Most people don’t connect obsessive-compulsive disorder (OCD) and sex, but the sad fact is that many people with the disorder are having struggles in one of the most important and intimate areas of life. We are not talking about people who have sex over and over again, compelled by a need to achieve technical sexual perfection. In fact, OCD is more likely to result in a sex life characterized by lack rather than repeated memorable performances. Here we discuss six ways that OCD can interfere with sexual bliss and drive couples to the brink of frustration.
1) Contamination fears
Over a quarter of those with OCD have contamination fears, and many of these people worry about germs that can cause a dreaded illness or disease. Perhaps the most feared disease is HIV, with other sexually transmitted diseases (i.e., herpes, HPV) also possible causes of concern. People with these worries will avoid places and situations that evoke disease-related obsessions, such as public restrooms, medical facilities, and above all, sexual contact. These fears are not rational, and OCD patients may have concerns about partners who are faithful and certified disease-free. OCD sufferers may have themselves tested repeatedly for STDs and demand their partners do the same.
Others with contamination fears in OCD may not worry about infection per se, rather they find sexual fluids unbearably disgusting. As a result, long post-sex decontamination rituals become necessary to regain peace of mind. This may involve hours of compulsive washing and scrubbing in scalding water, as well as laundering all bed linens, clothes, and towels that may have been witness to sexual activity. In the face of such onerous rituals, it becomes easier to avoid sex altogether.
Some people with OCD worry excessively about becoming pregnant or impregnating others. Women with this sort of OCD may engage in repeated washing to remove any traces of semen they may have encountered unknowingly during the day. They may avoid swimming pools and public restrooms, out of fear that such places put them at risk of pregnancy. Males with this type of OCD may resist touching objects or others out of fear that a random lone survivor sperm might be transferred to an unsuspecting female victim through something as innocuous as a handshake, leading to unintentional pregnancy. One of my patients made his girlfriend take pregnancy tests every week, just to be sure he hadn’t impregnated her – despite the fact they had stopped sexual activity many months ago due to his extreme obsessional fears. As you can imagine, people with pregnancy obsessions stay as far away from sexual activity as possible.
About 10% of OCD patients suffer from sexual orientation fears, which include worries about whether they are gay or straight, fears of changing sexual orientation, or fears that others may believe they are LGBTQ. People with this type of OCD are not attracted to people of the same sex emotionally or physically, but are nonetheless hypervigilant for signs of possible same-sex attraction. This hypervigilance typically extends to sexual activity, where sufferers may be obsessively monitoring their feelings of arousal to help confirm their orientation. The problem is that paying such close attention to the sexual process takes attention away from the experience itself, resulting in reduced arousal and poor performance as a self-fulfilling prophecy. More about this...
At least one in five people with OCD worry about having inappropriate sexual desires, such as an attraction to children, family members, religious figures, or even animals. People with such worries often try very hard not to think about sexual matters as this triggers OCD-related worries. For example, one of my patients asked, “If I have sexual feelings about my husband, but my baby is in the bed with us, could that mean I am actually attracted to my son?” She avoided anything that might cause sexual arousal, as she worried that the feelings would somehow transfer to her baby and make her a pedophile. As you can imagine, there was not much sexual happiness in the home.
Although laboratory studies suggest that some types of anxiety may facilitate sexual feelings (i.e. watching a scary movie, crossing a rickety bridge), anxiety associated with mental disorders is generally correlated to sexual dysfunction. One reason for this is that high levels of anxiety may be associated with mental distractions (such as worry, obsessions, and hypervigilance) that can interfere with sexual responding. People with OCD are generally anxious about any number of things, sexual and non-sexual, and this can reduce sex drive or interfere with being mentally engaged during the sexual experience.
Additionally, the reality of having chronic, unwanted thoughts – no matter what the content – is generally distressing. Therefore it is not surprising that over half of those with OCD also struggle with a diagnosable depressive disorder. Depression alone can result in a loss of sexual interest.
Selective-serotonin reuptake inhibitor (SSRI) medications, used widely as antidepressants, are a first-line treatment for OCD. SSRI’s and other similar medications usually reduce anxious feelings but will also cause sexual dysfunction in at least a third of patients. Furthermore, people with OCD typically require higher doses than people using SSRI’s for depression, making sexual dysfunction more likely. For many, relief from OCD symptoms is enough to overcome the resulting sexual problems, but for others the medication itself makes intercourse impossible.
Sexual problems caused by OCD can increase the stress level in a relationship that is already bearing the weight of the disorder in other areas. Partners may be frustrated by the apparent lack of sexual interest shown by their loved one. It is important to remember that sexual dysfunction is a symptom of the illness and does not reflect a lack of love or caring. The person with OCD may simply be too overwhelmed with worries to feel sexual.
Getting professional help for OCD is an important step in the right direction, but be aware that treatment can also contribute to the problem – at least at first. Exposure-based therapy for OCD may be stressful, temporarily contributing to decreased interest in sex, and medication can result in difficulties that may be temporary or long-term. It is important to discuss these issues with your mental health provider, and couples sessions may be a necessary part of the process. Make sure to find a therapist with experience treating OCD using exposure and ritual prevention – the gold standard treatment of this disorder. Understanding and patience is critical, but if both partners are motivated OCD can be beaten and love-life restored.
Sexual problems in OCD are a big problem, but unfortunately little research in this area has been done. If you are married and have OCD, or if you are married to someone with OCD, you can help us better understand issues faced by couples by participating in a 30-minute online survey. The study, conducted through the University of Louisville, is confidential and includes compensation. Go there now.
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