OCD and Sexuality
Obsessive-compulsive disorder has a way of attaching itself to whatever matters most to you. For many people that is their faith and their sexuality, which is why OCD so often shows up in a sex therapist's office rather than a general OCD clinic. The thoughts feel unbearable precisely because they contradict who you are.
If you are here because of a thought you have never said out loud, you are in the right place. This is common, it is treatable, and the thought is not evidence about you.
How common is this?
In a study of 293 adults with OCD, about one in four reported a history of sexual obsessions and one in eight had them currently. Women reported them as often as men. Notably, people with sexual obsessions were significantly more likely to also have religious obsessions, which is exactly the combination we see most often (Grant and colleagues, 2006).
Intrusive sexual thoughts are not limited to people with OCD. Most people have them. What differs in OCD is not the thought, it is what happens next: the meaning you assign to it, and what you start doing to make the feeling go away.
What it looks like
Unwanted intrusive sexual thoughts
A thought or image arrives that horrifies you. It may involve something violent, something forbidden, or someone you would never think of that way. Because it disgusts you, you conclude it must mean something, and you begin examining it. The examining is what keeps it coming back.
Checking whether your body is working
This one gets missed constantly, and it is one of the most common ways OCD reaches my office.
The obsession is that something is wrong with you sexually. The compulsion is verifying that it is not. You check whether you can get an erection, whether you feel aroused, whether penetration works, whether you can reach orgasm. Sex stops being something you are having and becomes a test you are administering.
And the test produces the result you fear. When your attention is on monitoring your own performance, it is not on arousal, and arousal does not survive being watched. So the erection fades, or the arousal does not build, or the orgasm does not come, and now you have proof. The next time, you check harder.
Sex researchers named this decades ago. Masters and Johnson called it spectatoring, watching yourself from the outside during sex instead of being in it (Masters and Johnson, 1970). Later experimental work confirmed the mechanism: directing attention to your own performance reduces genital arousal in men, and the effect is strongest in men who already have a sexual difficulty (van Lankveld, van den Hout, and Schouten, 2004).
The trap is that the checking feels responsible. It feels like paying attention to a real problem. It is the problem.
Religious scrupulosity
Scrupulosity is OCD centered on sin, morality, and worthiness. It looks like reviewing whether a thought counted, confessing the same thing repeatedly, seeking reassurance from a spouse or a church leader, praying until it feels right, and avoiding anything that might trigger a doubt.
What makes it hard to spot is that every one of those behaviors looks like devotion. A bishop hearing a fifth confession of the same thing may see conscientiousness. Clinically, it is a compulsion, and it works the way every compulsion works: relief for an hour, then the doubt returns stronger. Researchers have described scrupulosity as functioning exactly like other OCD presentations, with religious content rather than religious cause (Abramowitz and Jacoby, 2014).
Treating it does not mean loosening your standards. It means separating your faith from the disorder that has taken hold of it.
Doubts about your relationship
Some people get stuck in repeated doubt about who they are attracted to, and respond by testing themselves, scanning their body for a reaction, or reviewing their history for evidence.
Clinically, the content is not the point. The pattern is: a doubt, a check, brief relief, a stronger doubt. That pattern responds to treatment regardless of what the doubt is about.
What OCD does to a sex life
Beyond specific obsessions, OCD affects sexual functioning broadly. A 2026 systematic review examined the research across every phase of the sexual response cycle and found associations between OCD symptoms and difficulties with desire, arousal, orgasm, and genital pain, and concluded that sexual health deserves routine assessment in OCD care rather than being treated as a side issue (Doroldi and colleagues, 2026). An earlier review reported similar findings, with sexual dysfunction and dissatisfaction common among people with OCD (Koolwal and colleagues, 2020).
There is also a treatment factor worth naming. Medications commonly prescribed for OCD can reduce desire and delay orgasm. That is a real effect, it is worth discussing with your prescriber rather than quietly enduring, and it is not a reason to stop medication on your own.
How we treat it
We use exposure and response prevention, the treatment with the strongest research support for OCD. In plain terms: you gradually face the thought, the doubt, or the situation, and you do not perform the ritual that usually follows. No confessing, no checking, no reassurance seeking. The relief you give up is the relief that has been feeding the problem.
That is uncomfortable, and we do it gradually and with your agreement at every step. What happens over time is that the thought loses its charge. Not because you proved it false, but because you stopped treating it as a question that needs answering.
For the sexual side, treatment adds something ERP alone does not: getting your attention out of the monitoring role and back into your body and your relationship. That work is ordinary sex therapy, and it is what stops the checking from reconstructing the problem after the OCD piece improves.
When medication is part of your care, we coordinate with your physician. Research shows exposure and response prevention combined with medication outperforms medication alone (Mao and colleagues, 2022).
If your faith is part of this
We are not going to ask you to lower your standards, doubt your beliefs, or treat your faith as the problem. Covenant Sex Therapy was founded by a member of The Church of Jesus Christ of Latter-day Saints, and we have spent more than a decade working with people whose religious life and sexual life are tangled together.
Done well, this work makes your faith easier to practice, not harder, because you stop performing rituals that were never devotion in the first place. Where it helps, we can work alongside a church leader you trust.
Common questions
Does having these thoughts mean something about me?
No. The distress is the clue. People act on desires; they do not spend months tormented by them. The fact that the thought horrifies you is the strongest evidence that it does not reflect what you want.
Do I have to say the thought out loud?
Eventually, yes, and most people find that far easier than they expected. Saying it in a room where nobody flinches is often the first time it loses power. You set the pace.
Will treatment make me less careful about right and wrong?
No. Scrupulosity is not a surplus of conscience, it is a disorder wearing your conscience as a costume. Treatment gives you your judgment back instead of a compulsion making the decisions.
Should I see an OCD specialist instead?
Sometimes. If OCD is severe and running through every area of your life, a specialist clinic may be the better starting point, and we will tell you so honestly. Where we fit best is when OCD has landed on sex, on your faith, or on your marriage, because that is where the OCD work and the sex therapy have to happen together.
Can my spouse be involved?
Often it helps. Spouses usually get recruited into giving reassurance, and they give it because they love you. Learning to stop, kindly, is one of the more useful things a partner can do.
Starting
Fill out our contact form and tell us a little about what brings you in. You do not have to write the thought down. We usually reply within one business day. We see clients in Provo and Pleasant Grove and by telehealth anywhere in Utah.
Written by Dr. Anthony Hughes, PhD, LMFT, AASECT-Certified Sex Therapist and author of You, Me, and We. Last reviewed September 2026.
Research referenced
Abramowitz, J. S., and Jacoby, R. J. (2014). Scrupulosity: A cognitive-behavioral analysis and implications for treatment. Journal of Obsessive-Compulsive and Related Disorders, 3(2), 140-149. https://doi.org/10.1016/j.jocrd.2013.12.007
Derby, D., Tibi, L., and Doron, G. (2021). Sexual dysfunction in relationship obsessive compulsive disorder. Sexual and Relationship Therapy, 39(3), 711-724. https://doi.org/10.1080/14681994.2021.2009793
Doron, G., Derby, D., and Szepsenwol, O. (2014). Relationship obsessive compulsive disorder (ROCD): A conceptual framework. Journal of Obsessive-Compulsive and Related Disorders, 3(2), 169-180. https://doi.org/10.1016/j.jocrd.2013.12.005
Doron, G., Derby, D., Szepsenwol, O., and Nahaloni, E. (2016). Relationship obsessive-compulsive disorder: Interference, symptoms, and maladaptive beliefs. Frontiers in Psychiatry, 7, 58. https://doi.org/10.3389/fpsyt.2016.00058
Doroldi, D., Cialini, L., Origlia, G., Giannini, T., Blasutto, B., Del Casale, A., Spitoni, G., Boldrini, T., and Ciocca, G. (2026). The interplay between the obsessive-compulsive disorder and sexual function: A systematic review. Sexual Medicine Reviews, 14(3). https://doi.org/10.1093/sxmrev/qeag044
Grant, J. E., Pinto, A., Gunnip, M., Mancebo, M. C., Eisen, J. L., and Rasmussen, S. A. (2006). Sexual obsessions and clinical correlates in adults with obsessive-compulsive disorder. Comprehensive Psychiatry, 47(5), 325-329. https://doi.org/10.1016/j.comppsych.2006.01.007
Koolwal, A., Agarwal, S., Manohar, S., Koolwal, G. D., and Gupta, A. (2020). Obsessive-compulsive disorder and sexuality: A narrative review. Journal of Psychosexual Health, 2(1), 44-50. https://doi.org/10.1177/2631831819896171
Mao, L., Hu, M., Luo, L., and Wu, Y. (2022). The effectiveness of exposure and response prevention combined with pharmacotherapy for obsessive-compulsive disorder: A systematic review and meta-analysis. Frontiers in Psychiatry, 13, 973838. https://doi.org/10.3389/fpsyt.2022.973838
Masters, W. H., and Johnson, V. E. (1970). Human sexual inadequacy. Little, Brown.
van Lankveld, J. J. D. M., van den Hout, M. A., and Schouten, E. G. W. (2004). The effects of self-focused attention, performance demand, and dispositional sexual self-consciousness on sexual arousal of sexually functional and dysfunctional men. Behaviour Research and Therapy, 42(8), 915-935. https://doi.org/10.1016/j.brat.2003.07.011
