plays a role in the genesis and spread of the disease in the community. These are regarded as complete forms of koro, matching all the symptoms required for diagnosis without significant co-morbidity. Differentiation into primary koro, a culture-bound expression, and secondary koro. Chinese, means “the shrinkage of penis”. India, involving masses of non-Chinese people.

The incomplete forms of koro are regarded as the non-cultural forms, while the complete form with acute anxiety is the classical culture-bound type. Longstanding” refers to changes that are sustained over a significant period and do not appear reversible, unlike the effect of cold temperatures on some genital regions that cause retraction. These changes may trigger a koro attack when observed, although the effects of cold temperatures are objectively reversible. According to literature, episodes usually last several hours, though the duration may be as long as two days. In addition to retraction, other symptoms include a perception of alteration of penis shape and loss of penile muscle tone. Among females, the cardinal symptom is nipple retraction in the breast, generally into the breast as a whole. This is demonstrated by the fact that Asians generally believe koro symptoms are fatal, unlike most patients in the West.

Extremely anxious sufferers and their family members may resort to physical methods to prevent the believed retraction of the penis. A man may perform manual or mechanical penile traction, or “anchoring” by a loop of string or some clamping device. Similarly, a woman may be seen grabbing her own breast, pulling her nipple, or even having iron pins inserted into the nipple. Physical injury may occur from these attempts. These forceful attempts often lead to injuries, even death. When considering the biological mechanisms and evolutionary history of koro, it is important to look at it in the larger framework of mass hysteria. While the underlying mechanisms are still poorly understood, it has been suggested that the mirror neurons play a major role in mass hysteria outbreaks.

It is hypothesized that we evolved these mechanisms to learn from observation of others, as well as to facilitate imitation. However, within mirror neurons, there is some form of inhibitory process, which prevents us from blindly mimicking every action we observe others perform. New research into this area suggests that in mass hysteria outbreaks something goes amiss in this inhibitory process. A full medical, psychosexual and psychiatric history should be documented. Additionally, the physician should inquire about overall beliefs, personal values, and assumptions that the patient is making about his or her genitals. A physical examination should involve an assessment of overall health along with a detailed genital examination.

In men, genital examination should be performed immediately after penile exposure, to avoid changes due to external temperature. The presence of a significant suprapubic fat pad should be noted as well. Careful measurements of flaccid length, stretched length and flaccid girth will also be useful. A physical examination should note any injuries inflicted by the patient in an effort to “prevent” retraction as further confirmation of Koro. Several criteria are typically used to make a diagnosis of koro. This is accompanied by severe anxiety related to the retraction, fear of death as a result of retraction, and use of mechanical means to prevent retraction.

Cases that do not meet all the requirements are generally classified as koro-like symptoms or given a diagnosis of partial koro syndrome. It has been argued that the criteria are sufficient but not necessary to make a diagnosis of koro. Men who present with this complaint may have Koro, but they may also be misinformed about normal genital size. Additionally, they may be suffering from penile dysmorphophobia. BDD is different from Koro.