Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Do intrusive thoughts during climax mean anything?

By Elle Warren

Dec 20, 20238 minute read

Reviewed byApril Kilduff, MA, LCPC

Intrusive thoughts can be scary. They can feel like a threat to your sense of self, your relationships, and what you believe to be true about the world. For some people, they cause intense, debilitating anxiety. For others, these types of thoughts feel like nothing more than a leaf falling gracefully to the ground, neither good nor bad. 

Since you’re reading this, odds are you’re feeling some stress over intrusive thoughts. And that may include feelings tied to sex. The good news is, you’re not alone. Even more good news: There’s a highly effective treatment to help you manage them. 

Keep reading to learn more about what causes intrusive thoughts—particularly during highly intimate experiences like sex—and how to get help if you’re feeling negatively impacted by them.

What are intrusive thoughts?

Intrusive thoughts are a universal phenomenon. We all have them. They can involve ideas, feelings, urges, images, or sensations that are ego-dystonic, meaning that they don’t align with your beliefs or values. They are often uncomfortable, inappropriate, or taboo. A lot of people can recognize them as an odd or unexpected experience, and move on with their day.

But when these intrusive thoughts become chronic, distressing, and repetitive, it may be characteristic of obsessive-compulsive disorder (OCD). That’s the “obsessive” part of OCD. When you have OCD, you’re not able to dismiss intrusive thoughts as being untrue to yourself—you take those thoughts incredibly seriously, worried that they must actually mean something

“To people with OCD, the kind of uncertainty that comes from intrusive thoughts feels completely unacceptable,” says April Kilduff, LPCC, LCPC, LMHC, a therapist and clinical trainer at NOCD. “In the case of sex, since being intimate with someone is usually a valued time together, it’s a ripe opportunity for OCD to come in. 

“Our brains make associations. Having sex might make a time when you were intimate with someone else might pop in your head, just by associating the physical act. That doesn’t mean anything. It’s just your brain doing what brains do.”

What triggers intrusive thoughts during sex?

The causes of intrusive thoughts can be hard to recognize. Sometimes, they may come out of the blue. Usually, though, there is a feeling, sensation, thought, image, or external cause behind them. Common triggers include:

  • Stress 
  • Anxiety
  • Feeling uncertain (and that uncertainty can trigger more uncertainty)
  • Experiencing feelings of joy or love. Since you value joy and love, it’s a prime time for intrusive thoughts to pop up.
  • Partaking in a certain activity, such as sexual intimacy
  • Reading or watching something that connects to your fears
  • Having a dream that connects to your fears

As you move forward with working through these intrusive thoughts, you can cultivate mindfulness about what your triggers are. Ask yourself, What was I thinking, feeling, or experiencing before I had this thought? Understanding triggers is also a key part of OCD therapy, which we’ll delve into later on. 

When intrusive thoughts during sex are a sign of OCD

Having intrusive thoughts does not necessarily mean that you have OCD. What is a signifier of OCD is not being able to move on from your intrusive thoughts. You may feel a slew of uncomfortable feelings: anxiety, panic, guilt, shame, embarrassment, fear, or even terror. 

In an attempt to assuage those uncomfortable feelings and feel certain about their doubts, people with OCD engage in compulsions. Contrary to popular belief, compulsions are not confined to excessive hand-washing or checking to make sure the stove is turned off

While those can be compulsions, compulsions are actually any physical or mental actions done in the hopes of relieving the distress spurred by intrusive thoughts. Since they often happen mentally, they can sometimes be invisible. This can make them harder to recognize, which is why OCD education is so important—as is identifying specialized treatment options. 

Here are a handful of subtypes of OCD that intrusive thoughts may focus on:

One is called relationship OCD. With this type of OCD, you become worried about the validity or “rightness” of your relationship. You may question your feelings or attraction toward your partner or vice versa.

Another is called sexual orientation OCD, where you fixate on figuring out your “one, true” sexual orientation, and worry that you’re lying to yourself and/or your partner. 

Then there’s contamination OCD. This involves fears about being dirty, contaminated, or getting sick. This is the theme commonly associated with the well-known compulsion of hand-washing and excessive cleaning behaviors.

Finally, there’s harm OCD, where you worry that you might “snap” and hurt someone, or that you’re secretly a violent person. In some cases, on the other hand, you may fear being the victim of harm.

If your intrusive thoughts don’t fit into one of these categories, that’s OK. While these are some common OCD themes, intrusive thoughts can latch onto anything. In the case of intrusive thoughts during climax, you might think things like:

  • What if I’m faking my attraction to this person?
  • What if I’m not attracted to people of their gender?
  • What if our intimacy isn’t “good enough” and that means we should break up?
  • What if my face looks stupid?
  • What if they’re staring at my acne and think I’m unattractive?
  • What if I get a deadly disease from them?
  • What if our birth control doesn’t work?
  • What if the sheets we’re lying on are dirty?
  • What if I actually didn’t get consent from this person?
  • What if I’m hurting them, and that means I’m secretly a very violent person?

Because these thoughts go against your beliefs or values, they lead to compulsions. These can vary widely, and include any physical or mental action done with the intention of ridding yourself of intrusive thoughts and the uncomfortable feelings they bring. Here are some examples that may be likely to accompany intrusive thoughts during orgasm:

  • Reassurance-seeking from yourself or others. For example, you might force yourself to think over and over, I love this person or I am clean. When seeking reassurance from others, you may repeatedly ask the person you were intimate with, “Did you enjoy that?” or ask your friend, “Do you ever have intrusive thoughts during sex? Do you think it means I shouldn’t be with this person?”  
  • Avoidance. This looks like refusing to go to places, be in situations, or take in stimuli that may trigger your intrusive thoughts. In this case, you may start to avoid intimacy altogether. 
  • Rumination. Put simply, this is a form of overthinking where you turn something over and over in your mind, maybe even for hours a day. It stems from feelings of “needing to get to the bottom” or “think your way out” of intrusive thoughts and the feelings they bring. You might repeatedly wonder if your intrusive thoughts during sex mean anything, hoping new information or “evidence” will emerge.
  • Mental review. This looks like going through prior experiences and situations with a fine-toothed comb to look for proof that intrusive thoughts are or are not true. For example, if you have harm OCD, you might look back and ask yourself, In my prior experiences of intimacy, was I violent or aggressive? Or Am I completely sure the condom stayed on?
  • Distraction. This happens when you try to keep your mind occupied to distract from intrusive thoughts—like spending hours scrolling social media because it drowns out your own thoughts.

Do intrusive thoughts during climax mean anything?

It’s worth repeating: Intrusive thoughts don’t have to “mean” anything whatsoever. It can feel irresponsible to dismiss them, but that’s OCD talking—in reality, dismissing these thoughts is the best way to respond to them. 

Kilduff notes, “We know this is OCD’s number one trick—to put scary intrusive thoughts, images, feelings, or sensations in someone and then insist it has to mean something. And it doesn’t. Thoughts are really just thoughts, and we can never control all of our thoughts, so there’s no need to blame or judge ourselves for them.” 

How can you move on from intrusive thoughts?

If you can’t stop focusing on your intrusive thoughts, the best course of treatment, no matter the theme of your OCD, is exposure and response prevention (ERP) therapy. This type of treatment is also highly effective for anxiety disorders.

“ERP has repeatedly been shown to be the best treatment for OCD. There are many, many, many people who have gone through ERP and gotten better,” says Kilduff.

So what does ERP entail? To begin, you and your ERP-trained therapist will spend time understanding your unique experience of OCD. What do your intrusive thoughts, images, worries, urges, and feelings sound like? What are your triggers? What compulsions do you engage in? “From there, you’ll come up with a plan for ERP exercises you’ll do in therapy and as homework, where you gradually confront smaller uncomfortable triggers, and then work your way up to the more difficult ones,” she explains. “No one is going to ask you to do the scariest thing you can think of right away.” 

All the while, you’ll practice resisting the urge to engage in compulsions—this is the response prevention piece. Your therapist will give you strategies to help you do this. While exposures are bound to bring an initial spike in anxiety (in a way, that’s actually the point), over time you learn that you can tolerate that discomfort. 

When you don’t react to them, you begin to see that your intrusive thoughts are not dangerous, which can feel like a huge relief that allows you to enjoy a life full of love and intimacy. 

Remember: it’s perfectly natural—and common—to feel disturbed and even overwhelmed by intrusive thoughts that occur at the most awkward, inopportune moments, like during sexual intimacy. But they don’t have to interfere in your life and relationships. With the right help and understanding, you can learn to change your relationship with even the most distressing intrusive thoughts. 

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