For individuals with Obsessive-Compulsive Disorder (OCD) experiencing sexual dysfunction, medical and biological causes should be ruled out before psychological factors are considered. Some OCD medication can cause sexual dysfunction, and sometimes specific obsessions can affect sexual performance.1 While OCD can cause sexual challenges, there are strategies to manage OCD and sex issues.
What Is Obsessive Compulsive Disorder (OCD)?
Obsessive-Compulsive Disorder (OCD), is a psychological disorder where a person experiences either obsessions, compulsions, or both, which interrupt daily life and cause significant distress. Obsessions are recurring and persistent thoughts, urges, or images that cause distress,which you may try to ignore or suppress, sometimes by performing a compulsion.
A compulsion is a repetitive behavior or mental act that you feel compelled to perform in response to an obsession or in line with self-established rules. These behaviors and acts are not clearly related to the obsession, and are aimed at reducing anxiety or distress, or preventing a dreaded event or situation.2
How OCD Impacts Sex Life
Sexual dysfunction associated with OCD typically manifests in either biological sexual dysfunction, such as erectile difficulties or reduced libido, or psychological symptoms interrupting sexual function such as obsession around cleanliness preventing contact with bodily fluids. OCD is commonly treated with SSRIs, which can have adverse effects that impact sexual function including erectile difficulties, delayed ejaculation and female orgasm, and reduced libido.1
Psychological symptoms of OCD, specifically around obsessions with cleanliness, preventing contamination, or moralistic rules around behavior can negatively impact your sexual experience, or even prevent sexual activity. Some with OCD may experience the excessive need to control their thoughts and to take control, or fear around their own sexual urges or behavior.3
Impacts of OCD on sex and intimacy may include:
Intrusive Thoughts During Sex
People with OCD often experience intrusive thoughts during sex. These can lead to fear around engaging in sexual activity, or such intense shame or aversion to these thoughts that sexual activity is avoided. When these thoughts occur during sex, it can often interrupt the sexual encounter.
Unwanted Sexual Obsessions
Some people with OCD have unwanted or taboo sexual obsessions (sometimes considered sexual fantasies) that may affect their sex life. These may include things like thoughts of sex with family members, with children, with animals, homosexual encounters, aggressive sexual behavior, among other things that would be considered taboo or unhealthy.
While a majority of the general population have such thoughts occasionally—about 93% according to research in 2007—4people with OCD can view the thoughts as the moralistic equivalent of acting on them, thus leading to intense guilt and increased compulsion to control these thoughts or avoid triggering them.3
Questions About Sexuality
Some people with OCD may have thoughts that cause them to doubt their sexual orientation. People with OCD may experience unwanted thoughts concerning sex with a same-sex person, which can lead to fear about their own urges, doubts about sexual orientation, and sometimes excessive sexual behavior to refute the interpretation of these types of thoughts leading to riskier sexual behavior at times.
Compulsive Sexual Activity
Compulsive sexual activity behaviors typically involve culturally accepted sexual behavior done in response to obsessions or compulsions. For example, excessive masturbation can lead to genital injury, porn addiction may lead to hoarding or hiding behavior around this material, or the obsession around the feelings of a new relationship may lead to seeking out multiple partners.
Within relationships, compulsive sexual behavior may manifest as a constant need for sex or affection, or seeking to “prove” sexual attraction to or from a partner. Other behaviors mentioned may negatively impact a relationship, such as excessive use of erotica undermining trust and intimacy within a relationship, or even a compulsive need for new partners leading to affairs.
Impaired Sexual Functioning
Certain OCD medications, such as SSRI’s, can impact sexual functioning. This can lead to erectile difficulties, inability to orgasm or significantly delayed orgasm, and reduced libido.1,5
Avoiding Relationships Due to Fear of Disclosing OCD Symptoms
The fear of disclosure of OCD symptoms can lead people to not engage in intimate relationships at all.6 Those who do engage in relationships may avoid disclosing their obsessions or compulsions to their partners, or avoid sexual components of relationships altogether.3
Obsessions Around Cleanliness or Contamination
Obsessions with cleanliness and avoidance of contamination may prevent someone with OCD from engaging in certain sexual activities, or sexual activity altogether.
Why Avoiding Triggers Is Not the Answer
Avoiding sexual triggers acts as a compulsion, which can increase the impact of the obsession and perpetuate this cycle of compulsion in response to obsession. Avoiding sexual triggers also often means avoiding sexual contact, depriving the person with OCD from a significant aspect of the relationship and possibly something very meaningful and desired by the individual.
Treatment for OCD & Sex Problems
Treatment for OCD usually involves individual therapy in combination with pharmaceutical intervention. OCD treatment looks different from treatment for those who are more so focused on addressing sexual impairments because OCD treatment addresses the psychological and behavioral factors impacting functioning.
Here are some typical treatment options to consider with OCD:
Exposure & Response Prevention
One of the most popular approaches to treating OCD is exposure and response prevention therapy. It is often utilized for helping those with OCD overcome sexual impairments. This is a form of therapy that specifically focuses on desensitizing patients from triggering situations or their obsessions by incremental exposure to those situations. Symptoms can sometimes show improvement as soon as 4 weeks,7 however length of treatment depends on the individual needs of the person.
Sex therapy may be helpful in cases where sexual behavior is specifically the concern, and other symptoms of OCD are well managed or absent. There are many approaches in sex therapy, including sensate focus therapy, which is intended to reduce anxiety around sexual intimacy by incremental exposure. Sex therapy may also help with communication around sexual obsessions and navigation of the sexual relationship and setting healthy expectations.
Typically people are treated for OCD using antidepressants, such as SSRI’s, which have adverse effects, some of which can impact sexual functioning. It is best to speak with your doctor about medication options, as these vary person to person. There are online psychiatry options that could be considered if you are not able to connect with a provider locally.
Transcranial Magnetic Stimulation (TMS)
Meant for those who do not respond to traditional treatments, the TMS approach uses magnetic fields to stimulate nerve cells in the brain to improve functioning.
How to Cope With OCD & Sex Problems
It is possible to use things like mindfulness practices, communication, and CBT based techniques to cope with sexual problems that result from OCD. While professional treatment is best, these kinds of techniques can help manage symptoms.
Below are tips for coping with sex problems related to OCD:
- Practice mindfulness: Mindfulness is about recognizing thoughts as they occur and avoiding assigning judgment to those thoughts. This practice can help reduce efforts to control intrusive thoughts and allow them to pass.
- Communicate with your partner: Talking to your partner about sex and about why sex seems to be impacted can alleviate concern, and communication of OCD symptoms can allow your partner to provide support. This can open up exploring ways to approach sexual activity that is healthy and fulfilling for both of you.
- Join a support group: Getting support from others dealing with OCD symptoms can provide an outlet for communication and also provide a resource of people who have potentially found solutions that work.
- Stay healthy: Your overall physical health can play a big role in sexual health. If you are eating right, at a healthy weight, and exercising regularly, it is less likely that you will experience sexual dysfunction in general.
- Talk with your doctor: Whether it is about symptoms or medication options and navigating side effects, letting your doctor know there is an issue can open up medical intervention options that may work for you, and rule out potential other health issues that may be causing problems.
- Seek therapy: Therapy, including online therapy, is one of the most effective ways of addressing OCD symptoms in general, and should be an option considered if you have OCD.
In My Experience
In my experience, OCD symptoms tend to be cyclical and self-perpetuating. People with OCD who seek to avoid and control give more power over to their obsessions and compulsions, and it is best to get professional help through Cognitive Behavior Therapy (CBT) and exposure therapy to reduce symptoms and learn to navigate life with OCD. When it comes to sexual obsessions and compulsions, as long as they are not illegal or damaging to yourself or others, communicating about these with your partner can open up opportunities to increase emotional intimacy and understanding of each other and both of your needs.
OCD is a treatable condition, and you can reasonably expect improvement of symptoms with the right treatment. I would encourage you to talk with your doctor about medication options, and seek a therapist to work with you on managing the psychological aspects of OCD. There are really good options for treatment out there.