<P> A full medical, psychosexual and psychiatric history should be documented . The physician should explore the patient's concerns about appearance and body image (ruling out body dysmorphic disorder). Additionally, the physician should inquire about overall beliefs, personal values, and assumptions that the patient is making about his or her genitals . Given that Koro is often an "attack" with a great deal of associated anxiety, the physician should ascertain the patient's emotional state along with the timeline from onset to the presentation at the examination . </P> <P> 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 primary intent of the male exam is to exclude genuine penile anomalies such as hypospadias, epispadias and Peyronie's disease . 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 . If male patients insist that their penis is shrinking and disappearing, measurements after intracavernosal alprostadil may be used in the office to determine the true erect length and to diagnose any penile abnormalities in the erect state . A physical examination should note any injuries inflicted by the patient in an effort to "prevent" retraction as further confirmation of Koro . </P> <P> Several criteria are typically used to make a diagnosis of koro . The primary criteria is a patient's report of genital (typically penile or female nipple) retraction despite a lack of objective physical evidence demonstrating retraction . 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 . Researchers have identified Koro as a possible "cultural relative" of Body Dysmorphic Disorder . DSM - IV explains the process of differential diagnosis between these two disorders . </P> <P> 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 . Penile dysmorphophobia is related to body dysmorphic disorder (BDD), defined by the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (Text Revision) (DSM - IV - TR) as a condition marked by excessive preoccupation with an imaginary or minor defect in a facial feature or localized part of the body . BDD is different from Koro . In Koro, a patient is overcome with the belief that his penis is actively shrinking, and it may be in imminent danger of disappearing . Clinical literature indicates that these two psychological conditions should be separated during differential diagnosis . </P>

What is the condition of koro and in what countries has it been more reported