Abstract
Background/Objectives: Sexuality is a frequently overlooked but clinically significant dimension in patients with obsessive-compulsive disorder (OCD). Beyond comorbid anxiety and depressive symptoms, OCD can substantially affect sexual functioning and include obsessions and compulsions relating to sexual content. This review aims to synthesize current evidence on sexual dysfunction in OCD and the role of sexuality in OCD symptom dimensions, as well as associated neurobiological, cognitive, and clinical outcomes. Methods: We conducted a review of the literature including studies published in the last 20 years using the PubMed and Cochrane databases. Our search strategy used the terms "sexual AND (Obsessive-compulsive disorder OR OCD)", retrieving a total of 582 articles. After a screening and eligibility assessment based on predefined inclusion and exclusion criteria, 200 studies were included. Additional papers were retrieved through citation tracking. Results: Sexual dysfunction is highly prevalent in OCD patients, particularly among women, ranging from low desire and arousal to anorgasmia and pain during intercourse. Sexual obsessions affect a large proportion of OCD patients and are associated with an early onset, male sex, greater symptom severity, poorer insight, and suicidality. These obsessions often co-occur with aggressive or religious themes. Neuroimaging studies indicate distinct patterns of brain activation in patients with sexual obsessions. Treatment with SSRIs and CBT is often less effective in this subgroup, suggesting the need for targeted interventions. Conclusions: Sexuality-related symptoms in OCD patients constitute a distinct and clinically relevant domain that affects functioning, prognosis, and treatment response. Recognizing and addressing these symptoms is essential for the holistic and effective care of patients with OCD.