ADHD and SEX: What You Need to Know (That Sex Therapists Cannot Tell You)

By Gina Pera

ADHD and Sex 

Newly revised 2023

From the leading expert on Adult ADHD and Relationships, Gina Pera.

This is the first guide to understanding how poorly managed ADHD can interfere with sexual intimacy—and how to heal your relationship.
"Gina, sex is difficult for people with ADHD; it's tough to stay focused!" says a female friend who has ADHD. Staying focused during intimacy is only one issue challenging couples affected by adult ADHD.
Even many mental-healthcare professionals assume that sex constitutes an “ADHD Free” zone.  That is, when it comes to sex, brain-based challenges with attention, organization, mood-regulation, or motivation don’t matter or—in the minds of skeptics—don’t even exist.
Yes, sexual expression is yet another one of those areas—like sleep—where the public and professionals alike often fail to connect the dots to ADHD symptoms. As Gina Pera writes in her first book, Is It You, Me, or Adult A.D.D.?:

"When ADHD does create significant sexual problems, it usually falls into two categories: The ADHD partner initiates sex all the time or almost never. In the sexual relationship as in elsewhere with ADHD, we encounter variable challenges in self-regulation and summoning motivation."
In between these two extremes, always and never, there lies a range of ADHD-charged issues that can drive apart couples—if they don’t know what they’re dealing with or what strategies to implement. Ignorance about this critically important connection between ADHD and sexual intimacy creates enormous hurt.
In this Kindle book (125 book pages), you will find four major sections:
(1)  An expanded version of Chapter 6 in Is It You, Me, or Adult A.D.D.?—detailing the myriad ways in which ADHD can affect the sexual relationship.  Knowledge paves the path to problem-solving.
(2)  An eight-step strategy toward leaving the ADHD roller coaster and entering the Tunnel of Love
(3)  Post-Orgasm Irritability—A look at a common enough but little recognized phenomenon. It's one that leaves many people confused and stuck in a disturbing pattern.   BONUS: Two downloadable books from the early 20th Century that address this post-orgasm phenomenon and promote overall relationship intimacy in an intriguing way.
(4)  Adults with ADHD and Their Partners Speak Out—a curated, categorized selection of comments on the first blog post ever on ADHD and Sex, in 2009. Along with Gina’s responses. Consider it the first step in finding community—and finding your voice.

• Language: English
• Publisher: 1201 Alarm Press
• Release date: Oct 14, 2023
• ISBN: 9780981548791

Book preview

Preface

My wife is so easily distracted that boom, in the middle of a romantic interlude, she's suddenly talking about the cat! Talk about a mood killer.

Both my brother and I have ADHD, and what we've concluded is that thinking about sex is pretty exciting. But the reality? More often than not, boring. That's a hard thing for a guy to admit.

Our sex life is great! If only everything else in our life together was so easy.

If ADHD presents known challenges to 'self-regulation,' it makes sense that some of us could have a problem with regulation of intensity here along with everything else in life? My wife and I both have ADHD and are living proof of opposite ends of the ADHD spectrum when it comes to sex.

Sex is a natural animal urge, right? You don’t need to think about it. That’s right. You need to think about it only if you want a satisfying, ongoing sexual relationship.

What, ADHD affects sex? Who knew? 

Gina, sex is difficult for people with ADHD; it's tough to stay focused! says a female friend who has ADHD. She was responding to my query on this topic on my Facebook page in 2009. (Yes, we were talking about this way back then).  Staying focused during intimacy of any type is only one issue that challenges couples affected by adult ADHD.

Strangely enough, though, even many mental-healthcare professionals assume that sex constitutes an ADHD Free zone. Sex is a place where brain-based challenges with attention, organization, mood-regulation, or motivation don’t matter or, in the minds of skeptics, don’t even exist.

Yes, sexual expression is yet another one of those areas—like sleep—where the public and professionals alike often fail to connect the dots to ADHD symptoms.

As I write in my first book, Is It You, Me, or Adult A.D.D.?:

"When ADHD does create significant sexual problems, it usually falls into two categories: The ADHD partner initiates sex all the time or almost never.

Again, it seems, we encounter these pesky ADHD-related challenges in self-regulation and summoning motivation.

In between these two extremes, always and never, lies an entire range of ADHD-charged issues that can drive apart couples—if they don’t know what they’re dealing with or what strategies to implement. Those seeking simple tips and tricks are disappointed.

Ignorance about this critically important connection between ADHD and sexual intimacy creates so much unnecessary hurt.  Left with no other rational explanation for sexual difficulties—and often no ability to articulate what it is they are feeling—partners tend to blame themselves, each other, or both. The frustration seeps into all aspects of the relationship.

Likewise, ADHD-fueled frustration in the rest of life—such as around financial management, chore-sharing, and co-parenting—can seep into the bedroom.

My goal is to help you start disentangling the threads in order to create a stronger, happier, more integrated life.

In this book, you will find four large chapters:

ADHD and Sexual Intimacy: What Individuals and Couples Need to Know (That a Sex Therapist Cannot Tell You)

A greatly expanded version of my first book’s Chapter 6, on the myriad ways in which ADHD can affect the sexual relationship, along with healing strategies.  Knowledge paves the path to problem-solving.

Eight Steps Toward Stepping Off the Roller Coaster—And Into the Tunnel of Love

A basic strategy to start viewing any sexual intimacy challenges through the lens of ADHD—and figuring out next steps

Post-Orgasm Irritability

A look at a not entirely uncommon phenomenon, one that leaves many people confused and stuck in a disturbing pattern.

BONUS: Two books from the early 20th Century that address this post-orgasm phenomenon and promote overall relationship intimacy in an intriguing way.

Adults with ADHD and Their Partners Speak Out

A tightly curated selection of comments on my first blog post on ADHD and Sex, along with my responses.

We enjoy much more Adult ADHD awareness now than we did in 2009, when that post first appeared. But the issues around sex largely remain a mystery—or are misattributed to other causes.  Consider it the first step in finding community—and finding your voice.



Picture 17

Chapter 1: ADHD and The Sexual Relationship:

Introduction: This chapter is adapted from my first book, Is It You, Me, or Adult A.D.D.?  At that time, 2008, that was the term for all types of, using today’s term, ADHD.

The implied audience is the partners of adults with ADHD (some of whom, it must be pointed out, have ADHD as well). But the information is designed to be helpful to both partners. 

In fact, I wrote this book as the first comprehensive consumer guide to understanding ADHD, including its potential effects on loved ones, and its evidence-based treatment strategies. 

While I’ve come to understand Adult ADHD from all angles, I chose to address my first book to the partners of. Why?

Chiefly, because no other book had even acknowledged their situation. Yet also, many times it is the partners of adults with ADHD who figure it out first. They needed help with getting through their ADHD partner’s denial systems and guiding decisions around finding professional help.  A team approach is highly recommended.

Finding competent care for ADHD can be challenging enough. Add trouble getting organized, sifting through choices, making appointments, and remembering to keep them. It can be truly overwhelming for the solo adult with ADHD to navigate these tricky waters, especially when he or she has lived life without benefit of diagnosis for many years—and truly harbors no more optimism that change is possible.

At any rate, that’s why the first-person comments in this chapter skew more toward the partners of adults with ADHD.  You will find a more mixed selection in this book’s final chapter: Adults with ADHD and Their Partners Speak Out

Who knew so many women were begging their male partners for sex? It must be the world’s best-kept secret.  — Rory

What’s the group consensus on ADHD and sex? newcomer Jennifer timidly asks the veteran members of the local support group for adults with ADHD.

We’re against ADHD and for sex, quips Dave.

Some members joke about their sexual woes, but it’s gallows humor. Of course, they aren’t so much against ADHD as for properly treated or even acknowledged ADHD, not to mention being against the devastating impact it can have on a couple’s sex life—and a person’s self-esteem.

Dave’s wife refuses to consider an ADHD evaluation (despite three of her immediate family members being in treatment). She also resists connecting the dots between ADHD and the sensory sensitivities and distractibility make her more anxious than amorous. The part that really depresses Dave? They enjoyed a great sex life prior to their marriage, and then the passion went out, like turning off a light bulb. Now, he’s only half-kidding when he says, It’s death by a thousand nights of silent rejection. It’s enough to inspire really bad poetry.

Many support-group members who have male ADHD partners feel the same way as Elena describes here:

An amazing number of us go without sex because our spouses never initiate, and we get tired of always being the ones to make something happen. You just lose the energy for it somehow. Then, once you go a long time without intimacy—meaning months and even years—and on top of that your partner causes so much chaos, it’s difficult to care for your partner in other ways too.

But Nothing About Adult ADHD is Cookie Cutter

To be sure, many support-group members are not suffering from sexual starvation. In fact, almost one in five ADHD Partner Survey respondents reports having a great sex life, including many in long-term partnerships. This seems significant, because most survey respondents had sought a support group because they were experiencing significant partnership challenges.

Moreover, almost half say their ADHD partner is a skilled and considerate lover. Sex is not a problem, says one. If only everything in our life could be this easy! Other survey respondents, however, report more deflating scenarios.

For those who name the lack of sexual intimacy as a chief concern (one in three respondents report having sex anywhere from once yearly to never), it might help to know that brain function can affect sexual expression.

That knowledge, by itself, is not a solution. But this knowledge can go a long way toward at least relieving psychological pressures, hurt feelings, and blame. Knowledge also presents the only path toward realistic problem solving. In other words, equating she never initiates sex with me with she must not love me or love being physical with me might feel logical, but it’s not always true. Moreover, such mind reading serves to only make things worse. For both of you.

The Big Picture: Always or Never

When ADHD does create significant sexual problems, it usually falls into two categories: The ADHD partner initiates sex all the time—or almost never. Again, it seems, we encounter those pesky ADHD-related challenges in self-regulation and summoning motivation described in earlier chapters of Is It You, Me, or Adult A.D.D.?

Let’s have a little non-threatening comic relief, by framing the most commonly troubling scenarios in the context of the animal we typically associate with sex:

Energizer Bunnies self-medicate with sex and want it all the time. For years. Some aggressive bunnies demand 24/7 sexual access.

Power-surge Bunnies hyper-focus so sharply that they zoom to the finish line—yards before their partners do! Then they hop to the next source of stimulation—the TV, the computer, or revving up the chainsaw or leaf blower (to make some stimulating noise).

Generic-battery Bunnies begin in a blaze of glory but taper off to nothing after a few