The content of the obsessions varies widely. While some obsessions involve fears of contamination, concerns about contamination make up a small percentage of obsessional themes. Obsessions are often “taboo” in nature. For example, someone with OCD may experience violent thoughts and images (i.e. killing oneself or others), sexually intrusive thoughts and images that are disturbing (i.e., sexual thoughts involving children, family members, animals, religious figures, etc.), or blasphemous thoughts that go against someone’s religion. These compulsions are used to reduce anxiety or to prevent something bad from happening. The person dealing with OCD becomes locked in a vicious cycle that impacts all areas of one’s functioning, including sexual intimacy.
OCD’s Impact on Sex and Intimacy
OCD knows no bounds. Intrusive thoughts can and will show up anywhere. The bedroom, or wherever you decide to have sex, is not off limits. Some ways in which OCD can negatively impact someone’s sex life and intimacy may include the following:
Sex may trigger OCD and will become a part of that individual’s exposure and response prevention treatment (ERP). Sex may be used compulsively to solve, prove, or seek certainty about obsessions and must be prevented. Decreased libido and an inability to orgasm can result as a side effect of medication used to treat OCD, or as a result of increased anxiety from the OCD, and may tamper with the person’s sex life.
When Intrusive Thoughts Pop Up During Sex
Everyone experiences intrusive thoughts, but for those dealing with OCD, the thoughts stick because of the way their brain is wired. People with OCD have a hyperactive fear center in the brain that sends off false alarms when danger is not present. For example, think of the fear you feel when your fire alarm goes off in the middle of the night and it’s a false alarm. This is what happens frequently for those with OCD. The unwanted thoughts pop in and replay over and over and over again, attacking what the individual loves the most. For some, it’s unwanted thoughts or images of having sex with children, family members, religious figures, etc. For others, it’s unwanted thoughts or images of harming a loved one. The thoughts are not only highly anxiety-provoking for the individual with OCD, but also a massive turn-off. Even if one is feeling aroused and in the mood, engaging in sexual activity can be triggering for those living with OCD because of the content of their thoughts. Many people who are in treatment for their OCD report the following fears and concerns:
“I don’t want the thoughts to pop in while I’m having sex. It will terrify me and ruin sex.”“What if I reach orgasm and an intrusive thought pops in? Does that mean I like the thought?” “What if I am not as aroused as I have been at other times and it proves that my obsessions are ‘true’?”“What if I snap and do something to my partner during sex?”
This is where mindfulness and ERP treatment come into play. The reality is that our thoughts are out of our control most of the time. We can’t press pause on intrusive thoughts and the harder we try to suppress them, the more unwanted thoughts we have. Psychologist Daniel Wegner’s research on thought suppression is evidence of this. In his study, one group of participants was asked to think about a white bear for 5 minutes. Another group was told not to think about a white bear for 5 minutes. The results of this study found that the participants who were asked not to think about a white bear ended up thinking about the white bear more than the participants who were instructed to think about a white bear.
Sex in ERP Treatment
ERP may facilitate habituation, in which anxiety is reduced over time after repeated exposure to the feared stimuli. ERP also facilitates inhibitory learning, in which the patient learns that the feared outcome is not as likely to occur as their brain has led them to believe and that they can tolerate the discomfort and anxiety associated with the feared stimuli.
Sex as an Exposure
To re-wire the brain, a person with OCD must be exposed to the thing that they fear without engaging in compulsions. Enter: sex as an exposure. When a client values sex and wants to be having it, sex becomes a part of the exposure and response prevention treatment. Exposure When someone with OCD engages in sexual activity, their brain may become flooded with intrusive thoughts. This often terrifies them and leads them to avoid sex, despite how much they value it. To combat this avoidance, aka a compulsion, a therapist may assign sex as an exposure. When the client does have sex, they are often exposed to the intrusive thoughts that they do not want to be thinking about during sex. The client would then repeatedly have sex in order to work on tolerating the anxiety and discomfort that comes from dealing with intrusive thoughts that pop up during sex. In addition to exposure to mental stimuli (thoughts and images) while having sex, exposure to physical stimuli during sex is utilized for those with contamination obsessions surrounding semen, sweat, etc. The person will gradually and repeatedly expose themselves to bodily fluids and sexual activity without engaging in avoidance compulsions. Response Prevention The response prevention piece involves cutting out compulsions while having sex and is equally as important as exposures. For example, the person must not ruminate about thoughts that pop in, push thoughts away, or try to neutralize thoughts during sex. The goal is to tolerate discomfort and have sex mindfully.
Why Avoiding Triggers Doesn’t Work
Exposure is so clinically beneficial for those with OCD because the opposite of facing a fear is avoiding it. Avoidance of feared stimuli is what many people with OCD resort to, but avoidance is a compulsion and feeds the OCD. By avoiding sex because of intrusive thoughts, the individual is signaling to their hyperactive OCD brain that the false alarms their brain is sending out are real alarms that should be paid attention to. So, what does the brain do? It sends off more frequent and intense alarms because, after all, the brain is trying to keep you safe.
Compulsive Sexual Activity
While some avoid sex compulsively and must expose themselves to it throughout the course of treatment, others utilize sex as a checking compulsion to look for clarity and certainty about their obsessions. Response prevention is utilized in this situation to help treat the OCD. Common examples of compulsive sex based on obsessional themes are listed below.
Sexual Obsessions
The person with pedophilic obsessions, or any other sexual obsession like unwanted sexual thoughts about family members or animals, may utilize sex with their partner or others as reassurance that they are aroused by their partner. To the person dealing with OCD, this helps prove to themself that they are not a pedophile, have no desire to have sex with family members or animals, or engage in any other disturbing sexual act.
Sexual Orientation Obsessions
The person dealing with sexual orientation obsessions, intrusive thoughts that cause them to doubt their sexual orientation, may seek out sex with someone to “check” or prove their sexual orientation. For example, a person who has identified as heterosexual for 30 years may suddenly get sexually intrusive thoughts about the same sex that cause them to relentlessly doubt their sexual orientation. This applies to any sexual orientation. Someone who identifies as homosexual may relentlessly doubt whether or not they are truly gay because their OCD has latched onto sexual orientation. The fear with sexual orientation obsessions is not that the person with OCD is gay or straight or anything in between, but that they do not have 100% certainty of their sexual orientation.
Relationship Obsessions
Someone dealing with relationship obsessions (i.e., intrusive thoughts surrounding the “rightness” of their partner or relationship), may utilize sex to check whether or not they are aroused “enough” by their partner. This could look like checking physical arousal or mentally checking internal feelings during sex. In these cases, the person must utilize response prevention to cut out compulsive sexual activity. Checking, whether it be physical checking or mental checking of feelings and arousal levels, is very common amongst those with OCD and it is compulsive.
Mental and Physical Checking
Compulsive checking alerts the brain that the obsessions are meaningful and should be attended to. The checking not only fuels the OCD but often leaves the person further confused because checking can dilute their organic feelings. When people ruminate on something time and time again, like thoughts or feelings or memories, it gets cloudier over time. Another harsh reality is that what you look for, you will often find. For example, when clients check their groinal area for signs of arousal, they are likely going to feel something because of the attention they are placing on a specific body part.
OCD Seeks Certainty
Checking is also an attempt to seek certainty about obsessions. OCD is characterized by an inability to tolerate uncertainty. Hence, compulsions. The individual with OCD strives to obtain 100% certainty about their sexual orientation, relationship status, etc. when the reality is that certainty does not exist for anyone.
The Effects of Medication
There is a reason that OCD was once ranked by the World Health Organization as one of the top 10 most debilitating illnesses, physical and mental included. It’s a torturous mental illness. While ERP is the gold standard in OCD treatment and studies show its effectiveness in treating the disorder, many people with OCD are prescribed medication that can help manage brain chemistry and take the weight off of some of the obsessions. Medication can also help patients carry out their ERP work. Contrary to what the stigma surrounding the use of medication to treat mental illness leads people to believe, taking medication is not the easy way out. It’s not a Band-Aid or quick fix. It is often a complex decision people make because they are deeply suffering.
Medication’s Impact on Sexual Functioning
The decision to take medication may come at the expense of other things, such as one’s sexual functioning. For example, medications can have side effects that decrease one’s libido or make it difficult to achieve orgasm. Those with OCD who are contemplating adding medication to their treatment plan might have to choose between their sanity and sexual satisfaction. This can be a difficult and painful decision to make.
Anxiety and Arousal
Those with OCD who are not taking medication may also experience decreased libido and difficulty achieving orgasm. Anxiety alone can impact arousal, which may be triggering to the person with OCD who interprets the lack of arousal as evidence that their obsessions are true.
Managing OCD Through Mindfulness
Mindfulness skills are a cornerstone of OCD management. Mindfulness, otherwise known as acceptance, is about non-judgmentally noticing thoughts, images, feelings, urges, and sensations. Mindfulness is about accepting the presence of whatever thoughts and feelings the brain has produced without judgment. This is tough for the person with OCD who despises their thoughts, but it’s a crucial part of recovery. The reality is that the thoughts, images, and feelings are not the problem. It is the person’s way of responding to them, compulsively and with resistance, that is the problem. Thoughts are, quite simply, words in our mind. Those words are comprised of letters and those letters make up syllables. Thoughts are not necessarily facts and are never threats, which is difficult for the person with OCD to recognize. They automatically attribute meaning to the words and feelings, which keeps them stuck in the O-C cycle.
How Mindfuless Can Help During Sex
Mindfulness skills are helpful for someone with OCD who is engaging in sex as an exposure. The work is to notice and allow whatever pops in during sexual activity while bringing the attention back to the sexual experience. It is to co-exist with the thoughts during sex without responding to them compulsively. A mindfulness response during sex looks like: “Okay, that was a thought. It can be here while I re-engage with what is happening in the present moment.”
Handling Intrusive Thoughts During Sex
The goal is not to have sex without experiencing any intrusive thoughts, as that is out of your control. You do not get to choose what pops into your mind during sex or at any other time. Also, it’s highly likely that the intrusive thoughts will be there. Thoughts might pop in right before climax or all throughout the sexual experience. That is okay. You are not engaging with the thoughts compulsively or making meaning out of them. You are allowing them to co-exist with you, as uncomfortable as it may be. Many are so tempted to resist uncomfortable thoughts and feelings, which only keeps them around longer. Mindfulness has a paradoxical effect on thoughts and feelings.
A Word From Verywell
While OCD can make sex more difficult, difficult does not mean impossible. Through Exposure & Response Prevention treatment along with the use of mindfulness skills, sex can become more manageable and even enjoyable.
