Although there are a wide range of sexual obsessions, common themes include homosexuality/sexual identity, sexual abuse, sexual thoughts about friends, incest, infidelity, sexual perversions, sex with animals, violent sexual behavior, and blasphemous thoughts combining religion and sex. Importantly, sexual obsessions can occur with or without compulsions.
It is important to realize that sexual obsessions are not sexual fantasies. Whereas sexual fantasies are normally pleasurable, harmless and guilt-free, sexual obsessions are unwanted, distressing and rarely (if ever) lead to sexual arousal.
Many people with OCD worry that the nature of their sexual obsessions signify that they could be a pedophile, rapist, or sexually perverted in some manner. It is essential to remember that while a pedophile or rapist would enjoy imagining sexual situations involving children or violent sexual domination, and may have even acted on such a fantasy, the individual with OCD experiencing a sexual obsession does not want to experience these thoughts, finds these thoughts extremely distressing and guilt-provoking, and does not want to act on them.