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  • Writer's pictureFlatiron CBT

When OCD Affects Your Sex Life

OCD tends to worm its way into a wide range of meaningful moments, and sex is no exception. Clients often freely share how OCD takes a toll on work, school, physical health, leisure, and close relationships. Yet there is often some hesitation when it comes to talking about how OCD can make physical intimacy really difficult.

There may be many reasons why clients are hesitant to bring up sex in OCD treatment. Some clients are conditioned to view sex as a taboo topic, or feel significant shame about how their sex lives have been affected by OCD. Others want to build a foundation of trust and safety before sharing. Some clients have not yet considered that the intrusive thoughts they experience before, during, or after sex are related to OCD.

However, once clients feel comfortable enough to share, we can start to better understand the ways in which OCD infiltrates these moments. When it comes to OCD, sex is no different than any other activity—intrusive thoughts will hook you and try to pull you in, taking you away from the present moment. Though it can be challenging, and requires self-compassion and patience, we can apply some of the same Exposure and Response Prevention treatment principles that work in other contexts to moments of physical intimacy.

Consider a few common areas where OCD can interfere with sex and physical intimacy:

“I’m terrified of contracting HIV.”

“Is that herpes?”

“What if my STI test is a false negative?”

This category can involve preoccupation with contracting sexually transmitted infections. If you suffer from these obsessions, you may abstain from sexual intimacy entirely, perform elaborate rituals before and after sex, get tested for STIs repeatedly, seek reassurance from others about specific symptoms or sexual encounters, or check your skin repeatedly for signs and symptoms of infection (ie. herpes sores). You may also avoid using public restrooms or avoid medical clinics, fearing exposure to infection. Unfortunately, avoidance and rituals often provide very short-term relief, and obsessive doubts pop up again and again.

“My life would be ruined if I got someone pregnant.”

“What if I’m pregnant?”

This group of obsessions involves excessive fear of sexual encounters leading to pregnancy. As with all of these obsessions, the key word is excessive. If you suffer from these obsessions, you may become preoccupied by the possibility of becoming pregnant yourself or inadvertently impregnating someone else. These fears are often intrusive and persistent, despite taking measures to prevent pregnancy and despite no known failure in contraception. You may repeatedly scan your body for signs of pregnancy or ask others for reassurance. You may ruminate for hours about the consequences of getting another person pregnant or check condoms repeatedly before and after use. In some cases, sufferers may obsessively clean themselves and the items they touch (a toilet seat, a chair) for fear that semen will inadvertently impregnate someone.

“How can I be sure of my sexual orientation?”

“How can I be sure that I’m not gay (or straight/bisexual/etc.)?”

“Am I living a lie?”

Obsessions about sexual orientation can become debilitating for some OCD sufferers, and can understandably lead to changes in behavior around sex. People of all sexual orientations can struggle with this form of OCD, which involves intense fear of being a different orientation than you believed yourself to be all along. Often sufferers do not simply stop at “What if I’m actually gay?” or “What if I’m actually straight?” They can become paralyzed by the possibility that they may be lying or deceiving themselves or others. Many times, the core fear is “I don’t know my true self” or “I’ll never feel certain about my sexuality or my relationships again.” If you suffer from this form of OCD, you may avoid individuals or groups that trigger your obsession. You may analyze your attraction to strangers and friends, repeatedly check for the presence or absence of a “groinal” response, read “coming out” stories and compare them to your experience, or review your past for signs that confirm or deny your sexual orientation. With regard to sex, you may push yourself to have sex to “test” your attraction, overanalyze your sex drive (“What does it mean that I don’t want to have sex with my partner right now?”), overanalyze your arousal level, or anxiously try to prevent images or thoughts from popping into your mind during sex. Typically, the more you interrogate sex, the less appealing and more anxiety-ridden sex becomes. Simultaneously, “what we resist, persists” and the intrusive thoughts get louder and more bothersome.

“Is my partner right for me?”

Relationship OCD (R-OCD) involves obsessive fears of being in the wrong relationship. This

theme can take many forms: How do I know if I’m with the right person? What if I’m stuck with the wrong person and end up living a miserable life? Will I be bothered by my partner’s flaws forever? What if I end up hurting my partner? What if I’m deceiving my partner right now? Do I find another person more attractive than my partner, and if so, what does that mean?

If you struggle with R-OCD, you may compare your partner to others repeatedly to make sure you are with the “right” person. You may mentally gather evidence for and against staying with your partner, anxiously correct your partner, point out flaws, or search for hidden meaning in your partner’s facial expressions and words. You may frequently check to see if you are feeling “love” and whether that feeling is “strong enough.” You may even avoid romantic movies because they trigger incessant doubts about your relationship. Every moment with your partner becomes new material for the “stay or leave” game. You may feel crushing guilt about “stringing your partner along.” As sex is a part of many romantic relationships, your sex life with your partner may become additional fuel for the R-OCD fire. You may fear that you are not “into” your partner enough, obsessively question whether you would have better sex with someone else, repeatedly analyze attraction toward your partner, or use sex to confirm attraction to your partner. You may discuss your sex life constantly, hoping for some reassurance or resolution. You may become preoccupied by anxious thoughts if you don’t feel like having sex or if you feel bored during sex or if you think of someone else during sex.

“Am I sexually deviant?”

Many of our clients struggle with intrusive thoughts, images, or impulses that they perceive to be outside of societal norms or not aligned with their own moral code and values. This might involve intrusive thoughts and images of violent sex acts, incest, or sex acts involving children or animals. Clients may feel intense shame and disgust, in addition to anxiety. If you struggle with these thoughts, images, or impulses, you may find yourself compulsively Googling or trying to get information about pedophilia or sexual deviance, trying to block thoughts out of your head (both throughout the day and during sex), or trying to avoid eye contact with individuals that may trigger unwanted thoughts and images. You may spend time obsessively questioning your moral character or avoid sex and dating altogether.

This list is by no means exhaustive. OCD is really good at finding places where it is unwelcome, and sitting at the table. Yet a big step in removing OCD’s power is naming it when it sits down and settles in. Through exposure and response prevention, the evidence-based treatment for OCD, we can practice confronting OCD head-on and taking away the power it holds over sex and all other life domains. If nothing else, perhaps sufferers can take comfort in knowing they are not alone in these struggles, and that help is available.

Want to learn more? Request a 15 minute phone consultation.

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