Navigating Sex with OCD

No two brains are alike, and yet, our overall brain functions and associated behaviors are typically expected to meet a specific set of criteria prescribed by dominant culture as a whole. Anyone who strays from these criteria may be classified as neurodivergent. Unsurprisingly, neurodivergence can include a truly diverse range of conditions—the oft-referenced obsessive-compulsive disorder (OCD) among them.

OCD is an anxiety-based mental health issue characterized by recurring unwelcome and intrusive thoughts, visions, or impulses (AKA obsessions) which trigger anxiety, disgust, or discomfort, in turn leading to repetitive behaviors or mental acts (AKA compulsions) in an attempt to lessen or control anxiety.

If you have OCD your obsessions may revolve around hygiene, symmetry, a fear of being blasphemous, or a fear of harming others or yourself—to name just a few. Meanwhile, common compulsions include excessive hand washing, cleaning, counting, ordering, avoiding triggers, hoarding, seeking assurance, praying, and repeatedly checking on things. That said, some people with OCD may only perform mental compulsions, such as replaying conversations or memories, repeating words mentally, neutralizing, making lists, etc.

Ultimately, OCD can affect your brain’s circuitry, impacting social communication, judgment, planning, and body functioning, to name a few—and your sexual experience is not exempt.

How OCD can affect sexual experience

Although OCD is highly personal and can vary widely from person to person, chances are you’ve experienced challenging moments in your sex life. It’s also worth mentioning that sex may even be the thing that triggers your OCD.

If you have OCD, you may have experienced the following sexual challenges at one point or another:

Obsessive contamination worries. Contamination OCD is common, and might include overwhelming concerns about personal hygiene, exposure to germs and STIs, or the possibility of becoming pregnant, even when highly unlikely. When it comes to sexual intimacy, you may have an obsessive fear of a partner’s bodily fluids, and be prone to repeatedly cleaning yourself. You may even avoid touch as a way of minimizing contact.    

Performance anxiety. Spectatoring means being in your head instead of in your body—worrying about how you look naked, the expression on your face, the sounds you make, or how you’re performing sexually. Rather than simply being present, and enjoying the moment, you might find yourself obsessively watching (and critiquing) from a distance, rather than fully inhabiting your body, and connecting meaningfully with your partner.

Sexual orientation obsessions.  About 10% of people with OCD are plagued by sexual orientation fears. These may include obsessive worries about whether you are gay or straight, a fear of switching your sexual orientation, or a fear that others may think you are LGBTQ2+. If this sounds familiar, you may be hyper-focused on detecting signs of possible same-sex (or opposite-sex) attraction in yourself, even if you feel zero attraction to the group in question. In fact, you may find yourself obsessively monitoring your arousal to help confirm your orientation—thus stealing attention from the experience itself. 

Intrusive thoughts. While intrusive thoughts may be as simple as wondering if you turned off the oven, you might also have thoughts which provoke feelings of sexual disgust, shame, or violence (i.e., visions of sex with children, family members, religious figures, etc). For others, it’s unwanted thoughts of harming a loved one. Whatever it may be, these thoughts can, unsurprisingly, be extremely anxiety-inducing and distracting, as well as a massive turn-off.  Although we all have intrusive thoughts, those with OCD find that they stick. 

Decreased sex drive and anorgasmia. A 2016 study found that sexual dysfunction impacted 53.33% of women with OCD. Orgasmic dysfunction or anorgasmia represented 20.51% of said dysfunctions, followed by problems relating to desire, at 15.38%. Another study found that sexual dysfunction was present in 80.6% of women and 25% of men. Common sexual problems resulting from OCD include erectile dysfunction and premature or delayed ejaculation in men, and sexual pain or reduced arousal in women. This can stem from a variety of causes, including anxiety, depression, and medication side effects.

Medication side-effects. Common OCD meds like Clomipramine can affect your sex life. Possible side effects include a reduced libido, erectile dysfunction and an inability to reach orgasm. If this sounds all-too familiar, you may find yourself in a double bind of sorts, as the same medication used to treat your anxiety is also causing you anxiety via sexual malaise and dysfunction.

How to live your best sex life with OCD

Therapy. Exposure and Response Prevention (ERP), considered the gold standard treatment for OCD, is a type of behavioral therapy that involves repeatedly exposing a person to their fears while cutting out compulsions. If sex triggers your OCD, a therapist may assign sex as an ‘exposure.’ The idea here would be to gradually and repeatedly expose oneself to sexual activity without engaging in avoidance compulsions. The response prevention piece centers on training oneself not to dwell on thoughts, push them away, or try to neutralize them. Instead, the goal of ERP is to help you fully feel your discomfort and have sex mindfully. If you’re interested, NOCD has a nationwide network of licensed therapists from which to choose. You might also consider consulting a sex therapist.

Mindfulness. Rather than trying to ignore intrusive thoughts or push them away, practicing mindfulness can help you to meaningfully overcome your compulsions. Mindful sex requires you to stay present at the moment when intrusive thoughts occur, notice your thoughts, process them without self-judgement or criticism, and allow them to pass. With practice, a mindfulness protocol (whether ERP-derived or 100% personalized) can help ease some of your compulsions, be they directly triggered by sex or not. 

Medication. Another common treatment option for OCD is medication, specifically antidepressants. While the aforementioned sexual side effects are indeed possible, medication for OCD can help reduce symptoms and improve issues in your sex life, particularly when combined with other treatment options, like therapy. Different things work for different people, and that’s a fact. Consider scheduling an appointment with a medical professional to discuss what your next steps should be.

If your partner has OCD

Be patient. If you’re in relationship with someone who has OCD, the sexual issues caused by OCD can increase the level of stress and strain already affecting other areas. You may be frustrated by the apparent lack of sexual interest shown by your SO, or hurt by their apparent avoidance of your body. But it’s important to remember that sexual dysfunction is a symptom of the condition and does not by any means reflect a lack of love, desire, or capacity for pleasure.

Consider therapy. If your partner isn’t into seeing a therapist, there’s nothing you can do to convince them—therapy should never be coerced. But if they are open to it, you might consider seeing a sex or couples therapist together to learn how to better communicate about sex and intimacy. Chances are, attending therapy together will give you an opportunity to better understand your partner’s symptoms, and help both of you to better manage the situation.

Work on communication, always. Communication is to a relationship as water is to a thirsty plant. After all, stronger communication is the first step toward building intimacy and trust with your partner. Whether you seek therapy together, or find some alternate way of improving your ongoing two-way conversation, your efforts are bound to improve (and relax) the way you approach sex together—slowly but surely.