Contamination OCD: Blood, Fluids, and Bodily Waste… Part 2

Disclaimer:  This is a blog about semen.  If you don’t want to read a blog about semen, I suggest you turn away now, because this blog entry in the contamination OCD series is, well, full of semen.

Though many OCD sufferers who struggle with bodily fluids have issues with vaginal secretions as well, I will be focusing on semen here primarily to reduce the word count. As with other bodily fluids, this gelatinous mess of glandular secretions, sugar, and sperm appears to take on magical properties once it leaves the body, resulting in severe OCD behaviors that can meaningfully impair one’s quality of life. Also like other bodily fluids, semen is capable of hosting germs, bacteria, and viruses. Inserting semen directly into the bloodstream means inserting whatever is contained in that semen and risking that thing being responsible for the transmission of an illness. Several factors reduce risk of such transmission taking place, so many in fact that it would not be worth attempting to list them. The lowest risk factor would be physical touch with intact skin, which we could argue is statistically comparable to zero risk.

That’s all well and good when you don’t have OCD, but when you do, the disorder drives you to seek certainty. What does “intact” mean exactly? What does “touch” really mean? It is in this murky territory that OCD sufferers struggle the most, leading to compulsive efforts to avoid, clean, or otherwise neutralize thoughts about semen contamination. Though these behaviors may temporarily result in an illusion of certainty, their most notable byproducts are pervasive doubt, anxiety, and guilt. OCD sufferers who struggle with a fear of or intense disgust-response to semen may have contamination OCD, health anxiety, social phobia, moral or religious scrupulosity, or a version of harm or sexually focused OCD. Understanding what it is specifically that drives this fear can be useful in identifying strategies for treating it.

Common obsessions and OCD distorted beliefs involving semen:

• Any contact with another person’s semen is inherently dangerous, will result in disease or another health issue
• Any other person’s contact with my semen may result in a health issue I will be responsible for having caused
• Any semen left behind may inadvertently get someone pregnant
• Contact with semen will result in a state of disgust that is intolerable
• Semen may be visible somewhere on my body and result in public humiliation
• If another person has any contact with my semen, it is equivalent to engaging in a sexual act with that person
• Semen left uncleaned will spread everywhere and nothing I care about will ever be clean again

Common compulsive behaviors involving semen:

• Excessive or ritualized washing of hands, body, clothes or surfaces (e.g. bed sheets) that may have had potential contact
• Avoidance of masturbation, sexual intercourse, or sexual intimacy
• Avoidance of touching specific areas of the body (primarily groin) or clothes that may have come in contact with that area
• Avoidance of environments where semen could have potentially been present (hotel rooms, public restrooms, one’s own or another’s bed)
• Avoidance of objects with unidentified stains/checking objects for stains
• Reassurance seeking about whether semen may have or could have been present
• Excessive checking of surfaces or items for possible semen contamination
• Reassurance seeking about sexually transmitted diseases or pregnancy
• Reassurance seeking about what is a “normal” interaction with semen
• Reassurance seeking/excessive research about semen on the internet
• Mentally reviewing where or if semen could have had contact with things, what touched what and when, etc.

Shame-colored paint

A substance is just a substance, at least that’s what mindfulness would encourage us to believe, but something about where this particular substance comes from and why plays games with the mind. It associates the substance with quality of character in the sense of “I am terribly irresponsible if I allow even one molecule of semen to come in contact with anything but its intended target.” It associates it with tragic and humiliating death as in, “I will get AIDS if I come in contact with someone’s semen and everyone will think I got it from gay sex.” It associates it with disgust panic as in, “If I could have any amount of semen on me, I’ll freak out and be sick to my stomach.” It associates it with sexual assault of all things, as in, “If my child crawls by my underwear and touches an area that was exposed to my semen, I have basically raped my child.” Nobody can believe this, but shrugging off a thought that intense feels too flippant, too irresponsible. Like blood and other “scary” contaminants, the OCD mind presents semen like a neverending kind of wet paint that, once touched, gets transferred from place to place without ever diminishing. So a person who touches a door knob touched by a person who touched a towel that touched a wall that touched another towel that touched a person’s penis that may have ejaculated FEELS like he/she may have touched semen. Or from the other perspective, the person whose towel it is FEELS like his/her fluids may have been cross-contaminated to others.

ERP and Uncertainty

Exposure with response prevention (ERP) is the most effective form of treatment for any obsession. But direct exposure to the thing you fear is not always going to be more effective than indirect or theoretical exposures. By this I mean that a lot of the fear associated with something like semen contamination is not grounded in the direct knowledge that semen is getting on things, but the uncertainty about whether semen is present or absent at all. So even though it might be effective exposure to put some semen on your hands and go around touching everything in your house, there is something about knowing for certain that you’ve done this which almost takes the edge off. It’s so absurd, it elicits a different kind of fear than the one you are trying to overcome. Putting a heavier emphasis on ritual/response prevention may be more effective and more challenging. In other words, failing to check for signs of semen contamination can actually be more triggering than just going ahead and contaminating something with semen. Along these lines, the first and most effective step you can take to overcome a fear of semen isn’t necessarily going out of your way to make contact with it, but to stop washing your hands when you think you may have. The key is sending the message to the brain that it is indeed possible that a molecule of semen has made its way from inside your (or someone else’s) body on to you (or an object in your possession) and that you have no plans to do anything about it.

Even more true of semen than blood, there is no real reason to believe that tactile contact with this fluid is dangerous in any way, so compulsive behaviors that reflect a belief that it is dangerous only fuel obsessive thoughts and anxiety. You can’t protect yourself from something that isn’t dangerous. You only end up making yourself feel in danger. Identify activities you used to engage in before your fear of semen took hold and gradually resume engaging in those activities. This could range anywhere from intimacy with your partner or masturbation to simply allowing yourself to touch publicly used items, such as doorknobs or TV remotes. To approach things gradually, you could start by using indirect contact. For a fear of touching the groinal area, start by touching the outside of the pants somewhere between the knee and the stomach and then work closer to your ERP goal after you can tolerate the objective you are currently striving for. For environmental exposures, you can start by touching something with a Kleenex, not as a way to avoid touching something contaminated, but as a way of doing ERP to the contaminated Kleenex when direct contact may be too overwhelming a place to start. The intensity and pace of your ERP is not as important as the direction of the ERP – forward.

Get it off! Get it off!

A common question in any bodily fluid fear is, “What if it got on me?” The tone of the question usually implies a built-in OCD answer; something like, “Then I’ll die” or at least, “Then that is unacceptable.” But those are not really answers. Those are just expressions of discomfort and resistance. ERP for this form of OCD involves either refusing to answer the question, or insisting on giving the question an actual answer. Not answering the question would be a mindful approach. “What if it got on me?” is then responded to with an acknowledgment like, “Oh, there’s that semen question again.” Or “I am aware of thoughts about semen getting on me.” Answering the question accurately would be a direct ERP approach. “What if it got on me?” is thus responded to with, “Then there is semen touching me right now and it may get into my body or onto other things and it may disgust me or even cause some sort of other unwanted consequence.” Both approaches can work equally so long as the end result is choosing not to do a compulsion, such as washing, avoiding, or reassurance-seeking. The question that matters most is how much of your life, your freedom of movement, your time, your interaction with people and enjoyable activities, are you willing to sacrifice for your OCD? When will you say “no” to the OCD?

It had to be semen…

OCD sufferers often deal with painful thoughts and feelings about things most people rarely focus on, the details, the fringe thoughts. It’s not that people in general aren’t having any thoughts about semen everywhere; they just aren’t receiving those thoughts in a manner that distinguishes them from other incidental thoughts of low importance. Part of the pain and isolation felt by OCD sufferers goes beyond the more obvious upsetting nature of obsessions, but the isolation of not being able to really talk openly about things like semen contamination. “Ewww, gross, what’s wrong with you for even coming up with that?” This isn’t the voice of your therapist or your friend you try to confide in. This is your own voice.

All OCD fears are disgusting. OCD sufferers are disgusted with their impure religious thoughts or relationship thoughts in much the same way someone can be overwhelmed by thoughts about bodily fluids. It is the sense of uniqueness, of un-treatability, that is OCD’s most clever weapon. By opening up and talking about your OCD as it really is, warts and all, you create a paradigm shift. It is no longer about you and your “weird obsession.”  It is just you and your treatable, conquerable OCD.

Click HERE for Part One of this series