Is OCD Ruining Your Sex Life?

Most people on thinking about OCD do not associate obsessive-compulsive disorder (OCD) and sex. The sad fact is that many people struggling with the disorder are unable to face one of the most important and intimate areas of life. I am not talking about people who have continual sexual experiences and exploits compelled by a need to achieve technical sexual perfection. Instead OCD is more likely to result in a sex life characterised by lack and avoidance rather than repeated memorable experiences. I have seen how OCD can interfere with sexual bliss and drive couples to the brink of frustration. Here are but a few examples of how OCD can play out in relationships and in respect of ones sexuality.

Contamination Fears

Over a quarter of people experiencing OCD have contamination fears. Many of these individuals worry excessively about germs that can cause a dreaded illness or disease. These germs can be as simple as the common day to day bacteria we encounter all around us. Logically speaking we can assume that the most feared disease is HIV, with other sexually transmitted diseases (i.e., herpes, HPV) also being causes of concern. However, OCD sufferers heighten their emotional states to such an extent that they will avoid places and situations that evoke disease-related obsessions, such as public restrooms, medical facilities, and above all, sexual contact. 

These fears are not rational in any way, and OCD sufferers can begin to project their worries of contamination onto their partners and accuse them of being unfaithful and needing certification for their sexual health being “disease free”. The problem is that this process is not just a one test and you’re satisfied scenario, they will obsess excessively and position their partner to test repeatedly for STD’s and they too will do the same. Often called the worried well, this manner of thinking is immensely destructive to any form of relatability to the individual. 

Sufferers with contamination fears in OCD may not worry about infection per se, rather they find sharing or transmission of sexual fluids agonisingly sickening. As a result of the disgust felt, long pre and post-sex decontamination rituals become necessary to regain peace of mind. Both to endure the sexual act and after to eliminate any feelings of contamination. This may involve hours of compulsive washing and scrubbing in scalding water, as well as laundering all bed linens, clothes, and towels that may have been witness to sexual activity. In the face of such onerous rituals, it becomes easier to avoid sex altogether and this will result in the sexual partner being pushed away instead of being prioritised over the OCD. 

Pregnancy Obsessions

Some sufferers with OCD worry excessively about becoming pregnant or impregnating others. Women with this type of OCD may engage in repeated washing to remove any traces of semen they may have encountered unknowingly during the day. They may avoid swimming pools and public restrooms, out of fear that such places put them at risk of pregnancy.

Men with this type of OCD may resist touching objects or others out of fear that a random lone survivor sperm might be transferred to an unsuspecting female victim through something as innocuous as a handshake, leading to unintentional pregnancy. 

This preoccupation with pregnancy removes the possibility of the individual to experience depth and their preoccupation is never in the moment and present. Their partner will always feel a sense of unnecessary anxiety and this self-inflicted fear of pregnancy can lead to other sexological disorders such as premature ejaculation or erectile dysfunction. 

Sexual Orientation Obsessions

There are a number of individuals with OCD that experience sexual orientation fears, which include worries about whether they are gay or straight, fears of changing sexual orientation, or fears that others may believe they are LGBTQ. 

Individuals with this type of OCD may not necessarily be attracted to people of the same sex emotionally or physically, but are nonetheless hyper focused looking for signs of possible same-sex attraction. This hyper vigilance typically extends to sexual activity, where sufferers may be obsessively monitoring their feelings of arousal to help confirm their orientation. This often leads them to become very controlling sexually and can lead to other potentially harmful behaviour like excessive porn watching and a desperate need to feel aroused by the opposite sex. The problem is that paying such close attention to the sexual process moves ones attention away from the experience itself, resulting in reduced arousal and poor performance. This becomes a self fulfilling prophecy for the sufferer.

Obsessions Involving Sexual Deviance

At least one in five people with OCD worry about having inappropriate sexual desires. These desires may be experienced as an attraction to children, family members, religious figures, or even animals. People with such worries often try very hard not to think about sexual matters as this triggers OCD-related worries further. When they do use these triggering images to heighten the OCD, there is a real self-disgust experienced. This type of OCD is not associated with Paedophilia or other forms of sexual deviance as the core desire to act on these thoughts is not present. The whole process is one of torturing oneself or an act of self loathing. The meaning of why these thoughts are used to stir ones emotions would be specific to the individual, but on many occasions this need for feeling stimulated need be the only reason.

Anxiety and Depression Reduce Sex Drive

Many studies suggest that some types of anxiety may facilitate sexual arousal (i.e., watching a scary movie), however, anxiety associated with mental disorders is generally correlated to sexual dysfunction.

One reason for this is that high levels of anxiety may be associated with mental distractions (such as worry, obsessions, and hyper vigilance) and can interfere with sexual responsiveness. People with OCD are generally anxious about any number of things, sexual and non-sexual, and this generalised anxiety will inevitably reduce sex drive or interfere with being mentally engaged during sex. 

Moreover, the reality of having enduring, unwanted thoughts, regardless of the content, is generally distressing for the individual. Therefore it is not a surprise that over half of the people suffering with OCD are potentially carrying a dual diagnosis of depressive disorder. The state of depression alone will eventually impact your sexual function leading to other deeper set problems.  

Medication Side Effects

Selective-serotonin re-uptake inhibitor (SSRI) medications (used widely as antidepressants) are a first-line treatment for OCD. SSRIs and other similar medications usually reduce anxious feelings but will also cause sexual dysfunction in at least a third of sufferers. Moreover, individuals with OCD typically require higher doses of SSRI’s than people using SSRIs for depression. This raises the chances of sexual dysfunction becoming more likely. Relief from OCD symptoms may be enough for some sufferers to overcome the resulting sexual problems, but for many others, the medication itself makes intercourse impossible. This is not only a problem for the individual with OCD but also for their partners

Are You in a Relationship with Someone Suffering with OCD?

Sexual problems caused by OCD will inevitably increase the stress levels in a relationship. The relationship is already bearing the weight of the disorder in other areas and when you diminish the possibility of sexual expression form both parties, there will be a problem eventually. Partners may feel frustrated by the lack of sexual interest shown by their partner. This can happen for both parties and not just the individual suffering with OCD. It is important to remember that sexual dysfunction is a symptom of the illness and does not reflect a lack of love or care. But it is very important for this to be a topic of discussion between the couple and if not in a relationship, the discussion of sexual expression is vital in your progression. The individual with OCD may simply be too overwhelmed with worries to feel sexual, but this is not meant to be reason enough to not discuss the issues at hand.

Does This End Well?

We all carry a fair amount of obsessiveness and compulsiveness in general, but when it comes to severe OCD getting professional help is an important step. It is important to remember that OCD type treatments will no doubt add to the anxiety faced. Exposure-based therapy for OCD may be traumatic, temporarily contributing to decreased interest in sex. Medication can result in difficulties that may be temporary or eventually become long-term. 

It is important to discuss these issues with your mental health provider, and couples sessions may be a necessary part of the process over and above the individual sessions for the OCD. Ensure you find a therapist with experience in treating OCD and sexuality based disorders. Exposure and ritual prevention are essential tools in being able to beat OCD. Understanding and patience for both parties is critical, but if both partners are motivated and willing to be put through their paces, OCD can be beaten and solid and loving sexual relationship restored.