How Does ADHD Affect Erectile Dysfunction and Premature Ejaculation?
Attention-deficit/hyperactivity disorder (ADHD) is a complex neurological condition. Formerly classified as a behavioral disorder, ADHD now falls under the cultural and medical umbrella of neurodivergency. Under the Americans with Disabilities Act (ADA), it is classified as a disability, though not a learning disability. Then, of course, there are people who don't consider it a real condition at all, instead insisting that anyone who claims to have ADHD is lazy, unmotivated or simply needs to try harder.
The truth is no matter how you classify it, ADHD is real for the people who have the disorder. It interferes with nearly every aspect of day-to-day life, whether it manifests as an inability to sit still, difficulty focusing, forgetfulness, poor planning skills, impulsiveness, emotional dysregulation, poor time management skills or any combination of these symptoms.
Untreated ADHD can make it difficult for people to succeed in school, careers, relationships and, in general, life. Even with treatment, severity fluctuates and managing symptoms can prove mentally taxing.
Given that ADHD is such a pervasive and varied condition, and symptoms creep up and manifest in different ways for different people, it's not the slightest surprise that it can disrupt your sex life.
The symptoms that impact your orgasms
"There's a huge population of men and women who have the diagnosis of ADHD; some since childhood, some adult-onset; some are on psychostimulants, some are not," said psychologist Sheryl Kingsberg, Ph.D., division chief of OB-GYN behavioral medicine at University Hospitals Cleveland Medical Center. "So the bigger question is, is there a higher prevalence of sexual problems or sexual dysfunction in those diagnosed with ADHD? And the answer is yes."
Kingsberg said men with ADHD see higher rates of both premature ejaculation (PE) and erectile dysfunction (ED), conditions that sit on opposite ends of the sexual dysfunction spectrum. Some women with ADHD tend to have difficulty with desire, arousal and reaching climax, while others, paradoxically, have incredibly high libidos.
ADHD doesn't affect every individual the same way. For example, Kingsberg acknowledged premature ejaculation and ED both could be potentially linked to inattentiveness in different ways. In one instance, a man might not be stimulated enough and lose focus, leading to ED. In another, he might be so wrapped up in the experience that he doesn't realize he's about to orgasm until it's too late.
"Of course, everyone has an individual experience," said Amy Marschall, Psy.D., a psychologist at Sioux Falls Psychological Services in South Dakota. "Research has shown that, on average, people with ADHD have higher sex drives than people who don't have ADHD, which may be linked to the ADHD tendency to be sensory-seeking."
People with attention-deficit/hyperactivity disorder are prone to being physically hypersensitive and can experience sensory overload from certain textures in food or clothing. For example, itchy sheets might become a distraction, pulling focus away from the task at hand. Considering people with ADHD are already more likely to lose focus, it's a dangerous combination. Kingsberg noted that for some people, physical irritation might be overwhelming and inhibit sexual desire, or they may not be able to attend to sensations of pleasure.
Marschall cited a 2020 study indicating people with ADHD report more sexual desire, more masturbation frequency, less sexual satisfaction and more sexual dysfunctions than the general population.
ADHD and libido
Across the board, people with attention-deficit/hyperactivity disorder experience things differently from neurotypicals and other neurodivergents, including sex: We can identify that people with ADHD are more likely to encounter issues with their sex lives than neurotypicals.
"A potential problem that men and women with ADHD may have is difficulty in their interpersonal relationships if they struggle to attend to other social cues or communicate with their partner," Kingsberg said.
To that end, one research study from the University of Waterloo in Canada indicated people with attention-deficit/hyperactivity disorder have difficulty communicating and interacting with others, specifically in regard to looking at a situation from someone else's perspective. This can make conversations—such as those about sexual intimacy and desire—especially difficult.
"If your sex drive is higher or lower than that of your partner, this can lead to frustration when one person feels they are always initiating or not feeling desired by their partner," Marschall explained. "Mood swings, impulsivity and distractibility related to ADHD can also interfere with libido and sex life."
The effects of stimulant medications
The most effective treatment for attention-deficit/hyperactivity disorder is a combination of medication and behavioral therapy. Most commonly, the prescribed medication is a stimulant, such as methylphenidate [brand name: Ritalin] or a combination drug called mixed amphetamine salts containing four salts of amphetamine [brand name: Adderall], which can affect sex drive, as well.
As with anything else, though, the effects of these medications vary among individuals.
"Since stimulants can have a reverse effect on people with ADHD—for example, ADHD-ers may drink coffee to help with falling asleep—some report reduced energy and sex drive or even erectile dysfunction when on stimulant medication," Marschall said. "However, others report increased sex drive when taking stimulants. Still, others do not notice a change in libido when taking stimulants."
Kingsberg mentioned that many people with attention-deficit/hyperactivity disorder regularly receive a co-diagnosis of anxiety or depression—or a combination of the two—which means, in addition to stimulant medications, many patients are put on selective serotonin reuptake inhibitors (SSRIs).
"And we absolutely know there are sexual side effects with SSRIs," she added. "Sometimes, it's difficulty reaching orgasms. We often actually use SSRIs as first-line treatment for premature ejaculation because it often can cause a delay in our orgasm."
ADHD and your ability to climax
Yes, attention-deficit/hyperactivity disorder affects your sex life, but the "how" of it really can't be summed up in a general sense. Each person's experience is different based on a number of factors, such as the symptoms and their severity, medication reaction and the type of ADHD itself.
Ultimately, anyone being treated for ADHD should keep in mind that reporting changes in sex drive, sexual pleasure and performance to your doctor is the best way to ensure you're getting the treatment you need and avoiding as many negative side effects as possible.
"'Normal' is just a setting on the washer," Marschall explained. "There is no one normal sex life or level of sexual desire. There is a huge range within human experience, and you can be in a different part of that range than what's shown in media. And that's OK."