ADHD and Sexuality

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that can affect people of all ages. Symptoms of ADHD can impact many areas of an individual’s life, including their sex life and romantic relationships. In fact, research suggests that approximately 40% of women and men with ADHD will experience some sexual difficulties.

Since launching the Sex Talk With Amy Podcast, I’ve received several messages from neurodiverse listeners who’ve had questions about the relationship between their ADHD symptoms and the quality of their intimate relationships.

The Rise In ADHD Diagnoses

ADHD symptoms tend to emerge during childhood. However, not everybody receives a diagnosis. I, myself, was diagnosed with ADHD a few years ago, at the age of 22. After conducting research on the condition, and doing a lot of personal reflection, I gained a better understanding of how a late diagnosis of ADHD has negatively impacted my self-esteem, relationships, and professional endeavours.

“When I was growing up, I think ADHD was something that was typically underdiagnosed,” said Melbourne-based Sexologist & Psychotherapist, Daniel Di Pietro, on the latest episode of the Sex Talk With Amy Podcast. However, over the last decade, there’s been a significant uptick in diagnoses rates, with further spikes recorded since the onset of the COVID-19 pandemic: “I’ve seen a lot of people come to me recently with underdiagnosis of ADHD, and people who have been recently diagnosed,” confirmed Daniel.

This ongoing rise in diagnoses prompted the Melbourne Sexologist to attend a professional development programme earlier this year, designed to arm sexologists with the knowledge required to best support clients who present with ADHD, and subsequently obtained a certification in ADHD and Sexuality (2023): “All these people are now getting diagnosed for it, and I wanted to be around the ball on how to assist these people. I wanted to get a sense of how I could help these clients who have now come to me with this recent diagnosis, and what changes this has had on their sexual lives.”

ADHD-Related Sexual Difficulties

Despite the numerous challenges that can arise from symptoms associated with ADHD, many strengths are also reportedly linked to the condition, such as creativity, energy, adventurousness, adaptability, and thinking outside the box.

“ADHD does come with a lot of its strengths. People with ADHD can be great at many things. They’re also hyper-focused when they’re interested in something, and that’s a great quality to have,” said Daniel Di Pietro on Sex Talk With Amy. “But ADHD can also cause distraction during sexual experiences. It can also lead to risky sexual behaviours, hypersexuality, or relational conflict.”

When discussing the common challenges his ADHD clients present with, Daniel stated the following: “During their partnered sexual experiences, their mind will tend to wander, and they’ll tend to think of multiple things at once. There are difficulties with emotional regulation as well, and being able to articulate what they’re wanting within their experiences. There’s also a deficiency in coping strategies during moments where they feel overwhelmed, or there’s too much going on.”

Managing Sexual Challenges Caused by ADHD

When treating clients who present with ADHD, Sexologist Daniel Di Pietro refers to the Dual Control Model of Sexual Response, which was created by former Kinsey Institute director, Dr. John Bancroft and Dr. Erick Janssen.

This theoretical model of sexual response puts forth the notion that people’s sexual responses are the product of a balance between excitatory and inhibitory processes. Researchers compare it to “having both a gas pedal (excitation or SES) and a brake pedal (inhibition or SIS) in a car — every person will engage one or both pedals to a differing degree in any particular sexual situation, depending on their unique sexual physiology, history, and personality.”

According to Daniel, “that means knowing what your brakes are, and knowing what your accelerators are. So, things that turn you off, and things that turn you on.” For those with ADHD, building awareness of your turn-ons and turn-offs can be helpful in sexual situations: “The more accelerators we have, the more willing that we are to engage in sexual activity with our partner.”

People with ADHD may struggle with emotion regulation, which Cornell University defines as the “ability to effectively manage and respond to an emotional experience.” To deal with this difficulty, Daniel Di Pietro recommends seeing a mental health professional, such as a counsellor, psychotherapist or psychologist, in order to learn emotion-regulating strategies.

In an episode of Sex Talk With Amy, Daniel explained, “I’m an emotion-focused therapist myself, so that is the core of my work. A lot of grounding, mindfulness-based as well. And lot of breathing. When it comes to sexual activity, whilst you are breathing, there’s a colleague of mine that talks about breathing out from the area where you are wanting to focus pleasure. For example, in-breath through the nose and then out-breath, in a sense, through the vulva. Or, if it’s penetrative, through the vagina.”

Sexual Side Effects of ADHD Medication

ADHD medications have been reported to have both positive and negative effects on sexual behaviour and function. Some diagnosed adults who are medicated for their ADHD report improvements in their ability to concentrate, stay in the moment, and sustain interest during sexual encounters. Others report a decline in libido, as well as erectile difficulties.

“Stimulants, such as Ritalin or Dexamphetamine, can cause someone to either have lowered sexual desire or heightened sexual desire,” explained Daniel Di Pietro on the Sex Talk With Amy Podcast. “But it might not just be the medication. It might be other things that are going on in their life as well. For example, a partnered sexual experience where they’re not getting something within that, and not able to articulate that.”

Another thing to consider is the impact of SNRIs (serotonin and norepinephrine reuptake inhibitor). SNRIs are a class of medications that are often used to treat depression, among other conditions. ADHD medications are used by many in tandem with SNRIs, due to the fact that a high percentage of ADHD patients are also diagnosed with depression or bipolar disorder (Kollins, 2008). According to studies, “many antidepressants, including SSRIs, SNRIs and tricyclic antidepressants, may cause sexual side effects such as a loss of libido, difficulty reaching orgasm and erectile dysfunction.”

As Daniel explained on the podcast, “SNRIs improve concentration, and the impulsivity that typically emerges from ADHD. But SNRIs can also impact erectile functionality, sexual desire, and even menstruation.” He added, “medication typically always has its benefits in some areas, but they can have sexual side effects. The most common one I see with stimulants is changes in libido.”