OCD & Sex: Impacts, Treatment, & How to Cope

What Is Obsessive Compulsive Disorder (OCD)?

Obsessive compulsive disorder (OCD) involves experiencing obsessions and compulsions 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. An OCD compulsion is a repetitive behavior or mental act that someone feels compelled to perform in response to an obsession. It is often not related to the obsession and is aimed at reducing anxiety or distress or preventing a dreaded event or situation.²

Can Someone With OCD Have a Low Sex Drive?

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 obsessions around cleanliness that prevent contact with bodily fluids.³ In addition, OCD is commonly treated with SSRIs, which can have adverse effects that impact sexual function.¹

Here are several potential reasons why having OCD could lower your sex drive:

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.

Questions About Sexuality

Some people with OCD may have thoughts that cause them to doubt their sexual orientation. People with HOCD may experience unwanted thoughts concerning sex with a same-sex person, which can lead to fear about their urges, doubts about their 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

For some people with OCD, compulsive sexual activity behaviors may be 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 (a sign of relationship OCD). 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 Due to OCD Medication

Certain OCD medications, such as SSRIs, 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.

Decreased Libido Due to Anxiety

Anxiety leads to excessive worry and stress, which takes a great deal of a person’s focus and attention away from other things, including sexual interest. Anxiety can also impact brain chemistry, increasing stress hormones like cortisol and adrenaline which can reduce libido and cause a person to experience a fight or flight response. It’s difficult to be in an amorous mood when your nervous system thinks you are in danger.

Sex May Trigger Other OCD Obsessions

Sex can trigger other OCD-related obsessions like fears about contamination, morality, relationships, needing reassurance, or causing harm. A person may fear getting an STD, have obsessions about morality or guilt, and fear harming their partner, not pleasing them, or damaging the relationship in some way. These obsessions can cause significant damage to a person’s sex life and relationships.

Unwanted Sexual Obsessions & Intrusive Thoughts

Some people with OCD have unwanted or taboo sexually intrusive thoughts that may affect their sex life. These may include things like thoughts of sex with family members, with children, with animals, and 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—people with OCD can view the thoughts as the moralistic equivalent of acting on them, thus leading to intense OCD guilt and increased compulsion to control these thoughts or avoid triggering them.^3,4

OCD & Mental & Physical “Checking”

Mental and physical checking related to OCD and sex can be significant. This can include mentally reviewing one’s actions, behaviors, or thoughts during sexual activity, and checking for any embarrassing mistakes or regrettable actions. It could also include checking for physical signs of an STD or pregnancy, even if precautions were taken. These fears can also lead to compulsive reassurance-seeking from their partner or others.

OCD & Hypersexuality

Hypersexuality is not extremely common in people with OCD, but it is possible. This could happen when a person has obsessions about their security in a relationship, so their compulsive behaviors focus on sex. People may use sex as a coping mechanism to deal with anxiety and stress caused by OCD, or a person with sexual orientation OCD may have sex compulsively as a way to prove that they are heterosexual.

Why Avoiding Triggers Is Not the Answer

Coping by avoiding sexual situations can become a compulsion, and can ultimately increase the impact of the obsession and perpetuate the cycle of OCD related to sex. Avoiding sexual triggers also often means avoiding sexual contact, depriving the person with OCD of a significant aspect of their relationships, and possibly something very meaningful and desired.

Treatment for OCD & Sex Problems

Treatment for OCD usually involves individual therapy (typically exposure and response prevention) in combination with medication. OCD treatment looks different from treatment for those who are only focused on addressing sexual impairments because OCD treatment addresses the psychological and behavioral factors impacting functioning.

Common treatment options for OCD include:

Exposure & Response Prevention (ERP)

One of the most popular approaches to treating OCD is exposure and response prevention therapy (ERP), and it can certainly be utilized to help those with OCD overcome sexual impairments. ERP for OCD 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 four weeks, however, the length of treatment depends on the individual needs of the person.⁷

ERP Exposures for OCD & Sex

ERP is an extremely effective treatment for OCD, and it can be used specifically to treat sexual issues related to OCD. ERP works by gradually exposing a person to their fears, so that they become less upsetting over time. The other part of ERP is to be exposed to fears without practicing compulsions to try to relieve the discomfort.

Some potential ERP exposures for sexual dysfunction in OCD could include:

• Reading about topics related to sex
• Writing about their obsessions and fears
• Gradually being exposed to a place or situation that triggers the obsessive thoughts
• Mindfulness exercises focused on noticing body sensations
• Having sex while noticing obsessive thoughts that appear and resisting the urge to practice compulsive behaviors

Sex Therapy

Sex therapy may be helpful in cases where sexual behavior is the specific 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.

Medication

Typically, medication for OCD involves antidepressants, such as SSRIs, which can have adverse effects, some of which can impact sexual functioning. It is best to speak with your doctor about medication options, as these vary from person to person. There are online psychiatry options that could be considered if you cannot connect with a provider locally.

Transcranial Magnetic Stimulation (TMS)

Meant for those who do not respond to traditional treatments, TMS for OCD 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 in addition to therapeutic help.

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 communicating your specific 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 can also provide a resource of people who have potentially found solutions that work. Lots of online OCD resources exist for those looking to join a support group.
• Stay healthy: Your overall physical health can play a big role in sexual health. If you are eating a variety of nutritious foods 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. Specific online programs, like NOCD, can be convenient options for people looking to get help.

How to Stop Intrusive Thoughts During Sex

Working with a therapist will be paramount to reducing the effect of intrusive thoughts, but along with therapy, you can start to practice techniques to limit intrusive thoughts during sex. Most therapists will suggest not trying to stop the thoughts directly, but to allow and notice the thoughts or shift your focus on something else.

Here are some tips for how to combat intrusive thoughts during sex: 

• Remember that these thoughts are perfectly normal: Remember that these thoughts can be perfectly normal and may not indicate a problem. They are just thoughts and don’t mean you are going to act on them.
• Allow them to be present, don’t fight them: Simply notice that the thoughts are there without judgment or trying to stop them. Say to yourself “Oh, there’s that thought again.”
• Keep going: Ignore the thoughts and go on about your business—while this can be difficult, with enough practice your brain will learn that they’re not dangerous if you don’t let them interfere.
• Don’t try to “neutralize” them with a compulsion: Most importantly, don’t practice compulsive behaviors to try to deal with the discomfort of the intrusive thought. The key to successful OCD treatment is to be able to notice and tolerate thoughts without acting compulsively, thus breaking the cycle.