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Some evolutionists have construed obsessive-compulsive disorder (OCD) as the over-activation of warning systems in areas of evolutionary import. Using evolutionary theorizing, it is posited here that sex differences in the instantiation of specific obsessions and/or compulsions might correspond to sex-specific differences in the evolutionary import of the domain to which the particular symptom maps onto (e.g., mating versus parenting). Even in instances where no sex differences are found in the incidence of a particular obsession and/or compulsion (e.g., the extent to which men and women might suffer from intrusive thoughts), an evolutionary perspective might nonetheless propose that the contents of such thoughts map onto sex-specific adaptive concerns (e.g., social status and appearance-related concerns for men and women, respectively). An evolutionary approach might help not only in explaining sex differences in OCD phenomenology but also in elucidating within-sex manifestations of OCD symptoms (e.g., the shifting strength of contamination fears across a woman's menstrual cycle). The current evolutionary perspective not only provides an integrative ultimate-level meta-framework in understanding previously-found sex differences in OCD but also it permits OCD researchers to propose innovative hypotheses that otherwise might have been unlikely to be posited if one were to strictly focus on a proximate exploration of OCD. Cross-cultural clinical data, originating from a heterogeneous set of cultures and highlighting universal patterns of sex-specific OCD symptomatology, would provide a strong test of the posited hypotheses.