Is OCD or Sertraline affecting my sexual performance?

Question

Hello doctor,

I am feeling guilty about my sexual life with my wife. I feel that I have done an injustice to her by not being interested in having sex with her, despite getting pleasure from masturbation. I often do not orgasm with my wife and feel tired very soon. However, I get enough pleasure from masturbation, which I do two to three times a week, and I often watch porn during masturbation.

I have OCD and take Sertraline 300 mg once daily. I have always been apprehensive about my sexual fitness and have had low confidence from the beginning. But now, after more than 15 years of marriage, I feel selfish because I masturbate and satisfy myself, but I am not doing justice to my wife. This guilt is becoming a burden on me and is making me depressed.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I am deeply concerned about your worries.

First, let me reassure you that you are not a selfish person or a bad husband for experiencing this. What you are describing is quite common, especially in men who are on long-term, high-dose SSRI (selective serotonin reuptake inhibitors) treatment like Sertraline, which can reduce sexual desire, delay orgasm, and make it difficult to climax during intercourse even when erections are adequate.

At the same time, frequent masturbation with pornography can condition the brain to respond more strongly to specific visual stimuli and stimulation patterns, making partnered sex feel less arousing in comparison. Your long-standing performance anxiety and OCD (obsessive-compulsive disorder) likely add another layer, because anxiety increases mental pressure, leading to early fatigue and difficulty reaching orgasm, which then creates a cycle of guilt and low confidence.

Reviewing your medication with your psychiatrist, gradually reducing pornography, retraining arousal toward intimacy with your wife, and possibly undergoing structured sexual counseling can significantly improve the situation.

Hope I have addressed all of your queries and concerns. Do follow up whenever needed.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

You may kindly consider opting for a video consultation. As a sexologist, I provide treatment primarily through medication-based management.

However, in your case, consultation with a psychiatrist or psychologist would be more appropriate for a comprehensive evaluation and counseling.

I hope this helps you.

Thank you.