Sex, Intimacy, and OCD

Many people who struggle with OCD often have difficulties with their sexual health. I want to take a moment to review some of the literature on this topic and discuss the current treatment recommendations.

What we know from a cross-sectional study that was published this year, 2025, is that the authors suggest that women with OCD experienced more sexual difficulties than healthy women. These problems continued even after their OCD symptoms were controlled with the use of medication. They indicated that women with OCD struggled with desire, arousal, reaching orgasm and sexual satisfaction. Those on medication didn’t have any better sexual function. They believe that this may have been influenced by the OCD theme, as some themes, such as contamination or scrupulosity, may be contributing to the problem. Some typical SSRI can also have their own sexual side effects, and sometimes chronic stress and living with OCD can take a toll on intimacy. It’s important to note that the researchers didn’t assess those who have been through therapy and how that may sexual health may have changed as therapy progressed and ended.

Treating OCD symptoms alone doesn’t always bring sexual wellbeing back because sex involves more than just getting rid of anxiety or compulsions. Even when the intrusive thoughts and rituals improve, many people still struggle with shame, fear, or a loss of connection to their sexual self. They may avoid intimacy, feel anxious about what’s “normal,” or worry that their thoughts mean something bad about them. Medication side effects can also lower desire or make pleasure harder to feel. That’s why therapy needs to go beyond OCD management—it should help people rebuild comfort, confidence, and joy in their relationships. Working directly on sexual fears, communication, and self-acceptance helps restore both emotional closeness and sexual health.

We do know that some partners of people with OCD will describe feeling rejected, inadequate or feelings of resentment at times.

What we want to do as clinicians is really focus on helping relationships thrive for those with OCD. So, addressing symptoms of depression, providing hope and making sure that our clients and their partners are aware that OCD is treatable can help with managing the depressive symptoms that may exist with the OCD sufferer and their partner, who may also have depressive symptoms. Including the OCD partner in therapy to talk about progress and other important dimensions of treatment, such as how they may be influencing treatment both positively and negatively, can also support the couple.

Angela Smith at the OCD Conference spoke about addressing dating and intimacy with OCD a while back and spoke about how important it was to receive empathy and compassion from partners of people with OCD, as it could help with maintaining treatment gains. A significant amount of work can be accomplished with partners when they are actively involved in therapy. They can help reduce rituals and participate in rituals, encourage, and assist with behavioural modification. Open communication can go a long way in helping to secure the relationship, which in turn can help the OCD partner feel safe and comforted in addressing some of their concerns, and most importantly, build intimacy in the relationship.

Compassion can go a long way. The OCD partner is suffering and experiencing difficulties, ultimately being their true, authentic self because of the fear and the anxiety. Recognizing that they are suffering, struggling, and are likely in a constant state of fear can create awareness of how much they really need support. The connection between partners can go a long way. Most importantly, if a partner is supportive and willing to participate in the healing process, it can help build the relationship and provide stability as the OCD sufferer goes through treatment.

There are many compulsions that may influence a relationship, which may interfere with the connection. Some of these compulsions may be reassurance seeking, confessing, checking and avoidance. It can be challenging for someone to be intimate when they are constantly in a state of stress. Also, some OCD concerns may interfere with intimacy because some people with OCD may feel discomfort, not being in control, feeling a lack of control, disgust or feeling dirty, feeling grief, guilt and shame.

Part of the process of building intimacy when there are fears surrounding the sexual experience is to ensure that the OCD sufferer feels safe. They may experience some difficulties with engaging in sex because it may be tied to their OCD concerns. The person may also feel generally anxious from an OCD concern not related to sex, and may experience difficulties being mindful of the experience. Part of this process requires open communication, which may require engaging in dialogue to assist in remaining mindful of the experience. I think this needs to be broken down into two parts: those who have fears that are focused on sex as an exposure, and those who are just generally anxious and engaging in sex and are unable to be mindful.

Anxiety will pull you out of the experience, and thoughts often will creep up into your head at times when you don’t want them to. Many people often experience having intrusive thoughts during sex. At times, partners can misinterpret the OCD sufferer's reaction as about them, and it may influence the intimate moment. I think it’s important to remember that your anxiety is protecting you and it’s doing so by sending intrusive thoughts about something that you have deemed as a fear, and as a result, the intrusive images and thoughts feel difficult to get out of your head and therefore impact arousal and desire.

Sex does require both partners to put in work. There is quite a lot that gets in the way of good sex, and some of that includes inherent vulnerability, religious and cultural stigma and repression. Author Sheeva Rajee, who wrote the text Relationship OCD, speaks about how media insecurity around the body and perfectionism around sex are a recipe for disaster in the bedroom. She encourages couples to speak openly about sex and the expectations of sex that we often put on each other. Some of these expectations include:

- You should feel instant and immediate desire anytime your partner wants to have sex

- You should like the way your partner touches you and shouldn’t have to explain your turn on/turn offs, they should just know,

- You should be having sex multiple times per week.

- The only thing that counts is real sex

- If you can’t orgasm vaginally or if you require lubrication, it means your partner doesn’t turn you on enough

- You should always like the way your partner smells and tastes

- You should never fantasize about anyone other than your partner

- Sexual desire and interest should remain perfectly consistent over the course of a relationship.

Let’s spend some time talking about what good sex looks like for those with OCD. The first point to make is that sex can exist in multiple ways. It can be as simple as cuddling, making love, or kissing. When we consider what healthy sex is, I refer back to Rajee’s suggestions from her text, she states:

1. There is no such thing as the right amount of sex to have; there is only the amount and frequency that works for you and your partner

2. Your partner can’t read your mind, so it’s likely you will need to explain your turn-offs and turn-ons and communicate your needs and desires regularly

3. All forms of intimacy, including kissing and hugging and masturbation, can be called sex, not just intercourse

4. Lubrication or the use of toys has nothing to do with how much you want or don’t want sex with your partner, and is not an indicator of your level of arousal

5. Desires wax and wane over time and are influenced by many factors.

Some people may need to use toys to become aroused to engage in an experience fully. We often believe that we must achieve arousal right away, but we need to be mindful that not everyone responds to spontaneous arousal. Most people are responsive in their arousal, which means that they need to go slow and ‘warm up’ to the experience. The environment may also play a factor in arousal. Where you are, sounds you hear, and things you feel are all factors that may influence arousal. People who struggle with ADHD may also describe feeling sudden arousal loss when the environment is slightly off or there is a sudden shift in the environment.

Sometimes people with OCD have a hard time opening up sexually, believing that they may offend their partner, violate some social standard or be immoral in some way. This can come with a fear of rejection, which can put up walls that prevent the person with OCD from being vulnerable. Part of being centred with your anxiety is looking at the other issues that may be influencing your sexual health negatively and speaking openly about them. We all have a window of tolerance for managing life’s stress. When that window starts to fill up, we start to get overwhelmed. The same could be said about our sex life. The more we have competing against us and our partner when it comes to enjoyable sex, the harder it will become. Sometimes this requires a deep dive into what other factors besides OCD are getting in the way. This could be particular views of sex, perhaps driven by the media, religious and cultural stigma, and fears of emotional intimacy. Sometimes, when these are challenged and worked on, it actually becomes easier for us to become intimate with our partner, even when we have competing intrusive thoughts.

Anxiety can block arousal; there is a theory by John Bancroft and Erick Janssen that helps describe the sexual response. They argue that human desire is broken up into two processes. The activation accelerator, also called the sexual excitation system and the sexual inhibition system. The sexual excitation system is always looking for cues through our senses of things to turn us on. Once it receives a message through our senses that there is something that we perceive as sexual, the system sends a message, and our genitals are aroused. The system doesn’t even turn off, and it’s always ready, seeking out cues in the environment that may get us sexually aroused.

The sexual inhibition system will search out in the environment or internally for reasons not to be aroused. It looks for information or cues that may make sex unsafe or unwanted. It also notices threats in the external world and internal world and then sends a ‘turn off’ signal to the body and shuts down all desire. Using Sheva Rajaee’s reference from her text Relationship OCD, she describes this as a car hitting the brakes, and there is no slowing down. It just hits the break, and you are turned off. She lists a few reasons why the breaks may get triggered, and therefore reduce your sexual desire and libido

- Negative body image,

- Concerns about stigma

- Worries about pregnancy

- Painful sex

- Feelings used by a partner instead of wanted

- Intrusive thoughts about your partner or relationship

- Feeling tired or stressed

- Concerns about STI’s

- Low mood, depression

As soon as you feel anxiety, the brakes will turn on, and your desire and libido will go. One point Rajee mentions is that having a sensitive system is nothing to be ashamed of.

Jaiswal, N., Tripathi, A., Gupta, B., & Singh, S. (2025). Sexual Functioning in Females with OCD: A Comparative Cross-sectional Study. Journal of Psychosexual Health, 26318318251324316.