Can OCD affect your sex life?

The short answer is: Yes. But stick with us because there’s a lot you should know about the connection between obsessive-compulsive disorder (OCD) and the ways it can impact many different areas of your sex life—from triggering intrusive thoughts during sex to torpedoing your libido. 

It’s an issue that clinicians see all the time in their practice. “When it’s not properly managed with specialized therapy, OCD can really interfere with your overall relationship satisfaction or sexual dissatisfaction,” says Keara Valentine, PsyD, an OCD specialist and psychology professor at Stanford. 

In fact, one study found sexual dissatisfaction levels as high as 53% among people with OCD. Another trial showed OCD to be one of the most common predictors of sexual dysfunction in women.

But Valentine insists that with the right knowledge and treatment, “you can successfully navigate intimate relationships and have a satisfying sex life without your OCD getting in the way.”

How does OCD impact intimacy?

Tracie Zinman-Ibrahim, LMFT, CST regularly works with clients whose sex lives are impacted by their OCD. “It can even prevent people from having a sex life at all, let alone disrupt the one that they used to have,” says Zinman-Ibrahim, an OCD specialist and certified sex therapist with NOCD—the leading provider of virtual therapy for OCD. 

So why does this happen? Here are some of the most common reasons:

Sex can trigger your intrusive thoughts

Obsessions—those unwanted, repetitive thoughts, feelings, and urges—are a cornerstone of OCD, and intimacy can be a trigger for them. For example, sex might spark fears about your relationship, your sexual orientation, or getting “dirty” or “contaminated,” Intrusive thoughts around sex could include:

• I’m going to get an STD.
• I’ll never get clean enough after this.
• What if I’m not attracted enough to my partner?
• What if our sex isn’t good enough?
• What if I’m lying to myself about enjoying this, and I actually wish my partner was a different gender?
• Maybe I’m missing out on a better sex life because I’m secretly in denial about my true sexual orientation. 

“There are so many different ways that obsessions can show up during sex,” says Zinman-Ibrahim, but no matter the content, they tend to prompt people with OCD to want to know: Why is this coming up now? “There can be a lot of shame, a lot of confusion, and feeling fearful that this is a ‘sign’ of something bad,” she says. Naturally, these thoughts and feelings are incredibly distressing, and can make it nearly impossible to enjoy the moment.

For you, sex might be a compulsion

OCD compulsions are done in response to obsessions—with the intent of “solving” your intrusive thoughts, relieving the distress they bring, or making sure that nothing bad happens. Zinman-Ibrahim points out that some people compulsively have sex to try to confirm or deny their sexual orientation, to make sure they’re truly attracted to their partner, or to ensure their partner won’t break up with them. 

If you’re having sex compulsively, you might find yourself:

• Ruminating. Your mind races or goes in circles trying to solve your fears. You might repeat the same question to yourself over and over, such as, Do I really like this? and try to think your way into an answer.
• Checking. This involves scanning your body for signs of arousal, or checking your mental and emotional state to see if you’re really enjoying sex.
• Mentally reviewing. This happens when you comb through your memories to look for evidence that your intrusive thoughts are or aren’t true. When you’re having sex, you may compare it to previous times you were intimate, asking yourself, Do I like this as much as I did last time? or Did I really enjoy it last time, or have I just been in denial?
• Giving yourself reassurance. This might look like repeating reassuring phrases to yourself like, Of course I like this. Of course I’m attracted to him. Of course I’m not in denial of my sexuality.

You could avoid sex as a compulsion

”Avoidance is one of the more common compulsions with OCD,” says Zinman-Ibrahim. “You might avert having sex altogether, or just make up reasons why you can’t do it because you’re waiting for the ‘perfect’ moment.”

She explains that you may feel that by steering clear of intimacy it will make your intrusive thoughts go away. But in reality, all types of compulsions just reinforce the OCD cycle, and can make your symptoms worse over time. By avoiding sex, you actually train your brain to see your intrusive thoughts as real threats—and compulsions as the only way to stay safe and sane. This legitimizing of both obsessions and compulsions is what keeps the cycle going.

You feel distracted during sex because of OCD

Zinman-Ibrahim says that sometimes issues with sex involve intrusive thoughts that have nothing to do with intimacy or your relationship—but they still cause you to be distracted during sex, which doesn’t exactly make for a pleasurable experience for either of you. For instance, you may have harm OCD, or scrupulosity OCD rather than problems tied to sexual orientation or contamination. 

For many people with untreated OCD, she says, obsessions are like a constant hum in the background noise of their lives—or, when triggered, a loud, fire alarm that can’t be ignored. So it’s no wonder sex isn’t the least bit enjoyable if OCD gets in the way—and you can’t stop thinking about sinning or hurting your partner.

You’re experiencing a decreased libido because of OCD

In addition to feeling distracted, the constant anxiety and stress caused by OCD can lead to a decreased desire for intimacy, and also make it more difficult to orgasm when you do have sex. And if you’re taking medication, it can be a double whammy. The side effects of some medications used to treat OCD, such as antidepressants, have been linked to low sex drive and an inability to orgasm. The good news is that these side effects sometimes go away over time or, if not, can be managed by making tweaks in your dosage, switching you to a different medication, or adding another medication to your treatment plan.

Will OCD impact my sex life forever?

“Nobody’s sex life can be ruined forever,” assures Zinman-Ibrahim. “There are lots of different ways to be sexual, and there are effective ways to manage OCD—and specifically, OCD and intimacy.” The bottom line is: Don’t panic. As frustrating as it is to have this interruption to your sex life, you’re not stuck. There are a myriad of tools and treatments that can help you reclaim your relationship to intimacy—and to your partner. 

When should I get help for OCD that’s impacting my sex life?

It can be hard to know if what you’re experiencing is something you should seek help for or not. If you’re unsure, it’s always a good idea to err on the safe side and reach out to your doctor, or a therapist. But here are some signs that it’s time to see a therapist who specializes in OCD:

• You’re avoiding sex in order to reduce your intrusive thoughts or relationship anxiety.
• You’re having sex in order to solve your intrusive thoughts or stop some feared outcome from happening.
• You’re distancing yourself from your partner because you feel guilty about the intrusive thoughts you’re having that involve them.
• You’re clinging to your partner and constantly seeking reassurance to try to prove that your intrusive thoughts are wrong.
• You can’t enjoy sex because you’re too distracted by your intrusive thoughts. 
• Your overall mood has gotten worse.
• Your self-esteem has gotten worse.
• You’re having trouble focusing at work, home, or just generally in your personal life.
• You’re feeling doomed or hopeless about your sex life.

Zinman-Ibrahim says that if you’re consistently feeling distress, like anxiety, fear, panic, guilt, shame, or embarrassment, and your ability to function or live your life is being impaired, you should seek professional help. You shouldn’t just try to “live with it,” or get used to feeling the way you do. There are licensed clinicians who know exactly how to help mitigate the impact that OCD is having on you and your sex life.

What’s the best way to treat my OCD, so it doesn’t affect my sex life?

Getting the right treatment for OCD is key to managing the negative impacts of the condition—not just with intimacy, but in all areas of your life. This is what works best:

ERP Therapy

People often turn to generalized talk therapy. But it’s not only ineffective for OCD, it can actually make it worse by encouraging you to try to “solve” your intrusive thoughts, which can also encourage your compulsions. What does work for OCD—based on reams of evidence—is a therapy called Exposure and Response Prevention (ERP).

ERP works by gradually exposing you to things that trigger your obsessions and giving you the tools so you don’t respond with compulsions. The goal of ERP is to desensitize you to your fears and allow you to engage in the things you value—like intimacy—without OCD stopping you. For example, if sex is triggering, your therapist might begin by having you look at photos of rumpled bed sheets, or couples kissing.

You’ll learn strategies for response-prevention—that is, ways to resist the urge to engage in compulsions before, during, and after an exposure. Over time, you’ll be able to be more present in the moment, and let your intrusive thoughts come and go, without focusing on them. You’ll see that you can tolerate the uncertainty and discomfort of your intrusive thoughts, and that takes the power away from your OCD.

Zinman-Ibrahim says that intimacy can be a great time to utilize your response-prevention tools, such as cognitive defusion—where you recognize that your thoughts are just thoughts, not facts, or something you have to pay attention to. “You can learn to show up in a values-based way in whatever you’re doing, including sex,” she says.

Medication

If you’re wondering if your meds are at the root of your intimacy troubles, bring it up with your prescriber. It might feel uncomfortable, but they’re used to talking about any and all things involving your health—including your sexual health. They’ll be able to give you some options about what changes can be made to mitigate your medication’s negative side effects.

Other ways to manage OCD’s impact on your sex life

• Get your partner involved. Having your partner join a session or two of therapy with you can help them understand your experience and how to best support you. “If your partner is not aware of the challenges you are facing, it can lead to misunderstandings and false assumptions, which could prevent you both from building intimacy, as well as trust,” says Dr. Valentine. 
• Practice mindfulness. While mindfulness is not a standalone treatment for OCD, it can be a great complement to therapy. Mindfulness is the practice of noticing what’s going on in your mind and body without immediately reacting to it. So it could look like saying to yourself, I’m noticing that I’m having an intrusive thought. I’m going to continue enjoying intimacy with my partner anyway.
• Focus on other senses. “What are some things you can focus on outside of what’s happening in your brain?” says Zinman-Ibrahim. “Maybe you can have a scented candle going. Or you can focus on what it feels like to have somebody close to you.” Focusing on other senses can keep you from getting stuck in your own head.
• Join a support group. They can be another useful complement to ERP therapy. “Groups present you with the opportunity to hear from others about how they are coping with their sexual difficulties and OCD. It can be extremely validating to be reminded that you’re not alone,” says Dr. Valentine.

Above all, keep in mind that this is not a hopeless situation, even if it feels like it. With professional support and some hard, but extremely worthwhile work, you can quiet your OCD and reclaim your sex life.