Soifer, who is also president of the International Paruresis Association, a nonprofit organization located in Baltimore, Maryland, explains that in people who suffer from paruresis, the body senses the public restroom as an unsafe place. Hey, I have to go find a more private place to pee. The exact cause of paruresis varies, but approximately fifty percent of paruretics can cite an incident, usually one that took place when they were much younger, in which someone made a negative remark or hurried them in the restroom. For someone with a predisposition to paruresis, this type of offhand remark can trigger the condition. The other half of paruretics can't remember a specific incident, but nevertheless developed the phobia.
Some shy bladders are more social than others.
The severity of symptoms is measured on a scale from one to ten. Someone at level one may have experienced only one incidence of paruresis, whereas someone at level ten has such severe symptoms that they may be agoraphobic and unable to leave their home for fear of having to use a public restroom. Most paruretics fall somewhere in the middle of the spectrum. Women's restrooms, featuring several enclosed stalls rather than a row of urinals, tend to offer more privacy than men's rooms. This design feature may explain the IPA's numbers by suggesting that women seem to be able to cope better with public urination.