Navigating Sexual Intimacy with OCD: Understanding its Impact on Sexual Functioning
Author: Michayla Yost
Published: February 2023
Obsessive-Compulsive Disorder (OCD) is a mental health disorder characterized by recurrent, unwanted thoughts, ideas, or obsessions that often drive a person to engage in repetitive behaviors or mental acts (compulsions) to reduce feelings of anxiety or to prevent something bad from happening.
OCD can manifest in a variety of ways and can have a significant impact on one's sexual functioning. Symptoms of OCD can be distressing, especially when it comes to sexual intimacy. Understanding the various subtypes can help individuals with OCD and their partners understand the underlying causes of their difficulties and provide them with the tools they need to improve their sexual functioning and promote relationship satisfaction.
Relationship OCD
Relationship OCD is a subtype of OCD that is characterized by excessive and distressing thoughts and doubts about one's romantic relationship. These thoughts often revolve around questions of love, trust, and commitment, and can lead to a range of compulsive behaviors.
Obsession Examples:
Worrying whether their partner loves them: This obsession can manifest in the form of constant questioning, rumination, and doubt about whether one's partner truly loves them. This can cause feelings of insecurity, anxiety, and fear of rejection.
Worrying whether they love their partner: Similar to the above obsession, this can involve constant questioning, rumination, and doubt about whether one truly loves their partner. This can lead to feelings of confusion, guilt, and uncertainty.
Doubting their partner’s love and/or affection: This obsession can involve constant doubt and questioning about the authenticity of one's partner's feelings and affectionate behavior towards them. This can lead to feelings of insecurity, mistrust, and fear of abandonment.
Compulsion Examples:
Asking partner for reassurance excessively: One of the most common compulsions in Relationship OCD is seeking excessive reassurance from one's partner about their feelings, love, and commitment. This can involve asking repeatedly if their partner truly loves them, demanding immediate answers, and becoming obsessed with receiving reassuring responses.
Scanning body for arousal to validate the relationship: Some individuals with Relationship OCD may engage in physical compulsions, such as scanning their body for signs of arousal to confirm their feelings for their partner or to validate the relationship.
Mental checking to confirm relationship satisfaction by rehearsing memories and feelings: This compulsion can involve constant mental checking and reassurance seeking by rehearsing positive memories and feelings to confirm their sense of fulfillment in the relationship.
Contamination OCD
Contamination OCD is characterized by an obsession with the fear of getting sick or being contaminated by germs, dirt, or other substances. These thoughts may result in intense anxiety or distress when the individual encounters potential contaminants, and it can sometimes impact romantic relationships.
Obsession Examples:
Worrying about getting sick: Individuals may avoid physical contact, such as hugging or kissing, with a partner out of fear of contracting an illness, even when no symptoms of physical illness are present. This could lead to an emotional disconnect within the relationship.
Worrying about being contaminated: This obsession may cause individuals to experience intense anxiety surrounding places or situations that may lead to contamination, such as public restrooms, crowded spaces, and restaurants. It may be distressing for an individual with contamination OCD to spend time at their partner’s home or go on dates with their partner in public spaces.
Worrying about bodily fluids and the transmission of sexually transmitted infections (STIs): Individuals with contamination OCD may avoid sexual intimacy with their partner to reduce the likelihood of contracting an STI, even when no symptoms of an STI are present. This may lead one or both partners to feel a lack of emotional connection and could contribute to feelings of mistrust.
Compulsion Examples:
Repetitive washing or cleaning of personal items: If a person with contamination OCD engages in repetitive washing or cleaning of personal items, such as clothes, shoes, or belongings, it can take up a significant amount of time and energy. This can lead to less time and energy being available for the relationship and can create distance between the person with OCD and their partner.
Repetitive washing or cleaning of partner's items: If a person with contamination OCD engages in repetitive washing or cleaning of their partner's items, such as clothes, shoes, or belongings, it can create feelings of resentment or frustration in the partner. It can also lead to the partner feeling that their own personal space and belongings are not respected.
Rituals or rigid rules around sexual contact and intimacy to "prevent" contamination: Individuals may avoid sexual contact or intimacy or may have specific requirements for sexual contact or intimacy that are difficult for their partner to meet. This can lead to the partner feeling rejected or unsupported. These rituals or rigid rules can also create a sense of shame and guilt for the person with OCD and can lead to them avoiding sexual contact or intimacy altogether.
Sexual Orientation OCD
Sexual orientation OCD is characterized by an obsession with one's sexual orientation. Individuals experiencing this subtype of OCD may feel a sense of uncertainty, confusion, and self-doubt about their own sexual orientation, which can interfere with romantic relationships.
Obsession Examples:
Worrying whether they are misrepresenting their sexual orientation: A person who identifies as gay may worry, "What if I am actually straight?" or a person who identifies as heterosexual may worry, "What if I am actually gay?" This may lead to feelings of doubt and confusion in romantic relationships.
Worrying about withholding important information about their identity to their partner: An individual may feel like they are unable to fully express themselves and be open with their partner, which can contribute to difficulties in forming and maintaining a healthy and intimate relationship and may impact communication.
Compulsion Examples:
Overanalyzing sexual orientation (not to be confused with normal identity development): An individual with sexual orientation OCD may spend a significant amount of time and energy thinking about, researching, and questioning their own sexual orientation. This can create a lot of uncertainty and confusion in the relationship, which may lead to feelings of guilt.
Engaging in sexual encounters to gauge one's sexual orientation: An individual may feel as if they are using their partner for their own experimentation and may not be fully present and engaged during the encounters.
Avoiding sexual encounters: An individual who is experiencing sexual orientation OCD may avoid sexual encounters with their partner. As a result, the partner may feel rejected, unsupported, or hurt by the avoidance. This can lead to difficulties in sexual intimacy and forming and maintaining romantic relationships.
Harm OCD
Harm OCD is characterized by an obsession with the fear of causing harm to oneself or others, often in the form of violent thoughts or images that may be sexual in nature. These intrusive and violent thoughts may make an individual feel like they cannot trust their own mind.
Obsession Examples:
Violent thoughts or images that are sexual in nature: Having violent thoughts or images that are sexual in nature can be very distressing and may contribute to feelings of shame. This can lead to avoidance of sexual contact or intimacy altogether, creating distance and a lack of connection within the relationship
"Inappropriate" sexual desires: Having "inappropriate" sexual desires, such as attraction to children, family members, or animals, can also contribute to feelings of guilt and shame. This may cause an individual to experience intense anxiety and constantly worry that they might act on one of these desires.
Compulsion Examples:
Avoidance of triggering thoughts: If a person with OCD engages in avoidance of triggering thoughts, they may avoid certain places or people, or certain activities that might be associated with their obsession. This can create emotional withdrawal within the relationship and can lead to the partner feeling neglected or unimportant.
Scanning body for arousal and judging self based on feelings: An individual may become preoccupied with their own physical sensations and reactions to thoughts of harming others, which can lead to them being less present and engaged in the relationship.
Scrupulosity OCD
Scrupulosity OCD is characterized by an obsession with morality, faith, and spirituality, often in relation to religious beliefs.
Obsession Examples:
Worries that they will offend God or a religious figure due to sexual thoughts: An individual may feel as if they are not living up to their religious or moral beliefs because of intrusive sexual thoughts. This can lead to anxiety and avoidance of sexual intimacy with a partner.
Worrying that they are “immoral” due to their sexual thoughts, this can overlap with other domains: Pathological guilt may be a concern in individuals who worry that sexual thoughts and acts are causing them to be “immoral.” This could also overlap with other domains of OCD. For example, someone with sexual orientation OCD may worry that they are immorally deceiving others, and someone with harm OCD may worry that they are immorally having sexual thoughts about a child or family member.
Compulsion Examples:
Overanalyzing morality/faith/spirituality: Overanalyzing morality, faith, or spirituality can lead an individual with OCD to spend excessive amounts of time worrying if they are acting in accordance with their religious principles. This can create distance in a relationship if an individual is constantly overanalyzing and questioning their partner’s actions to see if they are morally in alignment with their religious beliefs.
Praying excessively: If a person with OCD is praying excessively, it can consume a significant amount of time and energy. This can lead to less time and energy being available for the relationship and can create distance between the person with OCD and their partner. It can also lead to the partner feeling neglected or unimportant if the person with OCD prioritizes their praying over their relationship.
Additional OCD Domains Affecting Sexual Functioning
OCD can manifest in a variety of ways beyond the more commonly known subtypes of relationship, contamination, sexual orientation, harm, and scrupulosity. Some additional domains of OCD that can impact romantic relationships and sexual intimacy include:
Fear of Becoming Pregnant: This subtype of OCD is characterized by obsessive thoughts and fears related to pregnancy, childbirth, and motherhood. An individual experiencing this fear may have obsessive thoughts related to accidentally becoming pregnant or accidentally impregnating someone else. These thoughts may lead to compulsions such as mentally rehearsing the details of sexual encounters, repeatedly taking pregnancy tests, or constantly tracking their menstrual cycle. Individuals may also avoid sexual intercourse with their partner to avoid pregnancy, which could result in issues cultivating feelings of intimacy.
Perinatal OCD: This subtype of OCD may affect an individual during pregnancy or following birth and may involve excessively worrying about abusing a child sexually or psychologically. Examples of obsessions include worrying that a child was left in the car, experiencing an intense fear of contaminating a child, and worrying that one may intentionally or accidentally act violently toward the child.
Body Dysmorphia: This subtype of OCD is characterized by an excessive preoccupation with a perceived defect or flaw in one's physical appearance. These thoughts and worries can be distressing and can lead to compulsive behaviors such as seeking reassurance, mirror checking, or avoiding social situations. This may also lead to feelings of insecurity within romantic relationships.
Sensorimotor OCD: This subtype of OCD is characterized by an obsession with automatic bodily processes, such as heart rate, breathing, or discrete physical sensations. Individuals with sensorimotor OCD may excessively worry that their attention to these bodily processes may become permanently conscious. Examples include hyper-focused attention to their own or someone else’s breathing, swallowing, or blinking. When these obsessions are directed toward the bodily processes of a partner, the partner may feel judged or uncomfortable, creating distance in the relationship.
If you or someone you know is struggling with any of the subtypes of OCD, it's important to seek professional help. There are effective treatments available, such as cognitive-behavioral therapy (CBT), which can help individuals understand and manage their thoughts, feelings, and behaviors. While OCD can present challenges in terms of sexual functioning and intimacy in romantic relationships, it is important to remember that with the right support and treatment, individuals with OCD can lead fulfilling and happy lives. Understanding the various subtypes of OCD can provide insight into the underlying causes of difficulties and give individuals with OCD and their partners the tools they need to improve their sexual functioning and promote relationship satisfaction.
If you are interested in services to treat or manage symptoms of OCD, The FLOAAT Center in Gainesville, FL, can help! Learn more about the specific programs we offer on our website, and contact our team to schedule your first appointment today!
