The Challenges of Sex with OCD

Are compulsions ruining your sex life?

Posted Jul 15, 2020

Sean Shinnock / Used with permission
Source: Sean Shinnock / Used with permission

I once had a client; let's call him Bob. Every time Bob had a triggering obsession that he could be gay (Homosexual/Heterosexual OCD) he would find his wife and have sex with her. Not for the reason a healthy married couple would have sex; rather, he needed to check and make sure that he was still aroused by his wife. This way, he got his reassurance that he was not gay; in turn, neutralizing his obsession and making him feel better. Sometimes this would work and other times he would not feel aroused by his wife and would experience panic and distress and would not be able to perform sexually. This pattern greatly affected his sex life and his marriage

This is an example of how an OCD sufferer could use sex as a compulsion. The OCD person may also have disturbing obsessions during sex: Did I turn the stove off? Is it possible the stove is still on? Suppose the house is starting to catch on fire? What if the house is on fire and I was too busy having sex to go stop it? Maybe I will be responsible for the house burning down! Maybe the house will be burning down and I will catch on fire and burn to death! I need to go see if the stove is on or off now! This example of obsessive thoughts is not sexy and the OCD sufferer will not be able to be present during intercourse. 

This is really unfortunate because all people deserve to experience one of the greatest joys of being human, which is sex. OCD robs them of this opportunity. The sufferer is unable to be present during the act of sex because either their mind is occupied with disturbing thoughts and images or they are feeling strong urges to do compulsive behaviors.

Recently, I had a client with contamination-type OCD. She felt she needed to put Purell on her spouse's penis before she could have sex with him. He actually allowed this to happen and they would begin the act, but it still was not good enough for her. She would begin to think that perhaps she did not get the Purell on him good enough, or what if she did not give the Purell enough time to dry. At times, she would even obsess about whether or not the Purell’s chemicals could give her cancer—or, if the alcohol in the Purell could get her drunk. So, the compulsion, in this case, actually became the new obsession. Typical of OCD, the compulsion protected no one and only made the obsession stronger and more real, and my client was completely unable to hop on and enjoy the ride. 

Speaking of not enjoying sex, relationship OCD (ROCD) sufferers are notorious for losing that loving feeling. Most of my ROCD clients use avoidance as a compulsion to reduce their anxiety during intercourse. For example, they will on purpose try not to look at one area of their partner's body. If they see the body part they are avoiding, it could trigger an obsession. For instance, I have a client that refuses to look at her partner's stomach during sex. She explained that if she sees it or feels it, her obsessions start with "Oh, you think his stomach is big and ugly and this must mean you are not attracted to him any more." That will definitely kill the mood. 

In terms of treatment, it does not matter what the person is doing, even during sex or masturbation; treatment does not change. The sufferer must still resist the compulsions. No checking, no avoiding, and lord knows, no Purell. Yes, it will be extremely difficult at the beginning of therapy to enjoy sex while resisting compulsions. Obviously, the sufferer will feel extremely uncomfortable and doubtful, but this should ease over time and eventually, with enough practice, the OCD person can reclaim their sex life.