You’ve had a date night worthy of a (non-cringy) Bachelor episode. The romance? Off the charts. The mood? Lit. The condoms? Stocked. And then it happens. OCD-related sexual intrusive thoughts burst into the bedroom like the threesome partner from hell.
Indeed, intrusive thoughts—a cornerstone of OCD—may be a common source of coitus interruptus. “All of a sudden you’re so fixated on that thought that you no longer have the desire to be intimate,” says clinical therapist Elizabeth McIngvale, Ph.D., LCSW, director of the McLean OCD Institute in Houston and a lecturer at Harvard Medical School.
While each person’s obsessive-compulsive disorder may present differently, any type of OCD can impact your sex life and have you avoiding situations. We set the scene with the common issues, then asked experts for advice that—while not easy—can hopefully, eventually, remove the bother from hot and bothered.
The OCD Issue: Contamination Fears
When you’re regularly worried about physical contact with things you see as harmful, doing the dirty can makes you feel literally dirty. You may imagine germs all over the sheets or your partner, and natural sexual fluids might trigger disgust.
You may feel compelled to wash the sheets before and after, or insist that both parties shower beforehand. “Sex isn’t that pleasurable for the person with OCD, or the person without, if they have to follow rules of rigidity,” says Dr. McIngvale, founder of OCDChallenge.com.
Try to… Minimize Sanitizing
Big picture, Dr. McIngvale recommends a type of therapy called exposure and response prevention (ERP) therapy, which, as the name suggests, exposes you to the things you fear and helps you learn to resist them. So, say you’re scared of frogs; first you’d look at pictures of the critters, then you might sit near one in a cage, next time maybe you’d touch it, then you’d hold it. Eek!
If you’re thinking um this will never work, we get it. But research shows that ERP therapy helps most people with OCD (about 7 out of 10), so the odds are ever in your favor. You’ll need a good therapist to guide you, an understanding soul who’s trained in ERP (find such a human via the International OCD Foundation’s resource directory).
While the ultimate goal of treatment is to ix-nay compulsions, it’s not like you’ll be asked to kiss the frog in session one. “There are a lot of steps on the path toward completely cutting compulsions out,” says Lauren Rosen, LMFT, director of The Center for the Obsessive Mind in California, an outpatient treatment center specializing in OCD, anxiety disorders, and eating disorders.
How does that translate to sexual encounters? Depends on how far you’re willing to go (and we don’t mean base-wise). It’s the question Rosen asks when she first starts working with a patient.
“For example, maybe we decide that they’ll wash the sheets once without bleach instead of twice with bleach,” she says. “We start there rather than going from washing twice with bleach to no washing.”
Or if you’ve been requiring your partner to perform a 15-minute cleansing routine, you can begin to scale back that time frame steadily.
The OCD Issue: What Ifs
Like pumpkin and spice, OCD and uncertainty are quite the pair…minus the fall festivity. And with uncertainty comes sexual intrusive thoughts, poking their way right between your pillows.
It’s difficult focusing on a sexual fantasy when all you can think is, What if I forgot to turn off the flatiron? What if the house burns down? What if we die in a fire because I was too distracted by sex to go check the plug? I need to check now!
Try to… Acknowledge Uncertainty
Sheryl Sanderg certainly wasn’t talking about OCD when she asked women to lean in, but it’s just what therapists advise with intrusive thoughts or images during intimacy.
Rather than trying to fight the thought (saying to yourself, Whatever you do, don’t check the flatiron!) or solve it (*runs to flatiron*), you acknowledge the uncertainty. “Think, Maybe I left the stove on, and maybe not,” suggests Dr. McIngvale. And then get back to your real-life sexual fantasy.
The objective is to diminish the grip your intrusive thoughts have over your mind. “It’s about approaching fear, not running away from it,” Dr. McIngvale says. Eventually, you’ll learn to tolerate the uncertainty and allow the intrusive thought to pass, so you can instead lean in to whatever it is that gets your rocks off.
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If you just can’t proceed as normal, you may try to replace the sexual intrusive thought with a completely unrelated one (that video of Kendall Jenner cutting the cucumber never gets old). But don’t. “That sounds like trying to distract or rid yourself of an experience rather than actively reengaging with life,” says Rosen, co-host of the Purely OCD podcast.
What you can do is refocus your energy to your partner and the moment, which allows your intrusive thoughts to exist while shifting your attention to the present.
The OCD Issue: Violent, Disturbing, or Sexually Inappropriate Intrusive Thoughts
Some people have what’s called harm OCD, when sexual intrusive thoughts turn violent. A mental image of strangling your partner could suddenly pop into your head.
Others might picture highly upsetting sexually inappropriate acts, like having sex with family members. This generates a nagging sense of doubt: What kind of person am I to have sexual intrusive thoughts about family?
Try to… Let the Intrusive Thoughts Pass
Everyone has weird thoughts sometimes, even about hurting a loved one. Most people can dismiss them, but with OCD, these thoughts can prompt severe anxiety, Dr. McIngvale says. And trying to magic-wand-them-away only encourages them to persist.
Instead, “practice allowing the intrusive thought to be there as you do your best to be present with sexual intercourse or intimacy,” says Kimberley Quinlan, LMFT, a cognitive behavioral therapist in Calabasas, California, who treats OCD patients. If the thought clings as tightly as a knit wrap dress, focus on your senses—the way your partner looks, sounds, smells, feels.
The OCD Issue: Identity Doubting
It’s common to ruminate over your sexual orientation with OCD—even if you’re pretty damn clear on your identity. “Someone who’s straight might think, What if I’m not straight? Someone who’s gay: What if I’m not gay?” Dr. McIngvale says.
If sex sparks these unwanted thoughts, you may become so triggered in the moment that you can’t stay present. You may even ask your partner for reassurance: “Do you think I’m gay?”
Try to… Get a Reappraisal, Not Reassurance
Streaming Friends re-runs? Warranted. Streaming your identity obsessions? That’s more like tuning in to thrice-weekly episodes and the 24/7 behind-the-scenes footage of Big Brother season 862: It’s available, but you probably don’t want to give it all that airtime.
Rosen encourages you to limit how often you ask your partner for reassurance, since the goal is to make space for the thoughts. As with other “what ifs,” lean in: Maybe I am gay. What would that mean? If I’m gay, what is the worst that could happen? You’ll be outside our comfort zone, says Dr. McIngvale, but confronting the thought cedes power back to you.
Also, give yourself a break. You’re human, woman! “I think the problem is the idea that the intrusive thought needs to get out of a person’s head or that we must be fully ‘in the mood,'” says Rosen. “You might have moments of pleasure interspersed with moments of anxiety, or moments of being present spliced by moments spent trying to resolve the [sexual identity] uncertainty.”
The OCD Issue: Scrupulosity Concerns
Some with OCD experience what’s called “scrupulosity,” or excessive worry that they’ve sinned or done something morally wrong. Perhaps you were taught by a religious leader that sex is sinful, says Quinlan. (Recovering Catholics, wya?) But even those without a religious background can still have I’m bad! thoughts—along with the guilt and shame that can follow.
To neutralize this concern, you may pray, mentally repeat “good” thoughts, or perform cleansing rituals before or during sex. Or you may avoid sex altogether.
Try to… Face Your Fears
We’ll let Rosen take it from here: “The thing about OCD is that people with the disorder are of two minds. People with moral or religious scrupulosity may very well have thoughts that they’re doing something ‘wrong’ when having sex,” she says. “But I’m willing to bet that there is also a side of them that thinks that having sex is part of living a healthy life. These two sides will then start to debate what the ‘right’ course of action is, to try to get certainty. This attempt at getting certainty is the problem. Trying to get rid of these feelings or to debate those thoughts doesn’t get rid of the thoughts or feelings, it just amplifies the struggle.”
In the moment, try to let the uncertainty—like that lame sex toy you tossed into your bedside drawer—just be there. You might think, Okay, so maybe I am bad and this is wrong. That’s really scary, but I guess I’ll have to take that risk if I want to live my life. Let that emotion expand as though you’re making physical space for it, says Rosen. Then pivot back to what’s happening between the sheets.
Of course, ERP therapy is where the long-term evolution happens. “It’s the behavioral change, ultimately, that changes your relationship to the thoughts and feelings,” says Rosen.
Your therapist may also suggest consulting members of your faith community for support, says Dr. McIngvale. If they actually reinforce your fears (A-holes!), consider working with a therapist who specializes in adverse religious experiences or religious trauma. (The nonprofit Open Path Psychotherapy Collective offers sliding-scale therapy options, between $30 and $60 a session, and you can select for specialties including religious trauma.)
The OCD Issue: Relationship Worries
Imagine questioning the person you’re with while you’re with them: In the middle of a sexcapade, you might wonder: Do I like this person? Am I attracted to them? Am I aroused enough?
“Even if you really do like and are wildly attracted to the person, these concerns can cause you to search for meaning in why they’re brain-bombing you—meaning that isn’t actually there,” says Quinlan. Naturally, this can instill doubts about your partnership.
Try to… Hash It Out with Your Inner Hater
Let’s remember that outside of rom-coms, it’s natural to have the occasional relationship qualm. But put that aside. Here, your OCD is the little devil on one shoulder, trying to sabotage what very well could be a great relationship. ERP helps explore and challenge that devil, so you can make decisions about your relationship based on your experience of it—not on your OCD fears.
Your therapist will teach you ways to resist the urge to mentally check for signs and feelings that you love your partner, or to overanalyze your partner’s flaws—or to avoid activities you value (like date night) to prevent the intrusive thoughts in the first place, Dr. McIngvale says.
Don’t try to reassure yourself either (for example, repeating “This is normal” or similar mantras in your head), as this, too, can be a compulsion. “We do not want to give the thoughts power,” Dr. McIngvale says. Instead—broken record alert!—allow them to be there while you move forward.
Be warned, though: Discussing these types of OCD concerns with your partner, where you question the “rightness” of your relationship, isn’t a bright idea. “When you involve you partner in the process of trying to resolve that uncertainty, it’s very destabilizing for the relationship,” Rosen says.
While there’s no quick fix, Rosen recommends self-compassion—”a great way to take care of yourself as you make the choice not to compulse”—and cites three components of the practice as defined by self-compassion pioneer Kristen Neff, Ph.D.:
- Mindfulness: Use non-judgmental awareness to ID what’s happening. Just something basic, like, Oh, I’m noticing that I’m experiencing anxiety.
- Common Humanity: Recognize that you’re not the only one experiencing this. I bet a lot of people with Relationship OCD or Sexual Orientation OCD feel anxious when they have thoughts about their level of attraction to their partner.
- Self-Kindness: Offer yourself the same support you would a friend. You’ve got this. I’ll be with you as you feel the anxiety.
Having “The Talk” About OCD and Sexual Intrusive Thoughts
Not that one. The other one—where you explain your OCD issues and even your sexual intrusive thoughts to your significant other. Dr. McIngvale, who both treats OCD patients and has the condition herself, brings it up right away, when the other person asks what she does for a living and why. But everyone’s different, she adds. “For some, it takes weeks or months.”
Pick a moment when you’re feeling comfortable and sharing life experiences, Dr. McIngvale says. Start by explaining what OCD is and revealing a bit about how it affects you. “Work your way up to more intimate details,” she says. “It should not feel like a disclosure, but instead like an educational conversation.”
Maybe don’t blurt it out right before the clothes come off, but try to say something pre-first-time. As Rosen explains, “Giving your partner a heads-up that sometimes you get a lot of intrusive thoughts and anxiety out of left field can help them to depersonalize in the event that you have a panic attack during an intimate moment.”
When you’re feeling anxious outside of the bedroom, Rosen suggests asking your partner to “do something together—like play cards or go for a walk. [You can say], ‘I’d much rather engage with you than get lost in my head trying to figure this out for the umpteenth time.’” A partner’s encouragement and acceptance can only help you in the fight against OCD—you’ll be two against one.
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