Why OCD can cause a groinal response—and what you can do about it

Noticing a change or reaction in your groin area—such as a tingle or swelling in the genitals—after an intrusive thought or image pops into your mind can naturally feel unsettling. That’s the thing about intrusive thoughts: they are not the same as other thoughts that cause arousal, because they are unwanted. Not only that, but they tend to be quite distressing or unpleasant. How, then, is it possible for a thought that causes you emotional distress to also lead to a physical sensation of arousal? What’s really going on down there? 

I’m a therapist who treats obsessive-compulsive disorder (OCD), and this is an exact concern that I’ve helped many patients understand. In the OCD community, a feeling of arousal that is unwanted and causes anxiety is called a “groinal response.” 

Now you’re probably wondering: How can you know if the arousal you’re feeling is a symptom of OCD, and if it is, what can you do about it?

Keep reading for all the answers you need.

What is a groinal response? 

Groinal response is a feeling of arousal. It can include swelling, tingling, warmth, moisture, lubrication, tumescence (swelling or feeling of fullness), sensitivity to small movements, partial erection or full erection. A groinal response in OCD is often linked to an intrusive feeling, thought, urge or image. 

As a clinician who has treated many patients with OCD, I have witnessed both the struggle and the coping mechanisms that people have resorted to in order to manage their groinal response.

Take Fatima, for example. Fatima had struggled with OCD as a child, but around her 18th birthday a new symptom showed up. After breaking up with her boyfriend, Fatima began to notice intrusive sexual thoughts about women.

Fatima had never experienced any thoughts about being gay before, and never believed she was gay, but suddenly felt very unsure. The intrusive thoughts about being attracted to women were accompanied by an unwanted feeling of arousal in her genitals. The result was a great deal of anxiety. 

To cope with the discomfort of her groinal response, Fatima developed some habits — like trying to distract herself by putting in her headphones when an intrusive thought appeared and scrolling on her phone. Some days, she deliberately stared at boys in her classroom whom she found attractive. But to Fatima’s surprise, the distraction never worked. Her self-doubt and fear continued to grow, and she couldn’t get her mind off the physical response.

Why do groinal responses happen?

Many people, like Fatima, wonder what their groinal response means. In Fatima’s case, it led her to fear she was gay and living a lie as a straight person. However, just like any intrusive thought that a person may have, a groinal response is not confirmation that your fears are real. 

For instance, someone who has OCD and worries about being a pedophile may have a groinal response when they see a child. This can be very distressing. However, it’s not a sign of being a pedophile. 

So why do arousal responses happen? It’s a phenomenon known as arousal non-concordance. Sometimes, our genital areas will respond to stimuli even though we don’t really find them sexually arousing—it’s a mismatch between our real desires and our body’s response.

To sum things up, when a person with OCD experiences a groinal response (or any other unwanted physical sensation that they associate with arousal, such as blushing), they often feel disgusted because they believe that groinal responses only happen due to sexual desire. However, there are many other causes that can contribute to these sensations. Groinal response can happen when one is in a heightened state of anxiety, feeling joy, feeling pain, or excitement. We call these high arousal emotions. 

Simply put, a groinal response is not always an indicator of arousal. Just because someone with OCD is experiencing a groinal response does not mean that their thoughts are representative of a desire or fantasy.

Does “groinal response” refer to any physical sensation related to arousal? 

Groinal response refers to a feeling of arousal in the genital region. However, a person may feel unwanted or distressing arousal in other parts of their body as well, like an elevated heart rate or blushing. 

When a person with OCD experiences a groinal response or any other unwanted physical sensation that they associate with arousal, they often feel disgusted, ashamed, and afraid of what it may mean. People make the mistake of thinking that groinal responses only happen due to sexual desire—as you might imagine, it can be quite disturbing for a mother to experience a groinal response when her 10-year-old son walks in the room, or a teacher gets this feeling when he looks at his first grade student. 

However, there are many other causes that can contribute to these sensations. It’s important to recognize that these responses do not only happen when a person is sexually aroused. Groinal response can happen when one is in a heightened state of anxiety, feeling joy, feeling pain, or excitement. We call these high arousal emotions. 

Can people of any gender or sex experience groinal responses?

People of any gender, sex, or age can experience groinal responses. A person with OCD who experiences groinal responses may engage in a wide variety of compulsions in order to reduce their distress.

What is the best way to respond to an unwanted groinal response?

Groinal response as a symptom of OCD can be treated with a particular form of therapy called exposure and response prevention (ERP) therapy. This evidence-based treatment has been shown to be instrumental in treating all forms of OCD. Most individuals who do ERP with a trained therapist experience a decrease in symptoms, reduced anxiety and distress, and increased confidence in their ability to face their fears and live with uncertainty and doubt. In ERP, people will work with their therapist to build an exposure hierarchy and intentionally face the situations that trigger their obsessions in order to sit with the distress they feel.

When doing exposures, the goal is always response prevention: your therapist will guide you in resisting the urge to respond to anxiety and other sensations like groinal responses by doing compulsions or avoiding triggers. Over time, this allows you to tolerate anxiety without relying on compulsions or avoidance to feel better. 

One method of effectively resisting compulsions is by using what we call response prevention messages. Some response prevention messages used to deal with a groinal response may look like this:

• “Who knows if I’ll have this aroused feeling at an inappropriate time. I guess I’ll never know.”
• “This feeling may or may not mean I’m ___________.” 
• “I may or may not be a monster because I am feeling this way.” 
• “You might be right, OCD. I will never be able to control this arousal feeling. Oh well!” 

It’s very different from talk therapy or other forms of therapy. In ERP, people work with a specially-trained ERP therapist to actively face their fears instead of avoiding them. (Don’t worry—as a therapist who facilitates ERP, I can assure you that this process is personalized for each person so patients don’t get too overwhelmed.) A therapist will guide you in resisting the urge to respond to anxiety and other sensations like groinal responses by doing compulsions or avoiding triggers. Over time, this allows you to tolerate anxiety without relying on compulsions or avoidance to feel better. 

Bottom line

Experiencing symptoms of OCD can be difficult and confusing—especially distressing sensations like groinal responses. If you’re having alarming groinal responses that are getting in the way of the life you want to live, you can work with a therapist who specializes in evidence-based treatment for OCD.