Although there have been several manuals written about how to treat obsessive-compulsive disorder (OCD) using cognitive-behavioral therapy (CBT), there has been little focus on application of CBT principles to those suffering from sexual obsessions. Treating sexual obsessions in OCD differs from the treatment of other forms of OCD due to heightened feelings of shame surrounding symptoms, widespread misdiagnosis from professionals, and the covert nature of ritualizing behaviors. This book provides clinicians with the tools needed to successfully help clients suffering from unwanted, intrusive thoughts of a sexual nature. It provides instructions on how to diagnose OCD in clients reporting sexual obsessions, guidance on measures to employ during assessment, and a discussion of differential diagnoses. It includes a step-by-step manual describing how to provide treatment, using a combination of exposure and ritual (response) prevention (Ex/RP), cognitive therapy, and newer CBT techniques. Also included are case examples of pedophile-themed OCD (sometimes called P-OCD) and sexual orientation worries in OCD (called SO-OCD or H-OCD) and their treatment approaches, along with a catalogue of specific ideas for in vivo exposures and detailed templates for imaginal exposures. Included are strategies therapists can use to tackle relationship issues that commonly emerge as a result of sexually themed OCD. Also included are appendices of handouts for clients and helpful measures for therapists to utilize with clients.