OCD does not respect boundaries. It can and will rear its ugly head at any given moment, even when you’re having or about to have sex. We cannot press pause on OCD. Part of living with OCD is living with the distressing, repetitive, and unwanted intrusive thoughts (i.e., obsessions). Since the content of OCD obsessions varies from person to person, the way in which OCD can impact sex also varies.
OCD can be triggered by sex. For example, people with contamination OCD may fear that they may contract an illness by being contaminated by germs. They may also find the idea of bodily fluids disgusting or worry that they might become pregnant or impregnate someone by accident. As a result, arduous rituals, and compulsions before, during and/or after sex may feel necessary. This can involve hours of washing (e.g., oneself, bed sheets, clothes, towels) and cleaning of relevant surfaces. It can also involve the avoidance of swimming pools, public toilets, or objects that others might touch, or complete avoidance of physical contact altogether, including sex. Such compulsions are perceived to reduce the likelihood of illness and/or pregnancy.
OCD can be triggered by a groinal response. This is because we can feel a response in our genitals when we encounter any sexual content, whether or not we find this content appealing or arousing. This is normal and part of our natural bodily responses. Since some people with OCD experience unwanted intrusive thoughts and/or images that are sexual in nature, they may find their genitals respond to such content. This can be extremely confusing and distressing for the individual as the content may be very disturbing or disgusting for them. They may find themselves worrying that they might subconsciously desire or enjoy these thoughts (which can be about paedophilia, bestiality, incest, and necrophilia). When we experience a groinal response in relation to sexual content we find distressing or disgusting, this is known as arousal non-concordance. It is important to remember that a groinal response is not the same as sexual desire or arousal: it is simply our body’s natural response to sexual content, no matter how we really feel about it.
Sex can also be a compulsion of OCD. For example, people with sexual orientation OCD may worry that they could have a sexual orientation that is different to the one they thought they had. People with relationship OCD may worry that perhaps they aren’t really attracted to their partner. To gain certainty that their sexual orientation hasn’t changed or that they are still attracted to their partner, these individuals may become hypervigilant to their level of attraction to others by monitoring their feelings of arousal. They may compulsively check or seek reassurance about to their attraction to others visually or through sex or even through porn. Naturally, such hypervigilance interferes with sexual intimacy and can lead to low arousal and poor performance. This, in turn, can trigger OCD and cause the individual to doubt their attraction to the other person (a self-fulfilling prophecy).
People with OCD can also struggle with low libido or problems orgasming. This can be the result of Selective Serotonin Reuptake Inhibitors (SSRI’s) or other related medications. SSRI medications can make it difficult to become aroused, sustain arousal, and reach orgasm. Some people taking SSRIs can’t have an orgasm at all. These symptoms tend to become more common with age. In addition to the above difficulties, experiencing violent/sexual intrusions thoughts involving children, family members or animals during sex is a huge turn-off. Getting in the mood for sex while experiencing such disgusting and/or terrifying thoughts is extremely difficult. Even if the individual can push through this, the content of their OCD thoughts can lead to further fears. For example, some people might worry that, if an intrusive thought pops up during orgasm, it means they like are sexually attracted to their OCD fears. It is important t to remember that the thoughts may be disgusting, but you are not a disgusting person. These thoughts are ego-dystonic and separate from yourself.
Given that sex triggers OCD in these individuals, sex ultimately becomes a part of the individual’s psychological treatment. Trying to suppress the intrusive thoughts only makes them come back more frequently and avoiding triggers is a compulsion that only serves to strengthen OCD. Instead, OCD can be successfully managed with gold standard treatments, such as Exposure and Response Prevention (ERP), and the OCD Clinic has helped countless people struggling with OCD to reclaim control over their sex lives.
Blog post written by Sally Youdale, Clinical Psychology Registrar at The OCD Clinic. If you have questions about psychological therapy please contact our intake team: email@example.com