How Sexual OCD Spoils Intimacy
M3 Global Newsdesk Nov 30, 2024
The article explores the high prevalence of sexual dysfunction in OCD patients, its connection to anxiety, and its impact on quality of life. It also discusses treatment options like CBT, EX/RP therapy, and alternative approaches for resistant cases.
Key takeaways
- Studies indicate high rates of sexual dysfunction among patients with OCD. Common issues include decreased sexual desire, difficulty achieving orgasm, and performance anxiety, which can greatly impair quality of life and intimacy.
- The interplay between anxiety and sexual function in OCD creates a vicious cycle—intrusive thoughts and compulsive behaviours can distract from sexual arousal and satisfaction, leading to a decline in both sexual desire and performance.
- While many patients may not fully respond to standard treatments like SSRIs and cognitive-behavioural therapy, alternative therapies can offer relief and help manage symptoms.
Obsessive-compulsive disorder (OCD) is one of the most serious causes of disability and impaired quality of life in those who struggle with mental illness—and although common, the related sexual OCD is typically underappreciated in clinical practice.[1]
In the community
An early study showed that 10% of women with OCD reported anorgasmia 22% exhibited problems with the sexual arousal phase, while 25% of men with OCD had lower sexual arousal and 12% experienced premature ejaculation. Overall, 39% of women with OCD experienced sexual dissatisfaction.[2]
In a more recent study from the same researchers, sexual dysfunction occurred in 53.33% of a sample of women with OCD, with orgasmic dysfunction affecting 20.51% of the sample and problems with desire affecting 15.38%.[1]
What it's like to live with the condition
Sexual obsessions are autogenous, meaning that they appear on their own and are highly unrealistic and averse, as well as possibly being perceived by the patient as dangerous.
Compulsions in sexual OCD, write authors in the Annals of Neuroscience, could include neutralizing behaviours, such as checking body situations that may activate obsessions by clenching muscles, or maintaining distance from another person to avoid touching.[3] Other neutralizing behaviours could involve mental actions (eg, praying).
Content may include thoughts about sex with family members, engaging in child abuse, fears or thoughts related to sexual orientation, inappropriate sexual activity (with animals, children, or inanimate objects), and aggressive sexual behaviours.
Symptoms
Anxiety results in increased sympathetic tone and can distract from erotic stimuli, thus resulting in impaired sexual arousal, desire, and orgasm. Consequently, a person with OCD can fall into a vicious cycle of anxiety, dysfunction, and performance anxiety.[4]
Anxious thoughts or feelings may interfere with female orgasm. In men, fears about meeting a partner’s expectations or performance anxiety may lead to premature ejaculation, which is attributed to sympathetic hyperactivity and loss of ejaculation control.
During intercourse, intrusive thoughts about sexual performance/adequacy may distract a person from pleasurable sensations that arise before ejaculation and orgasm. Some experts suggest that hypervigilance linked to anxiety results in attention spent on threatening stimuli during intercourse.[4]
“Increased noradrenergic activity over the frontal cortex has been suggested to reinforce the cortico-striato-thalamo-cortical circuit, associated with worries,” wrote authors in the Journal of Psychosexual Health. “All this, overall, results in the person getting distracted from the sexual cues and fantasies and focusing on intrusive thoughts, like getting concerned about the erection.”[4]
A study in female patients with OCD found a reduced or lack of desire for sex, disgust with sex, reduced or absent pleasure of thinking about sex, lack of sexual arousal, trouble achieving satisfactory orgasm, and lack of pleasure with sexual acts. Nevertheless, people with OCD appear to have sex just as frequently as others, although they often find it less pleasurable and even fear it.[4]
Obsessions over contamination with disease, sexual/religious/moral concerns, and the possibility of causing harm can also impair sexual life and functioning in those with OCD.
How you can help your patients
In total, 60% of patients with OCD respond either partially or not at all to OCD treatments such as SSRIs and cognitive-behavioral therapy (CBT).[5] In patients with resistant OCD, SNRI inhibitors, augmentative atypical antipsychotics, and glutamate-modulating agents have been tried to some effect.
As with other forms of OCD, exposure and ritual prevention (EX/RP) therapy may be useful in patients with sexual OCD.[6] With EX/RP, a form of CBT, patients are exposed to their feared stimulus, while eliminating the associated compulsion. This process teaches the patient that the feared outcome is unlikely to occur—even when an associated ritual is not performed. Patients with sexual OCD may need more time in therapy than patients with other forms of OCD.
Patients who do not respond to EX/RP or CBT might also benefit from art therapy, music, and exercise.
What this means for you
Sexual OCD is common among patients with the disorder. Patients presenting with OCD must be asked about sexual content, along with other obsessions. Possible treatments include pharmacotherapy and CBT.
Disclaimer: This story is contributed by Claire Wolters and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.
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