My problems began immediately after childbirth (33 years ago) when I just found it impossible to pee to order and didn't manage to get that ability back. I'm not a terribly confident person and I think the lack of privacy at that time, some extreme ignorance about childbirth, and a bit of post-natal depression all conspired to leave me with an inability to pee to order, notably in places where there are other people around. For instance, queuing to go to the toilet would be a waste of time as I couldn't go once it was my turn if there were still people waiting to go after me, unless someone else flushed a toilet, or there was a hot air hand dryer, or someone turned on a tap......
I love to travel and have never allowed my toilet difficulties to prevent me travelling, although it has sometimes been challenging. I always relied on the fact that at the end of each day, there would be a sufficiently private toilet available in whatever accommodation we were using. I used to drink little during the day so that I wouldn't need to use daytime facilities which may not fit into the category of "toilets I can use", and took cranberry capsules to reduce the risk of developing urine infections. I never went anywhere without cystitis powders, but not surprisingly still had numerous infections over the years.
A couple of years ago we went high altitude trekking in Nepal to Everest Base Camp - a long held ambition. As we got high up I discovered that I could not rely on there always being private facilities available - there were simply no flush toilets in the accommodation (water freezes at that altitude), the shared facilities often being little more than a hole in the ground in a dark shed with no lock on the door and composting leaves in the hole to assist with decomposition. If I had known that, we wouldn’t have booked the holiday. But if that's all there is, there really is no choice and I simply had to quickly find ways of being able to use those facilities - I timed my toilet visits for when everyone else was busy eating, for instance, so that no-one would notice me slipping out, or I would wait until everyone else had gone to bed. To my great surprise I found I could use the squat toilets under those circumstances given enough time to get comfortable etc. Half way through the trek I developed diarhorea, and while we were walking through the day there were no toilets available - we were above the tree-line so I literally had to squat behind rocks to defecate, and found that I could. The need for dignity and privacy disappeared!
I did wonder if this behavior would be transferable to "real life" when I got home, and it was up to a point. I do still have to plan ahead, use (or try at least) every toilet possible, and if I get a bit stressed it's the first thing to go. I wouldn't dream of doing things like shopping with friends, and at work I have to make sure that no-one else is in the ladies before I use one of the toilets. I do still get a lot of urine infections. But it doesn't dominate my life any more. Sometimes it affects my life, at other times it's in the background.
We're going back to Nepal again in October. I have to confess to slight misgivings, but I have used squat toilets on occasion since then, so I know I can do it.
I haven't been on a desensing course. I'm a little scared to fiddle with something which has become manageable and for that reason probably won't.