Hi Michael. There are two issues here. Let’s take paruresis first. A long time ago we managed to simplify our definition of the problem as “An inability to urinate in the presence, real or perceived, of others”. Within that there are a whole lot of variations; the majority of people are similar, but outside that there are be individual differences. Probably dependent on what event originally triggered it.
There is primary paruresis and secondary paruresis. Primary is the fact of locking up in social situations. Secondary is the beating yourself up about it. I have met a guy who came out of
A toilet saying he had not managed to go; he was not upset or embarrassed about it, just matter of fact; he had no secondary paruresis.
Now for the other issues: sitting down or standing up; again this is individual to the person. Most find it easier sitting down, but for a few its the other way around. On our workshops we find some guys find it easier when it is quiet, other when it is noisy, and so on.
Re urgency again for most it is easier the higher the urgency but for a minority it is the other way around. I myself am like you there.
Matching yourself to others is not worth doing. The way forward is to set up a sequence going from easier to harder, and to practice at the easier level until you have cracked it, and then to move up a notch of difficulty. For you, it sounds like you need to start practicing with a low urgency, and gradually up the urgency, in small stages.
Another sequence for you is proximity: again start with a good separation, and gradually reduce it. Do not set yourself a goal of standing next to someone; half the guys do not like doing that which is why, if it is too busy, you see them using the option of a cubicle. Cos personal space is the issue here, try to use toilets dividers between urinals first.
Being heard is a common worry. That goes when you can get it into your head that peeing for others is totally uninteresting; to them its off the bottom of the scale. And your peeing is even more boring. So whether you are making a peeing sound or not is off their radar.
Going back to low and high urgency: I have a theory, which I cannot prove, that in my case it is due to years from early childhood of having to hold it in. So the external urethral sphincter, which I can control (i.e. what I do to stop wetting myself) has become over developed. A high urgency means obviously I have to clamp it shut, and it can go into spasm; which means it is very slow to relax. It does so eventually, and a very thin stream starts, which slowly strengthens as the sphincter relaxes. So like you I am better with a low urgency.
There is a second issue with a low urgency in that it obviously does not matter if I don’t pee, so subconsciously I must be more relaxed.
I hope this helps. To summarise; identify what triggers you to lock up: i.e. making/not making a noise, proximity, urgency. Start with them all at the easiest level. When you can pee there, change one of them a small bit; and so on.
Cheers
Andrew
8 years 7 months ago