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OCD

Making Sense of Physical Sensations in Sexual-Themed OCD

Learn how it works so you know what it means.

Key points

  • Sexual-themed OCD is characterized by repugnant, intrusive thoughts about having sex with an unwanted or inappropriate partner.
  • People with and without OCD can experience genital sensations, referred to as the "groinal response," in situations of anxiety and fear.
  • The neuroscience of touch sensation, attention, and arousal explains why the groinal response occurs and why it's perfectly normal.

So, you just encountered, or thought about, someone, when suddenly, something “down there” tingles or moves.

The problem is that this person would be an inappropriate sexual partner—a minor, a religious figure, an authority figure, a same-sex partner if you’re straight, an opposite-sex partner if you're gay, etc.

Panic sets in, and you’re flooded with unwanted, repugnant, intrusive thoughts and images about having sex with this person.

You ask yourself, “What does this mean?”

You begin to entertain catastrophic reasons for the feeling “down there.” Why did it happen at this particular time—seemingly in step with an interaction with, a thought about, or an image of the inappropriate figure?

What if it means I am a pervert? A pedophile? A monster? What if I am lying to myself and my partner about my sexual orientation? What if I am bad? What if I lose control one day and do something awful?

You spring into an analysis of what just happened. You search online. You ask others about it. Perhaps you confess it to someone you care about. You try to do the right thing. You try to find assurance. And you resolve yourself to stay clear from all possible unwanted provocations of that sensation.

You keep a watchful eye on anything that happens “down there,” on all possible sensations and movements.

And you keep a watchful eye on anything that happens “up here,” on your thoughts and feelings.

You're scanning for danger, and you're scanning for reassurance. Your goal is to make sure this unwanted untimely sensation never recurs.

But to no avail. The thoughts and images always come back. And the unwanted sensations always strike at the worst times.

You begin to peel back from the things you once enjoyed, from people you love, desperately trying to keep a lid on everything. What started as a meaningless spasm has turned your life into a nightmare.

What is happening here?

This scenario describes the experiences of people with sexual-themed obsessive-compulsive disorder—an OCD subtype characterized by unwanted and intrusive sexual thoughts and images.

Many such OCD sufferers also experience unwanted genital sensations that activate a cascade of “what if” questions, over-interpretations, and compulsive monitoring. In the OCD community, this sensation is referred to as the groinal response.

Here's what you need to know about neuroscience to gain some perspective on the dreaded groinal.

1. Your body is a constant open signal for tactile sensation.

The entire surface of your skin, your musculoskeletal system, and your organs are all wired to neurons or nerves that send sensory information to your brain. These signals are live at all times, even when you don’t notice them.

Attention is what drives sensation most of the time. Focus on your hands, feet, or shoulders for a few seconds, and you’ll become aware of a low-grade tingle that is always present, constantly firing. Focus on your genitals, and you’ll notice the same. In other words, there is always a sensation in your genitals waiting to be detected.

2. Not all body regions are represented in the brain to the same degree.

A section of your brain called the somatosensory cortex receives tactile signals from your body and interprets them. Each body part is wired to a unique and specialized region in the cortex. There is a region for your hands, your feet, an area for your mouth, etc.

However, not all body parts are represented to the same degree. Your mouth, for instance, is much more densely innervated with tactile neurons than your ears—it has many more nerves signaling to the brain and many more neurons in the brain receiving the signal and creating tactile and haptic perceptions. If you pay attention to each region for a brief moment, you’ll notice the difference.

How about those pesky genitals?

3. The genitals are super densely represented in the nervous system.

The clitoris and penis have dense bulbs of nerves open for business at all times. They are like 24/7 signal stations firing haptic data to your brain. The fact that your genitals are so densely represented in the nervous system means that you are more likely to feel meaningless sensations there than other body parts, like the top of your head.

4. Not all genital sensation is sexual.

The genitals are densely packed with nerves, but they don’t all go to the same place. Some nerves go to the somatosensory cortex, which processes neutral touch sensation. Others go to the deep center of your brain—in a region called the limbic system—which processes pleasure and displeasure, excitement and fear. These two regions communicate both when you are turned on and when you are not. Therefore, it is very common to experience sensation (somatosensory cortex) without sexual arousal, depending on how your limbic system interacts with the sensory cortex.

There are at least three possibilities:

  1. Your limbic system is “off,” and you experience a neutral non-sexual touch sensation.
  2. Your limbic system is “on,” and you experience pleasurable sexual arousal.
  3. Your limbic system is “on,” and you experience unpleasurable anxious arousal.

According to some estimates, there is only a 10 to 50 percent concordance between sensation in the genitals and actual sexual pleasure. This means that 50 to 90 percent of the time, any tingling, moving, flushing, or hardening down there is non-sexual, be it neutral or fear-based.

5. Anxiety is a form of arousal, and all forms of arousal make your blood flow.

An adrenaline rush famously occurs when we are feeling both excitement and fear. Neuroscientists refer to this state as arousal. Sexual arousal and fear arousal have many of the same bodily symptoms. This includes increased heart rate and blood flow. When you’re anxious, your heart is furiously pumping blood throughout your veins. And that’s why many people are more likely to experience sensation and movement in their genitals in frightening situations. Sometimes fear can even cause an erection in males and lubrication in females.

Here is what’s really important to understand about this.

6. Arousal drives attention to the source of danger.

Fear (and excitement) cause a narrowing of attention. Some people call this tunnel vision. It is very difficult to think about anything other than the perceived threat when you are afraid. The perceived threat is external to most people—a break-in, a fire, a spider, a plane crash, etc. So, if fear-arousal causes a groinal response, they are unlikely to notice it. Their attention is elsewhere.

But what happens when the threat is the groinal response? Where is your attention going to go in triggering situations? That’s right. It goes directly to the groin and the anxious-arousal symptoms that may be occurring there. Before you know it, you quickly get caught in a loop of increased anxiety, → increased fear-arousal, → increased attention → increased sensation.

Over time this problem can get even worse. Why?

7. Attention and repetition strengthen neural pathways and increase sensitivity.

Professional chefs can taste subtle distinctions in flavor. Interior designers can see granular shades of color. Professional musicians can hear fine degrees of pitch variation. These individuals may start with some inherent talent. However, they continue to attune their perceptions through focused practice, repeatedly bringing attention to the subtleties of their craft. With time, they begin to detect nuances that are imperceptible to the average person.

The same is happening with the groinal response. By repeatedly checking down there, you strengthen neural pathways and lower your perception threshold. Over time, even minor tingles that most people can’t detect begin to pop out to you.

What does this mean for sexual-themed OCD?

Although all kinds of genital sensations can occur randomly, they are especially likely to occur when anxious. If your interpretation of a genital sensation is catastrophic, it will trigger the anxious arousal that produces a non-sexual groinal response.

Two unwanted outcomes occur if you deal with this anxiety through repeated checking of the region. Firstly, by giving attention to the area, you will notice some sensation there. Secondly, repeating this every time you are triggered lowers your threshold for detection over time, and you will become ever more aware of exceedingly minor neutral signals.

Sadly, everything that OCD tells you to do to stay safe worsens the problem.

But there is hope for change.

What can you do instead?

Accept the groinal response as normal. Cease compulsive checking and analyzing of the region. Learn how to do body scan meditations (this will help you reverse your attention bias). Practice exposure and response prevention (ERP) by going into everyday situations that you are now avoiding without performing rituals (i.e., no checking, analyzing, reassurance-seeking, etc.).

As always, seek out the support of a qualified therapist to help you through these steps. Many sufferers get better with the right therapeutic support from someone who gets it.

To find a therapist, visit the Psychology Today Therapy Directory.

References

Calabro, R. S., et. al. (2019). Neuroanatomy and function of human sexual behaviour: A neglected or unknown issue. Brain and Behaviour, 9. DOI: 10.1002/brb3.1389

Cazala, F., Vienny, N., & Stoleru, S. (2015). The cortical sensory representation of genitalia in women and men: a systematic review. Socioaffective Neuroscience & Psychology, 5. http://dx.doi.org/10.3402/snp.v5.26428

Keeler, J. J. (2021, January 25). Groinal responses in OCD: What they are and why they happen. Impulse Therapy, https://impulsetherapy.com/groinal-responses-in-ocd-what-they-are-and-w…

Wise, N. J., Frangos, E., & Komisaruk, B. R. (2016). Activation of sensory cortex by imagined genital stimulation: and fMRI analysis. Socioaffective Neuroscience & Psychology, 6. http://dx.doi.org/10.3402/snp.v6.31481

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