Groinal Responses in OCD: What They Are and Why They Happen
JJ Keeler
January 25, 2021
Dr. Dianne Stevenson
I am a Clinical Psychologist, with over 12 years experience working in private practice. I work with adults that are struggling with a range of mental health issues. These most commonly include OCD, anxiety, low mood, emotional dysregulation, trauma, relationship difficulties, and stress.
OCD sufferers with certain subsets of OCD are very familiar with groinal responses and, in fact, may experience intrusive sensations below the belt as a rule. These responses are egodystonic, which means they go against the sufferer’s true desires. Conversely, the sufferer experiences them because they explicitly don’t want to.
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A Groinal Response as an Obsession
In OCD, obsessions are marked by intrusive thoughts, images, fears, doubts, or impulses. When these things present, they always present against the sufferer’s will. Groinal responses are no different.
Groinal responses happen as a result of OCD playing tricks on the sufferer just as OCD lies to the sufferer through thoughts or images. The person experiencing a groinal response has no true sexual attraction or desire in the context of their obsession. For instance, an OCD sufferer who experiences a groinal response when they pass a child on the street has no true sexual attraction to that child. Instead, they are repulsed by the idea, which is exactly why OCD terrorizes them so.
How Groinal Responses Feel
Groinal responses can range from subtle to very obvious. Overall, some of the most common feelings include:
- Twitching
- Pulsing
- Tingling
- Vibrating
- An erection (if male) or increased lubrication (if female)
- Increased heart rate
- Sweating
- Rapid breathing
- Orgasm (in severe cases this may happen)
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How Common are Groinal Responses?
While most experts agree that groinal responses are common in those with OCD, it’s difficult to say exactly how common. For one thing, they’re not visible to the onlooker and no one will know someone is having one unless that person tells them.
Another factor is that of shame: The groin area is a taboo subject and many people may avoid disclosing as a result. For example, someone who experiences a groinal response around their brother probably isn’t thrilled with the idea of talking about this openly.
Nonetheless, OCD conferences and conventions are filled with speakers commenting on groinal responses or attempting to take away their power by poking fun at them in a lighthearted matter. This alone tells us that groinal responses are very common or else they wouldn’t be such a prevalent topic of discussion.
What Types of OCD are Affected by Groinal Responses?
There are several OCD subsets (or flavors) where groinal responses are common. These include:
- Pedophilia OCD: In this type of OCD, the sufferer fears that they are a child molester and fears that they have or will sexually harm a child. As a result of this fear, they may experience groinal responses around kids.
- Sexual Orientation OCD: In this type of OCD, the sufferer doubts their sexual orientation – if they’re truly straight, they may fear being homosexual and if they’re truly homosexual, they may fear being straight (this is different than legitimately questioning one’s sexuality). Those with Sexual Orientation OCD may experience groinal responses when around certain people. For example, a heterosexual man who fears being gay may experience them around other men while a homosexual woman who fears being straight may experience them around men.
- Relationship OCD: While Relationship OCD is not always linked to groinal responses, they may be seen in sufferers who fear being attracted to someone other than their spouse. For example, someone with Relationship OCD who is afraid of cheating on their wife with their attractive boss may experience groinal responses when they’re in their boss’s office.
- Sexual Obsession OCD: In this type of OCD, the sufferer fears deviant sexual attraction or action. One of the most common fears is being attracted to a family member (a daughter may fear being sexually attracted to her father, for instance, and experience a groinal response around him). Sufferers may also have doubts around sexual attraction toward the spouses of friends, to animals, or to religious figures.
- Harm OCD: Harm OCD involves the obsessive fear of harming others. Some people exclusively fear killing others but many may also experience fears of raping or sexually violating others. Someone with Harm OCD who experiences groinal responses may fear that they’ll act on those responses and rape a passerby.
Why Groinal Responses Happen
As mentioned above, groinal responses aren’t indicative of any kind of true arousal or sexual desire. Instead, they occur because the sufferer is repulsed by the idea of inappropriate sexual attraction – thus, they have a heightened sense of sensation. In short, they’re on the lookout for groinal responses so they naturally notice them more. This is a recipe for repetition: The more the sufferer notices the groinal responses, the more they occur.
Another piece of the puzzle is that it’s essentially impossible to think of the groin area without eliciting some sort of response (including a response that’s not wanted). This is because the brain is linked to the sexual organs and thinking about the groin directs focus to that area, resulting in a reaction.
Groinal responses, as well as increased heart rate and the like, can be the result of anxiety as well. The rush of fear can increase blood flow and make arousal feel more potent. But it’s not true arousal; it’s the body reacting to panic.
The cycle may go like this: A man with Sexual Orientation OCD walks by another man. He begins to fear that he’s attracted to that man. An intrusive groinal response occurs. The man begins to panic, enhancing his body’s physiological response and reinforcing his fears. This sets the stage for future incidents that worsen as time goes on.
Importantly, physical arousal and sexual desire are separate from each other as arousal is an involuntary response to external stimuli; it’s not tied to preference or underlying wishes. This is why it’s not that unusual for female rape victims to experience orgasms during sexual assault even though they clearly did not want to be sexually assaulted.
Conversely, it’s not uncommon for someone to fail to climax when they’re having sex with a person they desire and love.
The above is so prevalent that there’s a term for it: Arousal non-accordance. This is defined by the misalignment of subjective arousal and physical arousal. Simply, it’s an occurrence that happens when the mind and body are out of whack.
Groinal Responses as a Compulsion
While groinal responses belong in the “obsession” category since they’re intrusive and go against the sufferer’s true desires, one could argue that they may be used as a compulsion as well.
Those with OCD may attempt to “test” themselves by gauging their groinal response. Someone with Pedophilia OCD, for example, may test themselves around kids, checking for signs of arousal via a groinal response. This will usually backfire for the reasons addressed in the section above, worsening their OCD in the process.
The sufferer will then engage in further compulsions, including:
- Analyzing their response over and over again to reassure themselves that it’s not reflective of any genuine desire
- Conducting research (often via the internet) to discover what these responses mean
- Trying to stop the groinal response by stretching, straining, jumping or any other behavior that lessens the sensation or makes it go away
- Avoiding places that may trigger a groinal response (such as schools or gym locker rooms)
- Avoiding people who may trigger a groinal response
Treatment for Groinal Responses
Many people who experience groinal responses believe that the treatment lies in stopping the response from happening in the first place. This is akin to trying to stop an intrusive thought or image from popping in the head. In other words, it doesn’t work and only worsens the OCD in the long-run.
The reason lies in how OCD operates. OCD is a disorder that needs validation; it not only thrives on it but it literally requires it to survive. Attempting to stop a groinal response gives OCD the attention it craves. It also leaves the sufferer concentrating on their groin area, which undoubtedly makes their sensations more obvious.
Instead of attempting to change a body’s physiological response, the OCD sufferer is instructed to treat groinal responses the same way they treat any obsession: By accepting and ignoring.
This is done through therapy and, in some cases, medication.
Cognitive Behavioral Therapy with ERP
Cognitive Behavioral Therapy with ERP (short for Exposure and Response Prevention) is largely regarded as the most effective form of treatment for OCD.
In the most classic example of someone with Contamination OCD, CBT with ERP works as follows: The sufferer exposes themselves to an intrusive thought of germs by touching a doorknob or trash can. The sufferer then refrains from performing their compulsion by refusing to wash their hands.
Groinal responses are treated similarly. For instance, someone with Pedophilia OCD may be instructed to walk by a playground where children are playing. When they experience a groinal response, they’ll then be instructed to refrain from reacting to that response at all. They’ll be asked not to analyze the thought, not to check themselves for other signs of arousal, and not to seek reassurance.
A large part of CBT with ERP is also avoiding avoidance (as avoidance is among the most common compulsions in those with OCD). Thus, the OCD sufferer will be instructed not to avoid places where they fear a groinal response may occur. For example, a gay woman with Sexual Orientation OCD who fears that she’s straight will be instructed not to avoid nightclubs or bars where men may be dancing.
People will be asked not to avoid engaging in certain activities as well. For example, an OCD sufferer who fears that they’re sexually attracted to their sister will be instructed not to avoid sitting by their sister on a couch or riding with her in a car.
None of the above is easy to do and CBT with ERP often involves several starts, failures, and restarts before it’s completed successfully. The reason it’s so difficult is that not engaging in the compulsion (whether the compulsion is avoidance or reassurance or anything else) causes intense anxiety for the sufferer. But the end result is worth it: If the OCD sufferer can successfully sit with their discomfort and succeed in not reacting to their groinal sensations, the groinal responses begin to go away. As discussed above, OCD needs attention and, when you refuse to give it attention, it starts to disappear.
The end goal of ERP is to view the groinal responses as meaningless because that’s exactly what they are.
Supplemental Therapy
Other types of therapy, such as Mindfulness or Acceptance and Commitment Therapy (ACT), may be used in conjunction with ERP (though ERP is virtually always necessary). In ACT, the sufferer may further diffuse their thoughts by playing with those thoughts.
For example, if an OCD sufferer experiences a groinal sensation when looking at their dog, they may be instructed to say, “OCD is telling me that I’m attracted to my dog.” This is much more helpful (and more accurate) than saying, “I’m attracted to my dog.” ACT involves a lot of clever gimmicks that may prove helpful, including imagining obsessions on billboards, tv screens, or magazine covers.
Of course, one of the largest aspects of OCD is the need for certainty – OCD sufferers experience a need to be 100% certain, 100% of the time. This means that any treatment must teach the OCD sufferer acceptance of uncertainty. If those with groinal responses don’t care about their groinal responses, they’ll begin to heal.
Medication
Medications don’t cure OCD (at least not yet) but they are helpful in about 70% of people. They generally don’t have the power to make the groinal responses disappear, but they can help the sufferer accept those responses and label them as insignificant.
The most common medications used in OCD include:
- SSRIs
- SNRIs
- Anafranil (a tricyclic antidepressant)
OCD medication, like all medication, is designed for people who metabolize drugs normally (which is why they are only successful in 70% of the population). Those who metabolize drugs too slowly may experience dangerous levels of medication in their bloodstream, leaving them at risk for serious side effects. Those who metabolize drugs too quickly have systems that essentially “chew up” the drugs and remove them from the body before they kick in, rendering the medication ineffective.
A person’s pharmacological metabolism is dictated by their genes and they can do nothing to change it. Unlike fat-burning metabolism that may be enhanced by working out and building muscle, drug metabolism is set in a chromosome stone.
As a result, those with different-than-normal metabolisms usually require more trial-and-error when finding a drug that works for them. They may also need to seek off-label medications. These are medications that aren’t approved by the FDA for OCD specifically but they are approved for other reasons.
Some of these include:
OCD sufferers may use over-the-counter supplements as well. While the juries are still out on what works from a research standpoint, scientific studies are somewhat irrelevant: If the OCD sufferer finds something that works for them, it doesn’t really matter if it works for others.
Even so, supplements are not risk-free and anyone considering them should speak to a doctor beforehand. This is especially true for people who are on SSRIs or SNRIs and considering taking a supplement that increases serotonin in the body (as St. John’s Wort does).
Overall, some of the supplements commonly use include:
Working with an OCD Therapist
Anyone who is experiencing intrusive groinal responses should seek help from a therapist rather than trying to treat themselves. However, because so many clinicians are treating OCD without proper credentials, it’s of vital importance that those with groinal responses seek therapists who specialize in OCD and those who have completed OCD-specific training. Going to a therapist who is unqualified can lead to a misunderstanding of what these groinal responses represent, leaving the OCD sufferer traumatized and worsening their disorder.
A few red flags to look out for include:
- A therapist who appears shocked or disgusted by the groinal responses
- A therapist who attempts to treat the OCD sufferer for sexual deviancy
- A therapist who applies meaning to the groinal responses
- A therapist who urges avoidance of people or places that trigger groinal responses
- A therapist who threatens to report an OCD sufferer to the authorities
- A therapist who implies that groinal responses are representative of underlying or latent desires
The International OCD Foundation offers a directory where those with OCD can search by zip code and location for qualified providers, thus avoiding any red flag-waving clinicians. This directory may be the best place to start.
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