While we think of erections as a response to sexual arousal, it’s important to know that many of the erections a person has over their lifetime will pop up as a result of something else entirely. Changes in blood flow, hormonal fluctuations, high levels of stress, anxiety, or nervousness, and even changes in ambient temperature can cause erections—other times, there’s no discernible cause whatsoever. Called “spontaneous” or “unprovoked” erections, they’re an ordinary (albeit sometimes conspicuous) physiological response.
A lot of these unprovoked erections—between three and five per night, on average—happen while their owners are sound asleep. They typically happen during the rapid eye movement (REM) sleep stage, a phase associated with vivid dreaming. Interestingly, however, these erections are not typically related to sexual arousal or dreams of a sexual nature, although they can co-occur.
Though spontaneous erections happen more frequently in adolescents and young adults, they typically continue to occur throughout adulthood. Why? Some experts suggest that they help maintain healthy penile tissue by ensuring regular oxygenation and blood flow. Others propose that they may be associated with regulating male/AMAB reproductive functions.
Regardless of why they happen, most people would likely agree that getting an erection at an inopportune moment would be less than ideal. But for many people, fears about getting an unwanted erection cause undue distress on a regular basis and negatively impact their professional, social, and romantic lives. In these cases, it’s helpful to discover what might be driving these fears, and find some strategies for regaining control.
Conditions that could cause fear of getting an unwanted erection
A big driver for concerns about getting an erection in an inappropriate setting could be that spontaneous erections happen most frequently when we are in our hormone-addled youth and surrounded by other youngsters primed to bully and ridicule. I can clearly recall feeling panicked at the thought of getting a spontaneous erection in the showers after gym class for the entirety of high school, despite it never once happening to me or, to the best of my knowledge, any of my classmates.
“Fears around having an erection or more generally exhibiting some form of sexual arousal in a public setting are fairly common,” explains Dr. Nicholas Farrell, licensed clinical psychologist and a Regional Clinical Director at NOCD. “‘What if I’m at a dinner party? What if I’m up on stage giving a presentation, and it just happens?’ It’s certainly a thought that could flash through people’s minds, but a few mental conditions could lead to these fears impeding someone’s ability to function.”
Social Anxiety Disorder
“One that springs to mind is social anxiety disorder (SAD), formerly known as social phobia. People with SAD fear any scenario in which they could imagine embarrassing or humiliating themselves. Although erections are just a normal bodily function that can occur as a response to several things, it’s easy to see how the prospect of having one at an inopportune time and place would be particularly distressing to someone with social anxiety.”
SAD is very common, with an estimated 7.1% of US adults meeting the diagnostic criteria in the past year and 12.1% having the condition at some point in their lives.
Generalized Anxiety Disorder
Dr. Farrell adds that another mental disorder that could result in fears about having an unwanted erection is generalized anxiety disorder (GAD), a condition that approximately 5.7% of US adults will experience at some point in their lives.
“As the name suggests, people with GAD are often worrying about anything that could theoretically go wrong at any time and in any circumstance,” he says, adding that their extreme fear about getting an erection in public could be a confluence of several factors including catastrophic thinking, social anxiety, hyper-awareness of bodily sensations, and negative self-perception. It’s important to note that these concerns are not based on rational assessment, but rather on the distorted thinking patterns that are characteristic of GAD.
The first-line treatments for GAD and SAD typically involve psychotherapy and medications. Cognitive Behavioral Therapy (CBT) focuses on identifying and modifying negative thought patterns and behaviors and can yield significant relief for many individuals with either SAD or GAD. Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are commonly prescribed medications. They help regulate neurotransmitter levels, reducing excessive anxiety in either condition.
Another mental disorder that could underpin extreme fear about getting an unwanted erection is Obsessive-Compulsive Disorder (OCD), a mental disorder affecting an estimated 2.5% of the global population. People with OCD are unable to stop fixating on intrusive thoughts, sensations, images, or urges. These obsessions result in significant distress, which they then try to reduce or avoid by engaging in repetitive mental or physical acts called compulsions.
Some people’s OCD is focused on sexual and even pedophilic themes, so they may have an obsessive fear about having an erection in a setting where children are present. One related compulsion might be to repeat a phrase that confirms that they are not attracted to children. Another might be to avoid being anywhere children are. Others’ obsessions might involve uncertainty about their own sexuality, and they may feel afraid of getting an erection around people they don’t believe they’re actually attracted to, and avoiding these people or hyper-fixating on sensations in their groin whenever they’re around others. Unfortunately, this fixation only makes them more likely to show up.
While compulsions like these may alleviate their fear of the short term, they’re reinforcing a vicious cycle of obsessions and compulsions that tends to get worse over time. Being caught in this cycle can severely impact a sufferer’s quality of life, strain relationships with friends and family, and increase their risk of developing depression and other mental disorders.
“Another interesting link between OCD and a fear of unwanted erections is a phenomenon called the ‘groinal response,’” explains Dr. Farrell. “A groinal response specifically refers to the physical or physiological reaction in the groin that may accompany intrusive thoughts. It’s important to note that the groinal response is not a sign of a person’s true desires or intentions, but rather a symptom of the disorder—or a completely meaningless physical occurrence.”
While SSRIs can also be highly effective in reducing the symptoms of OCD, there exists an evidence-based therapy that was specifically developed to treat the condition and actually addresses its underlying cause. It’s called exposure and response prevention therapy (ERP).
Exposure and response prevention therapy
In ERP, you’ll deliberately face situations or triggers that provoke obsessive thoughts, sensations, images, anxiety, and discomfort. This process is carefully structured in collaboration with an ERP-trained therapist. You’ll begin with less distressing scenarios and gradually progress to more challenging ones.
The crucial aspect of ERP is preventing the compulsive response that typically follows the obsessive thought. This allows you to experience the discomfort that comes from your obsessions without resorting to your usual rituals. Over time, repeated exposure to these anxiety-provoking situations teaches the brain that they are able to handle uncomfortable feelings like fear or anxiety without relying on compulsions.
For people struggling with a fear of unwanted erections, exposure exercises would be designed based on the scenarios that are most likely to trigger their obsessions. If someone is afraid that they could be sexually attracted to their pet, for instance, they might start by reading stories about people who were imprisoned for sexually harming animals. This exercise is intended to trigger some discomfort or anxiety, so they would work with their therapist to accept this discomfort and allow it to dissipate on its own, instead of engaging in compulsions.
In the event that they experience an unwanted erection or other groinal response, they would do the same thing: accept the sensation and allow it to fade with time, without doing anything to get rid of it. In time, this process teaches their brain that they can tolerate uncertainty or fear about their sexual attraction and sensations, and that unwanted erections don’t mean anything about their identity, values, or behaviors.
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All of our therapists specialize in OCD and receive ERP-specific training. If you think you might have OCD and want to learn how it’s treated with exposure-based therapy, schedule a free 15-minute call with the NOCD Care team to learn more about how we can help you get your life back on track.