Get to Know OCD Podcast

Episode: Sexual Thoughts, Anxiety, and OCD — The Truth That Doesn't Get Talked About
Host: Dr. Patrick McGrath, Chief Clinical Officer, NOCD
Guest: Tracy Ibrahim, Therapist, Sex Therapist, and Chief Compliance Officer, NOCD
Release Date: December 11, 2025

Episode Overview

This episode tackles the often-taboo intersection of OCD, sexual thoughts, and anxiety, exploring how intrusive thoughts related to sex manifest in OCD sufferers. Dr. Patrick McGrath and "Taboo Tracy" Ibrahim engage in an open, humorous, and validating discussion about the realities and misconceptions around sexual obsessions, compulsions, and the path to treatment and recovery. The episode aims to destigmatize these experiences, stress that people are not alone, and demystify effective therapeutic approaches like Exposure and Response Prevention (ERP).

Key Discussion Points and Insights

1. Introducing Taboo Topics and the Role of OCD in Sexual Thoughts

• [01:28 - 03:10]
  • Tracy is introduced as "Taboo Tracy," reflecting her candid approach to discussing stigmatized topics in OCD.
  • Discussion about how sexual topics are one of many areas OCD can "attack."

  “OCD just loves to rain on a parade...if you don’t want it to show up during intimacy, guess what, it’s popping in your head while you’re doing the thing.” – Dr. McGrath [03:20]

2. How OCD Shows Up in Sexual Scenarios

• [03:42 - 06:47]

  • Avoidance behaviors: People avoiding sex due to contamination fears, discomfort with bodily fluids, embarrassment, etc.
  • Real-life examples of compulsions: including excessive decontamination rituals before and after sex, or throwing away any item that touched bodily fluids.

  “I have worked with somebody who, if their bodily fluids like semen would get on any part of their clothes or sheets, they would throw them away.” – Tracy [06:00]

• [06:33 - 08:05]

  • A common OCD manifestation: fear of contaminating others with bodily fluids or that sexual orientation can be "spread" through touch.

  “I worked with someone who thought that if anyone touched anything that his semen had touched, he could cause them to become his sexual orientation.” – Dr. McGrath [06:33]

  • Bizarre intrusive thoughts: e.g., semen traveling through pipes and impregnating someone else or through indirect contact (e.g., brushing jeans on a couch).

3. Intrusive Sexual Thoughts and Paradoxical Effects

• [10:53 - 13:59]
  • Explains the concept of “contamination” in OCD—can be emotional, physical, or subjective, not just about germs.
  • Intrusive thoughts during sex: what if an image of a child, a relative, or something disturbing comes to mind?

  “The more you hope that thought doesn't pop into your head, the more guaranteed that that thought will be popping into your head when you don't want it to pop into your head.” – Dr. McGrath [11:46]

  • Example: Worried about orgasming while thinking of something disturbing; clarifies this does not indicate desire or intent.

4. Groinal Responses and Arousal Non-Concordance

• [14:11 - 19:56]
  • Explains “groinal response”: physiological reactions (tingling, erections, moisture) that OCD sufferers fear indicate truth about their desires.
  • “Arousal non-concordance”: your body doesn’t always match your mental desires (e.g., unwanted arousal or inability to get aroused when you want to).
  • Normalizes that arousal can occur for many reasons, not just desire.

  “Maybe your brain is saying, 'No thanks, I would hate that.' And your genitals go, 'Wrong. Love it, love it.' Doing the stuff. That's also arousal non-concordance. And what does it mean? ...not connected. Don't care.” – Tracy [18:55]

5. Checking and Confessing in Relationships

• [14:11 - 17:25]
  • Confession compulsions: feeling compelled to share sexual thoughts with partners for reassurance.
  • “Checking” via pornography or sexual experimentation to “prove” or disprove a feared orientation.

6. Sexual Orientation and Gender Identity OCD

• [34:20 - 38:33]

  • OCD targets core identity: sexual orientation and gender identity, leading to constant checking, seeking certainty, and confusion.

  “There’s no trying to… if I was only certain… OCD is not a fact disorder... The endless search for certainty—OCD will never let you have it.” – Tracy [35:09, 36:49]

  • These themes are not rooted in prejudice but in doubts about one’s own identity.

7. Scrupulosity and Religion

• [24:59 - 26:02, 42:28 - 43:56]
  • Scrupulosity: religious/moral OCD; intrusive sexual or blasphemous thoughts during religious observances, leading to significant shame and compulsions (e.g., praying to neutralize thoughts).

  “There are no limits. There's no place. And again, this is where people will say to me and Tracy, 'But why does it have to happen there?' ...Because you don't want it to. That's why it happens there.” – Dr. McGrath [25:34]

8. Medication, Therapy, and Practical Tips

• [22:53 - 24:07]

  • Medications can have sexual side effects; Tracy emphasizes consulting with knowledgeable prescribers and notes some practical timing solutions.
  • “Don’t read the side effects pamphlet” – a nod to OCD’s tendency to obsessively research risks.

• [38:17 - 41:37]

  • ERP (Exposure and Response Prevention) is the key treatment for OCD regardless of theme; it’s equally effective for sexual obsessions.

  “If you aren't doing response prevention, you aren’t going to see change. And this is the hardest part of therapy, because we're asking people to just be with whatever their thoughts, images, and urges are and not attempt to neutralize them in any way whatsoever.” – Dr. McGrath [39:28]

  • The process is not about eliminating intrusive thoughts, but changing your response so the thoughts lose power.
  • Tracy’s advice: Don’t try to figure it out. Accept discomfort and stop performing compulsions.

9. Hope and the Reality of Living with OCD

• [29:02 - 31:21]

  • Tracy personalizes the experience: after ERP, her intrusive thoughts persist but no longer control her (“just used to it, it’s like somebody offering me a glass of water that I don’t want”).
  • Intrusive thoughts are “synthetic”—not chosen, not a reflection of morals or desires.

  “You do not create your content. OCD comes up with it. We don’t... It just happens.” – Tracy [26:26]

• [44:15 - 44:52]

  • ERP applies universally to any theme of OCD; learning the strategy once equips sufferers for new manifestations.

Notable Quotes & Memorable Moments

• “OCD just loves to rain on a parade...if you don’t want it to show up during intimacy, guess what, it’s popping in your head while you’re doing the thing.”
  — Dr. McGrath [03:20]

• “I have worked with somebody who, if their bodily fluids... would get on any part of their clothes or sheets, they would throw them away.”
  — Tracy [06:00]

• “The more you hope that thought doesn't pop into your head, the more guaranteed that that thought will be popping into your head when you don't want it to pop into your head.”
  — Dr. McGrath [11:46]

• “Maybe your brain is saying, ‘No thanks, I’d hate that.’ And your genitals go, ‘Wrong. Love it, love it.’ ...That’s also arousal non-concordance.”
  — Tracy [18:55]

• “You do not create your content. OCD comes up with it. We don’t... It just happens.”
  — Tracy [26:26]

• “There are no limits. There’s no place... Because you don't want it to [happen there]. That’s why it happens there.”
  — Dr. McGrath [25:34]

• “If you aren't doing response prevention, you aren’t going to see change... we’re asking people to just be with whatever their thoughts, images, and urges are and not attempt to neutralize them.”
  — Dr. McGrath [39:28]

• Tracy’s humorous moment:

  “I had the spotlight on me and... just like, screaming in the back of my head was... you are just going to jump on top of the microphone stand and it’s going to go up your vagina and come out your mouth... and I was just sharing my story and just talking.” [29:02]

Timestamps for Key Segments

| Timestamp | Segment | |--------------|---------------------------------------------------------------| | 01:28-03:10 | Introduction to Tracy and why the topic is taboo | | 03:42-06:47 | How OCD leads to avoidance and compulsions around sex | | 10:53-13:59 | Intrusive thoughts/images during sexual activity | | 14:11-19:56 | Groinal response, arousal non-concordance explained | | 22:53-24:07 | Medications and sexual side-effects | | 24:59-26:02 | Scrupulosity and related religious themes | | 29:02-31:21 | Tracy’s lived experience after ERP (hope for listeners) | | 34:20-38:33 | Sexual orientation/gender identity OCD; endless seeking | | 38:17-41:37 | ERP explained—universal for all OCD content | | 44:15-44:52 | ERP as a toolkit for all OCD themes |

Conclusion

The episode demystifies taboo sexual obsessions in OCD through humor, compassion, and validation. Tracy and Dr. McGrath reassure listeners that intrusive sexual thoughts—even the most bizarre or distressing ones—are not reflections of character, but the way OCD tries to seize what matters most. Effective help exists, principally through ERP therapy, which teaches sufferers to live their lives fully and stop letting OCD dictate their choices.

Final note:
If your OCD manifests around taboo or sexual topics, you are not alone and you are not broken. OCD is a liar; its content doesn’t reflect your desires or morals. Treatment works, and as Dr. McGrath says, “Be better to yourself than your OCD ever has been to you.”
[44:52]