ADHD and sex: distractions and difficulties

Man in bed with his wife, but distracted by ADHD thoughts

Research suggests that men who struggle with premature ejaculation are more likely to have ADHD.

Erectile dysfunction, low desire and intense feelings of rejection are also linked to ADHD. So what can men and their partners do to overcome these challenges and find sexual satisfaction?

A 28 year-old man comes to my therapy practice. He’s in a 6-month relationship, he’s very much attracted to his girlfriend and his sex drive is on the high and healthy side.

But he’s having difficulties in the erection department. No matter how hard he tries to be present, he loses focus during sex.

He’s fine for a few minutes, and then his mind starts to go places. Work, what to eat later and random things. Pokemon was mentioned a few times.

And it’s happened before. He starts dating someone new, it’s all good and then a couple of months in, focus issues and disappearing erections. And the stress and apologising that goes with it.

It’s not a coincidence that he has a diagnosis of ADHD

Did you know that on average, people with ADHD have higher sex drives? But also a higher prevalence of sexual difficulties, including erectile dysfunction.

In the psychotherapy industry, we’re still getting our heads around ADHD. And we’re learning more about how ADHD can complicate sex.

Distraction, lots of thoughts running at the same time – it figures that we could lose focus, leading to loss of erection or difficulty reaching orgasm.

It’s like when guys who want to last longer deliberately think about work meetings and sports and random things during sex. This distraction can slow things down, sometimes too much and they lose their erections. With ADHD, it’s not such a deliberate choice.

And there’s a tendency to get bored easily, and I think we’re seeing that here. A relationship starts off super-hot and then the novelty wears off. The ADHD partner needs more stimulation and variety.

So loss of focus, boredom and insufficient arousal is common. But that’s not all we see in guys with ADHD and sex. The opposite can happen too.

Take this recent study, where 48 married men with lifelong premature ejaculation were assessed for ADHD.

20 of them – 41% of these guys – were diagnosed with ADHD. Whereas in the general population, it’s estimated that 5% of people would get that diagnosis.

So ADHD is a factor in early ejaculation too

But why? Because men get bored and distracted and come too soon?

No, it’s probably the flipside of ADHD: the hyper-focus on an experience. Guys can get so wrapped up in the sex that they lose all sense of control. They don’t realise how close they are to coming, until they hit the point of no return.

Now we can all get carried away and overwhelmed by sensations of pleasure during sex. And a big part of learning how to last longer is finding ways to stay more grounded, more present. But with ADHD, the entrancement can be more difficult to step back from.

That’s one of the misconceptions about ADHD – that it’s all about being fidgety and having a short attention span.

A better definition of ADHD: disregulated attention system

Focus can be fragmented, or it can lock on to an activity to the exclusion of everything else. And this hyperfocus might be deliberate. People with ADHD sometimes need to hyperfocus to push out the distractions. Or it can feel more automatic and habitual.

Either way, hyperfocus can be a gift in other realms of life. Fixing complicated code, for example, or crunching through a project. But not so helpful during sex, when we need to be able to change up and down the gears a bit.

A spectrum of sexual complications

Too excited, not excited enough. Reaching orgasm way too quickly or taking too long. And that fits with our growing understanding of ADHD as a neurobehavioural condition with a spectrum of symptoms.

Even the name – Attention Deficit Hyperactivity Disorder – isn’t really that helpful. It’s not a deficit of attention, it’s variable attention. And this presents both challenges and gifts in navigating through life.

And of course, women with ADHD can experience this spectrum of sexual experience too. Some women with ADHD have difficulty with desire, arousal and reaching orgasm. While others experience an extremely high sex drive.

Rejection sensitivity in the mix

Another aspect of ADHD for men and women is heightened sensitivity to rejection. This adds an extra layer of emotional distress to desire or performance issues.

We all have the capacity to feel hurt, apologetic or rejected after disappointing sex, and this can be turned up to the max for people with ADHD. So communication is key here.

So what can people with ADHD do?

Well, medication is the go-to treatment. It’s usually some form of stimulant like Ritalin, Concerta or Adderall. They stimulate the parts of the brain that help regulate attention and behaviour.

The meds can help balance out our concentration and impulsivity, and some people find it helps with sex too. Their desire and ability to get into a sexual groove might improve, or overly high sexual excitement might reduce to a more manageable level.

But things can also go too far the other way. It’s a bit trial and error with ADHD medication. Seek your doctor’s advice if you’re considering.

Variety and exploration

Mixing things up sexually, having plenty of variety – that’s good in any relationship and especially when a partner has ADHD. Different positions, places, scenarios, fantasies can all help keep us focused and into it.

That said, don’t ditch good old missionary position. Some sex therapists say this really helps, because when our partner is right in front of us, we’re less likely to get distracted and start thinking about pokemon.

And as people who struggle to reach orgasm are often advised, making that extra bit of effort – letting go, vocalising, gyrating, going into porn mode if you like – can sometimes help push us over the threshold. And there are toys and vibrators and gadgets to assist too.

ADHD gets in the way of treatment and self-help

Something I’ve noticed in sex therapy: even if ADHD might not be the direct cause of a sexual difficulty, it can get in the way of working on it. The rejection sensitivity can make us self-conscious or worried about opening up, sharing our struggles with our partners.

And sometimes perfectionism and overthinking. I’ve spoken with guys who came up with elaborate plans of all the things they were going to do to up their sexual game. Sometimes with spreadsheets and timelines.

But it wasn’t doable and it was a huge ask of their focus. They got bored and frustrated, they didn’t stick with any of it.

So just be mindful of that tendency. Work with your partner or a therapist to keep things doable and realistic, so you can start to make real progress.

I hope this has been helpful and a shout out to the ADHD Adults podcast which covers all aspects of the ADHD experience. Recommended!