The unexpected ways OCD wreaks havoc on our sex lives

Because many of us still aren’t comfortable discussing mental illness (and live in a deeply capitalist society), they’re often brought up in the context of productivity. Both ADHD and OCD, for example, are flippantly used to explain why we take forever to respond to one email or get upset when our work doesn’t turn out perfect. But OCD, for example, isn’t nearly as simple as “I have to have things a certain way” — there’s a whole spectrum of severity to it, and it manifests in different ways for different people. The symptoms don’t start and end at our office jobs. For people with OCD, they lurk everywhere, including the bedroom.

The National Institute of Mental Health defines OCD as a “disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and/or behaviors (compulsions) that he or she feels the urge to repeat over and over.” Although it’s perfectly normal to obsess over certain aspects of sex now and again (especially if it’s your first time doing something), persistent OCD could be seriously undermining intimacy. Even if someone hasn’t been diagnosed, new research has suggested that traumatic events can trigger the onset of OCD, according to the National Center for Biotechnology. Other research has found that about 30% of people diagnosed with PTSD also develop OCD within a year.

Without going into too much detail, I can count myself as someone whose sex life was completely thrown off by a bad experience. There was a long period of my life in which the fear of STDs consumed me, even if I was protected or not having sex at all. That obsession made me fearful of intimacy, but it also made me realize how deeply linked our mental health and sex lives really are. Whether or not my own experience is considered disordered, the impacts of what I went through were real and continue to affect me today. I decided to speak to clinical experts and people with OCD to better understand how we can identify that the disorder is impacting us and how folks can start to take control.

Pete Kelly, an Ottawa-based psychologist and host of the mental health podcast Thoughts on Record, tells me that there are some major ways we can identify symptoms of OCD when we’re getting it on. The main way you’ll note it, he tells me, is through constant intrusive or unwanted thoughts related to violence, germs, and/or STDs. Dr. Pete tells me that, for example, some clients go to him worried that they’re going to become violent during sex. Mostly, he can identify these instances as being related to OCD because the person is very distressed by those thoughts whereas an actual violent person, he says, would welcome them.

For many people with OCD, sex is not just about having uncomfortable thoughts now and again, says Monnica Williams, a psychologist and Canada Research Chair at the University of Ottawa. When they continue to occur against all evidence, intrusive thoughts become the only way in which a person can relate to others sexually.

“[Individuals with] contamination-OCD believe they might accidentally impregnate a partner — or even family member — from residual fluids left on clothing or other materials, even if they’ve been extensively cleaned,” she tells me. “This can lead to avoidance of sex, or even avoiding the partner in general. In more severe cases, clients have had to leave their partner and disengage in any sexual activities because of the fear’s intensity.”

Again, these types of thoughts tend to fall on the more severe end of the OCD spectrum, but similar, less intense versions of them can come up for a lot of others. They become a serious issue when we allow those thoughts to dictate our actions.

Anika, who’s in her late 20s and asked me not to use her full name to protect her privacy at work, has been diagnosed with both PTSD and OCD and tells me that the disorder has impacted her ability to have romantic partnerships. For her, OCD most often rears its head after she’s had sex. “If I feel any weird textures or the ‘sex smell’ I have to compulsively wash my hands,” she tells me. “I can be very particular about people washing their hands, using hand sanitizer, and just other general neuroses related to germaphobia.”

Teresa, a queer 23-year-old grad student who prefers not to use their real name for fear of potential employers finding out, notes a similar obsession over cleanliness surrounding sexual encounters. “I am quite averse to having sex in my bed, which tends to cause some friction,” they tell me. “If a partner wants to be spontaneous but they haven’t washed their hands, I often kill the mood and that annoys people a bit.”

Talking to people about their experiences made me curious about whether our identities and education around sex could also have an influence in how intrusive and unwelcome thoughts manifest. Chris Trondsen, a clinician who specializes in the treatment of OCD and related disorders at The Gateway Institute in California, tells me that although sexual trauma or a lack of sex education do not cause OCD on their own, existing cultural beliefs about certain types of sex as being “dirty” can make it even easier for folks with OCD to indulge in irrational fears.

“Some marginalized communities, such as the LGBTQ+ community, often do not receive any sex education specific to their community's needs,” Trondsen says. I’m profoundly aware of this disappointing reality. “Therefore, a person with OCD who is also in the LGBTQ+ community may be getting all of their sex education from friends or other non-science-based factual sources.”

The best step towards treating the disorder is to get an official diagnosis from a psychiatrist. Once someone is diagnosed with OCD, a clinician can put a plan which will include medicine, therapy, or a combination of both. The most common cognitive-behavioral therapy used to treat it is called Exposure and Response Prevention (ERP). ERP, which has to be guided by a trained professional, actually encourages exposure to the source of the OCD.

Once we stop letting our compulsions determine our actions, we can finally start to ask ourselves the important and exciting questions.

Trondsen explains that there are typically five steps to ERP therapy: 1. The client has to push themselves to do the opposite of what the disorder wants them to do— for example, seeking sex instead of avoiding it. 2. The client has to accept the uncertainty brought on by that behavior, even if intrusive thoughts and anxiety are momentarily triggered. 3. The client has to try and not engage in compulsive behaviors that feel comfortable.

For example, if they always shower thoroughly after sex, avoiding doing that the next time. 4. The client should continue to try and incorporate sex in their lives and repeat the previous steps. 5. The client should take note of the process and track how they’re doing.

When done consistently, this technique can lead someone with OCD towards a functioning and fulfilling sex life. But for those who might not have access to therapy, Trondsen adds, he recommends starting with The Complete OCD Workbook by Scott Granet.

Once we stop letting our compulsions determine our actions, we can finally start to ask ourselves the important and exciting questions — like what type of partner we want to share our time with or what frontiers of intimacy we have yet to explore. “In OCD treatment, the person is learning to live a life based on values instead of fear,” Trondsen says. “[They are learning] to fight through and go after what they want.”