How Might OCD Impact a Person's Sex Life?

Obsessive compulsive disorder (OCD) is a chronic mental health condition that involves recurring unwanted thoughts or impulses (known as obsessions) that lead to repetitive behaviors (compulsions). These obsessions and compulsions can interfere with a person’s day-to-day life and may cause relationship problems, occupational issues, and significant emotional distress.

Often, a person’s obsessions fall into themes such as needing cleanliness and order, fearing contamination, or having difficulties dealing with uncertainty. Accordingly, their compulsions may fall into themes such as washing, cleaning, organizing, counting, or checking things repeatedly.

A person’s sex life may not be immune to the effects of OCD, and past research has shown an association between OCD and sexual dysfunction. People with OCD may be at higher risk of low sex drive, worse sexual functioning, lower sexual satisfaction, disgust with sexual activities, or fear and/or avoidance of sex.

Additionally, some medications for OCD such as selective serotonin reuptake inhibitors (SSRIs) can negatively impact sexual functioning. These medications may delay ejaculation and female orgasm, contribute to decreased libido, and cause erectile difficulties.

Some individuals with OCD who have contamination-related obsessions may avoid sex for fear of sexually transmitted infections (STIs), coming into contact with bodily fluids, or experiencing moral or religious “contamination.” For other OCD patients, it may be difficult to concentrate during sexual activity as a result of intrusive, repetitive thoughts and fixations.

A subtype of OCD known as relationship OCD may further interfere with a person’s intimate connections. As the name suggests, people with relationship OCD experience obsessions and compulsions related to their relationships. This may involve constant fears or doubts about the relationship, concerns about whether a person’s partner is “right” for them, and/or insecurities about one’s own attractiveness, sexual desirability, and worthiness in a romantic relationship.

While these circumstances may be challenging for patients with OCD and their romantic partners, there are ways to lessen the effects of OCD on sexual function. Cognitive behavioral therapy for OCD consists of exposing a person to objects or situations that would generally trigger their obsessions and compulsions, then helping them manage their distress so that they are able to cope with it better over time.

Prior research has suggested that including partners in therapy that targets both OCD and non-OCD related couple problems can reduce symptoms and improve the couple’s sexual and relationship outcomes. If you or your partner are struggling with OCD and it is affecting your sex life, consider involving a sex therapist with experience in this area to help you work toward greater sexual satisfaction.

For more information on this topic, please read these publications from the ISSM Journals: The Journal of Sexual Medicine, Sexual Medicine Reviews, and Sexual Medicine Open Access:

• Right or Flawed: Relationship Obsessions and Sexual Satisfaction
• Orgasm, Serotonin Reuptake Inhibition, and Plasma Oxytocin in Obsessive-Compulsive Disorder. Gleaning From a Distant Randomized Clinical Trial

References:

Pozza, A., Veale, D., Marazziti, D., Delgadillo, J., Albert, U., Grassi, G., Prestia, D., & Dèttore, D. (2020). Sexual dysfunction and satisfaction in obsessive compulsive disorder: protocol for a systematic review and meta-analysis. Systematic Reviews, 9, 1-13. https://link.springer.com/article/10.1186/s13643-019-1262-7