HOCD (Sexual Orientation OCD): Part Three – The Groinal Response

I had planned to write about several things in this entry to the series on sexual orientation obsessions (a.k.a. HOCD), but after outlining what there is to consider about groinal response and OCD, I realized there’s enough about what goes on in our nether-regions to make its own installment.  Note that I am focusing on HOCD, but the issue of groinal responses shows up in several sex-focused or relationship-focused obsessions (including intrusive thoughts about pedophilia, incest, and other unwanted sexual themes).

Few subjects get more attention and cause more distress for the HOCD sufferer than the subject of groinal response.  Let’s start with a definition.  A groinal response is:

  • Any physical reaction in the genital area (movement, tingling, swelling, etc.) after exposure to an OCD trigger, whether real or imagined, pleasurable or discomforting

When HOCD sufferers tell me about “groinal responses” they often describe them as being fundamentally different from desired sexual arousal.   For example, a man viewing a sexually pleasing image may fantasize about touching the person in that image, blood will flow to his penis and he will become erect.  This, though technically a response in the groin, is NOT the “groinal response” the HOCD sufferer is concerned about.  If you struggle with HOCD or another sexual obsession, you may find it difficult to articulate the experience, only that it is, well… something.

The disorder has a way of distorting how we interpret our experiences, making it sometimes difficult to tell, “Was that a groinal response from my OCD or was that a genuine sensation of arousal because I’m gay?”  Mental checking and mental review are compulsions aimed at getting certainty about this distinction.  Through repeatedly analyzing the experience, the focus of the HOCD evolves from “how do I know if I’m gay?” to the even more abstract “what kind of sensation was that and what does it mean?”

Why do groinal responses happen?

Any sensation anywhere in the body is going to have a variety of potential sources, the most common of which are:

  • No apparent reason, stuff happens
  • Chemical changes naturally occurring in the body, sometimes affected by stress or diet, in which blood flow is increased or decreased in different areas
  • Fear itself.  Fear is expressed in the body by a number of symptoms, including increased heart rate, sweating, shortness of breath, and for many, changes in blood flow to the groin.
  • Happiness.  Like it or not, when we feel happy, our bodies become activated, which sometimes results in sensations in the groin.  This can be particularly triggering for an HOCD sufferer feeling the love of a meaningful friendship or someone with pedophile obsessions (a.k.a. POCD) experiencing the joy of parenthood.
  • The presence of all sexual thoughts, whether preferred or not, trigger groinal responses by their very nature of being sexual thoughts
  • Focused cognitive attention on specific body parts resulting in either an actual physical response or the perception of a physical response

The phenomenon of groinal response in HOCD is easily re-created in other parts of the body.  If I ask you to divert your attention to the pinky finger on your right hand, you will immediately trigger the firing of nerve endings in that area.  Now, focus only on the knuckle of that finger… now on one crease in that knuckle.  Whenever your attention shifts away naturally, try to bring it back to the crease in the knuckle of your right pinky finger.  Now tell yourself it feels weird.  Does it feel weird?  Tingling?  Itching?  Something is setting it apart from the rest of your body.  The attention causes the magnification of thoughts about sensations.  This leads to the perception of sensation and sensations themselves.  Furthermore, thoughts and feelings about these perceived and real sensations intensify the experience, creating a vicious cycle of thinking, sensing, fearing, thinking, and sensing some more.

Myths about groinal sensations:

  • The presence of a groinal sensation indicates that the sensation is caused by whatever it happens to be near.  Wrong.  This fallacy is among HOCD’s greatest weapons and shows up in other OCD manifestations as well.  If you notice a groinal sensation when pouring a bowl of cereal for breakfast, it is unlikely that you are sexually attracted to Fruit Loops.  If this sensation happens when you are near a member of the same sex, your HOCD is likely to tell you that it’s because you’re gay.
  • I am supposed to have groinal responses to that which I am attracted to.  Wrong.  If a heterosexual looks at an attractive member of the opposite sex, they may or may not have some kind of groinal response.  The typical response for an adult heterosexual male passing a beautiful woman on the street is not a full blown erection.  Heterosexual women are not required to faint or blush at the sight of every hunk.

The HOCD sufferer is very likely to have groinal responses around the same sex for the precise reason that they are checking and telling themselves not to.  Just as trying NOT to think of a purple unicorn just made you think of a purple unicorn, trying NOT to experience sensation often generates sensation in this very sensitive part of the body.  Conversely, trying to generate groinal responses to the opposite sex will often fail to produce results.  By trying to create the experience, you are generating a somewhat synthetic version of what you were hoping for.  Instead of the spontaneous arousal you assume you should be having, you get your brain’s attempt at arousal.  It’s much like trying to tickle yourself.  Because you are aware that you are doing it, it only sort of feels like tickling and doesn’t make you laugh.

Mindfulness and groinal sensations

In a perfectly mindful world, we would all observe our thoughts, feelings, and physical sensations as simple data streams flowing through us, free of judgment and meaning, accepted as what they are without analysis.  But for most OCD sufferers, this is a serious challenge for thoughts, an even more serious challenge for feelings, and seems just plain impossible for physical sensations.  To say, “Oh, I just noticed an attractive member of the same sex and also happened to notice a funny feeling in my pants, but they’re probably not a sign of me being gay” – just seems like confessing denial.  And no matter how many times your CBT therapist tells you that groinal sensations are not important and compulsively checking them is the problem, it just doesn’t see to ring true in the moment.

So this is where exposure and mindfulness often join forces quite gracefully.  If you can observe that a groinal sensation occurred and treat this observation the same as you treat thoughts about being gay, then you can also observe that this coincides with a feeling of dishonesty, and doubt.  If you can practice the mindfulness of truly being in the moment with your doubt instead of trying to find a way to feel better, then you can use this mindfulness to expose yourself to fear and overcome it.  In other words, if thoughts can be unwanted and intrusive, why not sensations too?

Cognitive therapy for groinal sensations

Cognitive therapy is aimed at identifying distorted thinking that often pushes us to do compulsions.  Common cognitive distortions about groinal responses include:

  • All-or-nothing (seeing something in absolutist terms):  If anything happens down there when I am thinking about something same-sex, I’m gay.
  • Magnifying (exaggerating the thought):  It moved! It moved!  That’s the same thing as being totally turned on!
  • Disqualifying the positive (disregarding evidence): I had a groinal sensation while driving but that’s different.  Groinal sensations around people always mean sex.
  • Perfectionism/Should statements (being too rigid-minded):  I should never have any sensations down there unless they are the ones I want.

Challenging distorted ideas like these can be helpful for resisting compulsions.  The key is challenging them on the basis of their logic and not just with self-reassurance about your orientation.  In other words, the purpose is to resist the urge to do compulsions, not to prove you’re straight.

Groinal responses and ERP

Exposure with Response Prevention (ERP) is all about identifying and resisting compulsions.  In the previous blog entries, I discussed some of the common compulsions associated with HOCD.  But within that list is a sub-list of compulsions dedicated exclusively to groinal response:

Compulsions related to groinal sensations:

  • Checking to see if groinal sensations are occurring in the presence of an HOCD trigger
  • Mentally reviewing the significance of a groinal sensation to determine if it was a product of gay denial or OCD
  • Physically checking your groin after an HOCD trigger to measure growth or other physical changes
  • Researching scientific literature on groinal sensations and their relationship to sexual orientation
  • Re-reading this article on groinal sensations (you may be doing this now, time to stop)

Doing Exposure with Response Prevention for sexual orientation obsessions is likely to trigger groinal responses.  So when I talk about ERP in this regard, there are really two elements here.  First, when engaging in the types of exposures that work for HOCD, such as viewing triggering material or writing triggering stories, it’s important to remember that this is one of the responses your body will have.  If you get caught up thinking this proves something, you will disengage from the exposure and miss the point.  The key here is recognizing that groinal responses will occur and acknowledging them as part of the exposure.  In other words, not analyzing or doing anything about the groinal response needs to be a part of the ERP.

Another opportunity that might be approached is doing ERP with the objective to bring on groinal responses.  For example, you might strike up a conversation with someone of the same sex and purposely try to generate a sensation at the same time.  Yes, this will make your anxiety go up, but what goes up must come down.  (It sounds strange saying that here, I know.)

Remember, the purpose of exposure is to make contact with your anxiety, your disgust, and your fear.  When you are no longer in such a state that all you can think of is escape from these feelings, you can skillfully master the symptoms of your OCD.  In the end, obsessions are more than intrusive thoughts.  They are intrusive experiences.  This includes feelings and physical sensations.  Addressing groinal responses in the context of HOCD or any sexual obsession should be done in the same manner as one would address intrusive thoughts; mindfulness and CBT with ERP.

In the next installment of this series, I will try to tackle the subject of denial.  Or maybe I’m just telling myself that.

Jon Hershfield, MFT is a psychotherapist in private practice licensed in Maryland and California, specializing in the treatment of OCD.  Follow him on Twitter and Facebook


Click here for HOCD: Part 4

Click here for HOCD: Part 2

Click here for HOCD: Part 1