OCD and Rituals Related to Sexual Activity

Reader’s Question

Sorry to bother you, but I hope you can give me an answer. I have been diagnosed with OCD and every time I have sex (not very often due to this problem), even if I have used a condom and the pill, I worry that I’m pregnant even from the next day. I then take test after test until I am satisfied that I am not pregnant. Why does this torment me, and is there any way I can stop this anxiety? I just can’t seem to trust the pill or condoms. Is this my OCD or am I just nuts?

Psychologist’s Reply

This is very likely part of your OCD and no, you’re not nuts. OCD is part obsessional thinking and part compulsive behaviors. You are describing a reaction to sexual experience that contains both classic symptoms. You have obsessions about being pregnant and following sexual activity, engage in a ritual/compulsive behavior of testing and retesting, like someone who washes their hands time and time again.

The obsessive part of this OCD reaction is actually stronger than you think. When we look at your description of what happens, you are having obsessive thoughts before and after sexual activity. You describe decreasing sexual activity due to this problem, suggesting that you are now upset and obsessive before engaging in sexual activity, at times worrying and obsessing so much that you avoid sexual activity. Following sexual activity, you probably quickly begin a ritual of pregnancy worry — including repetitive pregnancy testing. It’s also important to note that while you mention you can’t trust condoms or the pill, you also can’t trust the pregnancy test, prompting repeated testing.

In OCD, it’s very common for symptoms to attach themselves to life activities that have a certain amount of risk: hand washing due to the risk of germs in public, multiple rituals prior to driving, obsessive thoughts and rituals when boarding an airplane, door locking when living in a rough neighborhood, etc. In your experience, your OCD symptoms have focused on sexual activity which carries some risk of pregnancy. What can you do about this?

• Obsessive-Compulsive Disorder is likely creating this and other obsessions/rituals. Seek treatment for your OCD that may include medications and therapy/counseling. With OCD, you are likely experiencing other compulsions and obsessions as well so a general treatment will be very helpful.
• OCD and Depression are clinically related to low levels of the neurotransmitter Serotonin. The good news is that many medications are designed to treat both at the same time. The bad news is depression symptoms are almost always found when OCD is present. For this reason, I’d recommend taking a few of the depression screening tests on this website. You are likely to be experiencing depression symptoms as well such as worry, sleep/appetite problems, chronic fatigue, crying spells, etc. OCD is a neurochemical issue — not just a collection of thoughts or rituals/behaviors.
• Try to reduce your rituals. You have already established that each pregnancy test gives the same result — no many how many times you take the test. Gradually reduce the rituals to one test, giving the testing process credit for its ability to identify pregnancy. Reducing rituals also helps lower your anxious and obsessive thoughts prior to sexual activity as at this point you know that each sexual experience is followed by anxiety and repetitive testing. By reducing the rituals, you may be able to lower your anxiety about sexual activity and pregnancy and eventually discontinue the ritual.