r/psychology • u/mvea MD-PhD-MBA | Clinical Professor/Medicine • 1d ago
People with more ADHD symptoms reported greater difficulty reaching orgasm and less satisfaction when they did. The association was stronger in males. One possible explanation is that men with ADHD may feel more pressure to perform sexually.
https://www.psypost.org/new-study-finds-link-between-adhd-symptoms-and-distressing-sexual-problems/57
u/mellowmushroom67 1d ago
LOL they didn't control for medication that people with ADHD might be taking. I cannot believe they would miss something so obvious and important. Can we PLEASE, I am BEGGING, STOP posting Psypost articles!! Especially because the link to the actual study in the write up never shows their data! The actual statistics are behind a paywall, you have to download it. None of us can have a real conversation about the study because of that
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u/According-Title1222 1d ago
Taken from the study (because I have institutional access):
Note: I copied and pasted this directly from a pdf, so there are frequent spelling and grammar errors, but I don't have the time to go through and fix right now. Perhaps I will later. Regardless, it's better than nothing.
Abstract:
Cognitive models of sexual dysfunction situate distraction as a core mechanism underlying difficulties with sexual function. It follows that individuals who have difficulties with inattention and distractibility (e.g., attention-deficit/hyperactivity disorder; ADHD) may be at increased risk of problems with their sexual function, though previous research is mixed, and no research has examined links with sexual distress despite distress being a necessary criterion for sexual dysfunction. The goals of the current study were to: (1) examine associations between ADHD symptoms, sexual function, and sexual distress; (2) examine group diferences in sexual function and sexual distress as a function of presumptive ADHD diagnosis; and (3) establish whether individuals with presumptive ADHD are at greater risk of distressing problems with sexual function relative to controls. In a large mixed-gender community sample (N=943: controls n=837, presumptive ADHD n=106), we found that ADHD symptoms were positively correlated with worse overall sexual function, as well as orgasm difculties and greater sexual distress. Relative to controls, individuals with presumptive ADHD reported worse sexual function and greater sexual distress, controlling for age, biological sex, and sexual orientation. Individuals with presumptive ADHD were signifcantly more likely (OR=2.16) to have distressing problems with sexual function than controls. Core difculties related to ADHD, including inattention, distractibility, and emotion dysregulation, may make individuals more vulnerable to experiencing problems with sexual function and sexual distress, putting them at risk for developing sexual dysfunction. Taken together, these data support associations between ADHD and distressing sexual function problems, including possible mechanisms explaining these links such as difficulties with emotion regulation.
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u/mellowmushroom67 1d ago edited 1d ago
Thank you for the data! They still didn't account for medication though. I think that would be a pretty important factor to consider
Edit: I just realized why. They identified the participants as having ADHD symptoms, not a diagnosis
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u/According-Title1222 1d ago
Glad you posted the edit. They seldom use diagnosis in psych studies. They do psych evaluation to all participants and feed out those who do not have symptoms for whatever they are studying.
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u/According-Title1222 1d ago
Introduction:
Cognitive models of sexual dysfunction situate distraction as a core mechanism underlying difficulties with sexual function—arousal, desire, orgasm, and pain. Becoming distracted by internal thoughts during sex (e.g., worries about performance) can interfere with sexual function since attention is directed away from positive sexual cues (e.g., pleasurable sensations). Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by executive function difculties that can include inattention and disorganization, as well as hyperactivity and impulsivity (American Psychiatric Association, 2013). It follows that individuals who have difculties with inattention and distractibility, such as those with ADHD, may be at increased risk of problems with their sexual function, though previous research is equivocal. In general, relative to controls, individuals with ADHD report poorer sexual function across almost all domains (Abdel-Hamid et al., 2021; Amani Jabalkandi et al., 2020; Bijlenga et al., 2018) with the most notable diferences related to orgasm (Bijlenga et al., 2018; Soydan et al., 2013). Other studies, however, do not fnd signifcant group diferences in sexual function between individuals with and without ADHD (Anderson-Schmidt & Signerski-Krieger, 2017; Hertz et al., 2022) or fnd better sexual function in the domain of sexual desire among men with ADHD but lower desire among women with ADHD (Canu & Carlson, 2003; Comings, 1994; Kooij, 2013). With regard to the links between ADHD symptoms and other domains of sexual function, one study found that greater ADHD symptoms were correlated with orgasm difculties in both men and women (Amani Jabalkandi et al., 2020) and another found that symptoms of hyperactivity were correlated with symptoms of erectile dysfunction (Hertz et al., 2022).
To date, no studies have examined associations between ADHD symptoms and sexual distress, despite sexual distress being a necessary criterion for sexual dysfunction (American Psychiatric Association, 2013). Given that ADHD is associated with emotion dysregulation and greater psychological distress (for systematic and meta-analytic reviews, see Beheshti et al., 2020; Soler-Gutiérrez et al., 2023), individuals with ADHD might be at greater risk for sexual distress. Preliminary support for this hypothesis comes from a recent study finding links between emotion dysregulation and greater psychological and sexual distress in a community sample (Raposo et al., 2023). Our understanding of links between sexual function and ADHD is limited by reliance on relatively small sample sizes (Abdel-Hamid et al., 2021; Beşiktepe Ayan & Gıynaş Ayhan, 2022; Canu & Carlson, 2003; Soydan et al., 2013), the use of non-validated or nonspecifc measures to assess sexual function (Abdel-Hamid et al., 2021; Anderson-Schmidt & Signerski-Krieger, 2017), and lack of examination of sexual distress. Thus, the goals of the current study were to bridge these critical gaps by: (1) examining associations between ADHD symptoms, sexual function, and sexual distress using validated measures in a large sample; (2) examining group diferences in sexual function and sexual distress; and (3) establishing whether individuals with presumptive ADHD are at greater risk of distressing problems with sexual function using clinical cutofs.
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u/According-Title1222 1d ago
ADHD measured:
ADHD Symptoms. The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5 (ASRS; Ustun et al., 2017) is a validated 6-item measure used to screen for adult ADHD based on the DSM-5 (American Psychiatric Association, 2013). Respondents indicate how often (“never” to “very often”) they have experienced symptoms of inattention, hyperactivity/impulsivity, and executive dysfunction over the past 6 months on a 5-point scale. To determine the likelihood of ADHD, the scoring method outlined in the validation paper was followed (Ustun et al., 2017). After item-level scoring adjustments, a total score was computed by summing the adjusted items (range 0 to 25), with higher scores refecting more frequent ADHD symptoms. Internal consistency was acceptable in the current study (α=0.76). The ASRS has an established clinical cutof score, such that scores greater than or equal to 14 are suggestive of ADHD. The ASRS cutof score detects the majority of adult ADHD cases with high sensitivity (91%) and specifcity (96%) in the general population.
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u/According-Title1222 1d ago
Sexual Functioning Measurement:
We observed signifcant associations between ADHD symptoms and problems with sexual function and greater sexual distress in a large community sample. Relative to controls, individuals with presumptive ADHD reported both greater difculty reaching and greater dissatisfaction with orgasm, as well as greater sexual distress. We did not observe signifcant group diferences for other physiological domains of sexual function (i.e., arousal, lubrication/erection) or sexual desire, suggesting that some aspects of sexual response may be less closely related to ADHD symptoms. Finally, using established clinical cutofs we found that relative to controls, individuals with presumptive ADHD were more than twice as likely to report distressing problems with their sexual function. Taken together, these data reveal links between ADHD symptoms and problems with sexual function and greater sexual distress, suggesting that individuals with ADHD might be at greater risk for developing sexual dysfunction. Cognitive models of sexual dysfunction posit that distraction and inattention are core mechanisms underlying sexual dysfunction (Barlow, 1986). Core features of ADHD, including inattention, distractibility, hyperactivity, and impulsivity, may be a risk factor for developing or experiencing problems with one or more domains of sexual response. Consistent with prior work, ADHD symptoms were positively associated with greater difculties with orgasm and individuals with ADHD reported greater problems with orgasm relative Sexual Function. The Arizona Sexual Experiences Scale (ASEX; McGahuey et al., 2000) is a validated 5-item measure used to assess fve distinct domains of sexual function that correspond with DSM-5 sexual dysfunctions (American Psychiatric Association, 2013). Respondents indicated their ease of orgasm (e.g., “extremely easily” to “never reach orgasm”), arousal, and lubrication/erection (based on their anatomy), orgasm satisfaction, and strength of sex drive over the past week on a 6-point scale. Individual items were summed (range 5–30), with higher scores refecting greater problems with sexual function. Internal consistency was good in the current study (α=0.83). The ASEX has an established clinical cutof score, such that total scores greater than or equal to 19 are indicative of clinically signifcant problems with sexual function. This ASEX cutof score detects problems with sexual function in the majority of cases with high sensitivity (82%) and specifcity (90%). Sexual Distress. The Sexual Distress Scale Short-Form (SDS-SF; Santos-Iglesias et al., 2020) is a validated 5-item measure of sexual distress based on the original 12-item Sexual Distress Scale (SDS; DeRogatis et al., 2008; Derogatis et al., 2002). Respondents indicated how often (“never” to “always”) they felt various forms of negative afect (e.g., inadequate, distressed, anxious/worried) related to their sexuality over the past four weeks on a 5-point scale (e.g., “How often do you feel frustrated by your sexual problems?”). Items are summed (range 0–20), with higher scores refecting greater sexual distress. Internal consistency was excellent in the current study (α = 0.92). The SDS-SF has established clinical cutof scores for women (≥7) and men (≥ 8) that perform similarly to the original SDS (Santos-Iglesias et al., 2020). Indeed, using these cutofs almost 95% of women and men were correctly classifed as having distressing sexual problems.
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u/According-Title1222 1d ago
Discussion:
We observed signifcant associations between ADHD symptoms and problems with sexual function and greater sexual distress in a large community sample. Relative to controls, individuals with presumptive ADHD reported both greater difculty reaching and greater dissatisfaction with orgasm, as well as greater sexual distress. We did not observe signifcant group diferences for other physiological domains of sexual function (i.e., arousal, lubrication/erection) or sexual desire, suggesting that some aspects of sexual response may be less closely related to ADHD symptoms. Finally, using established clinical cutofs we found that relative to controls, individuals with presumptive ADHD were more than twice as likely to report distressing problems with their sexual function. Taken together, these data reveal links between ADHD symptoms and problems with sexual function and greater sexual distress, suggesting that individuals with ADHD might be at greater risk for developing sexual dysfunction. Cognitive models of sexual dysfunction posit that distraction and inattention are core mechanisms underlying sexual dysfunction (Barlow, 1986). Core features of ADHD, including inattention, distractibility, hyperactivity, and impulsivity, may be a risk factor for developing or experiencing problems with one or more domains of sexual response. Consistent with prior work, ADHD symptoms were positively associated with greater difculties with orgasm and individuals with ADHD reported greater problems with orgasm relative to controls (Amani Jabalkandi et al., 2020; Beşiktepe Ayan & Gıynaş Ayhan, 2022; Bijlenga et al., 2018; Soydan et al., 2013). This effect was moderated by age, such that the strength of association between more frequent ADHD symptoms and difculties reaching orgasm was stronger among younger participants. While age is minimally associated with orgasm ability (Gesselman et al., 2024), ADHD symptoms tend to improve with age (Döpfner et al., 2015; Faraone et al., 2006). Thus, the stronger association among younger people may be related to them having more frequent and impairing ADHD symptoms. In line with theory (Barlow, 1986) and previous research (for a systematic review, see Tavares et al., 2020), difculty reaching orgasm may be the result of individuals being distractible during sex or having trouble focusing on the pleasurable sensations and stimulation necessary to reach orgasm. Similarly, problems with impulsivity and inhibition may contribute to individuals reaching orgasm too quickly or before they would like to because they are unable to delay or inhibit ejaculation and in turn experiencing orgasm as less satisfying (Beşiktepe Ayan & Gıynaş Ayhan, 2022; Soydan et al., 2013). Consistent with other research (Anderson-Schmidt & Signerski-Krieger, 2017; Hertz et al., 2022), we did not fnd signifcant consistent associations or group diferences with motivational and physiological domains of sexual function including desire, arousal, and lubrication/erection. One possibility is that symptoms of ADHD may interfere with some aspects of sexual response more than others. For example, there is consistent evidence that sexual desire/sex drive is not linked with ADHD symptoms (Amani Jabalkandi et al., 2020; Anderson-Schmidt & Signerski-Krieger, 2017; Hertz et al., 2022), and in some cases, sexual desire is greater among individuals with ADHD relative to controls (Canu & Carlson, 2003; Comings, 1994).
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u/According-Title1222 1d ago
Perhaps ADHD symptoms interfere most when high levels of focus or attention are required, as is the case for orgasm (Tavares et al., 2020), but less so for motivational aspects such as sexual desire. Despite sexual distress being a necessary criterion of sexual dysfunction and emotional dysregulation being core to ADHD (Beheshti et al., 2020; Soler-Gutiérrez et al., 2023), no research had examined associations between ADHD symptoms and sexual distress. We found, for the frst time, that ADHD symptoms were positively associated with greater worries and concerns about one’s sex life and this efect was stronger among males relative to females albeit present for both sexes. This sex diference warrants further examination, but one possibility is that it is driven by the greater severity and variability in ADHD symptoms among males (Arnett et al., 2015). Another possibility is that the efect is driven by the strong societal emphasis placed on male orgasm as a requirement for sex (Maher et al., 2020). Given that ADHD symptoms had the strongest association with orgasm difculties, and the prioritization of male orgasm in society, it is possible that the infuence of ADHD symptoms on orgasm is experienced as more distressing among males relative to females. We also observed greater sexual distress among individuals with presumptive ADHD relative to controls. Given that group diferences in sexual function and correlations between ADHD symptoms and sexual function were relatively small in magnitude, whereas associations with distress were moderate, our fndings suggest that individuals with presumptive ADHD may experience these sexual function difculties as more distressing relative to controls. Indeed, we saw that individuals with presumptive ADHD were twice as likely as controls to have clinically signifcant distressing problems with sexual function. This is consistent with prior work fnding higher prevalence of specifc sexual dysfunction among individuals with ADHD relative to the general population (Amani Jabalkandi et al., 2020; Beşiktepe Ayan & Gıynaş Ayhan, 2022; Bijlenga et al., 2018; Soydan et al., 2013). ADHD is associated with emotion dysregulation (Hertz et al., 2022) and poor distress tolerance (Pond et al., 2019; Van Eck et al., 2015). It is possible that when sexual challenges arise, such as difculties reaching orgasm, individuals with ADHD are less adept at managing and tolerating the associated negative emotions, and this in turn contributes to higher levels of distress around these sexual difculties. Indeed, among community individuals, emotion dysregulation is linked with greater sexual distress (Raposo et al., 2023). We explored this hypothesis with our own data (see Supplemental), fnding that difculties with emotion regulation signifcantly mediated group diferences in sexual distress. This fnding aligns with other research fnding associations between afective lability and orgasm difculties and dissatisfaction (Hertz et al., 2022). This suggests that emotion dysregulation may be one mechanism through which individuals with ADHD are at greater risk for distressing problems with their sexual function.
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u/According-Title1222 1d ago
Limitations and Future Directions
Though our sample was much larger than previous studies (Abdel-Hamid et al., 2021; Beşiktepe Ayan & Gıynaş Ayhan, 2022; Canu & Carlson, 2003; Soydan et al., 2013) and we used validated measures for each of our constructs with established clinical cutofs with high sensitivity and specifcity, our participants were not assessed via diagnostic clinical interview. As such, we are unable to determine whether our participants would meet criteria for ADHD assessed via diagnostic clinical interview and cannot rule out the possibility that high scores on the ASRS refect the presence of another psychiatric disorder associated with inattention/distractibility (e.g., anxiety, depression). Even so, relative to prior work, our fndings better approximate sexual dysfunction because we assessed sexual function and sexual distress together and interpreted the fndings using established clinical cutofs. Given the limitations to previous research that relied on non-validated measures of sexual response, our data provide promising directions for future research with respect to specifc domains of sexual function that might be most implicated for individuals with ADHD (i.e., orgasm). Moreover, our post hoc analysis supports diffculties with emotion regulation as one potential mechanism driving these efects; however, future research might seek to elucidate the other mechanisms driving these associations, including cognitive distraction and poor distress tolerance in line with theoretical models of sexual dysfunction (Barlow, 1986; Rosen & Bergeron, 2019; Tavares et al., 2020). Taken together, these data support associations between ADHD and distressing sexual function problems, and difculties with emotion regulation as a potential mechanism underlying ADHD and sexual dysfunction.
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u/masterwad 1d ago
I don’t know, because Adderall is often prescribed to those with ADHD, and it’s basically an amphetamine (an analog of dopamine) which should increase libido by decreasing prolactin. Although, people with ADHD are more likely to have paradoxical reactions to drugs (ie, the opposite effect). Another drug commonly prescribed for ADHD is Vyvanse, which can lead to hypersexuality. Another drug often prescribed for ADHD is Ritalin, which is not an amphetamine, but is a dopamine/norepinephrine reuptake inhibitor.
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u/ZenythhtyneZ 1d ago
Yeah too busy being distracted by everything I see and hear so I can never really be in the moment or spacing out and getting lost in your own thoughts is a big one for me, I just automatically tune out if I’m not SUPER into it but as a woman I would say that’s almost all sexual encounters regardless of partner
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u/Thatssowavy 1d ago
This is true in my case, and some medication make it worse.
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u/juroden 1d ago
Which ones make it worse/which one don't affect it?
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u/anonmehmoose 1d ago
Off-label for ADHD, but the antidepressant Wellbutrin helps with mood and focus and doesn't have the sexual side effects of some of the others.
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u/theADHDfounder 1d ago
Yep, totally get that. ADHD symptoms can be super frustrating to deal with. I've personally found that tracking my symptoms and really paying attention to what triggers them has been helpful. Like, keeping a simple journal where I note down when I'm feeling extra scattered or impulsive.
The ASRS screener you mentioned is a good starting point, but remember it's not a full diagnosis. If you're really struggling, talking to a professional who specializes in adult ADHD can give you more clarity.
One thing that's helped me a ton is building small habits that support executive function. Like always putting my keys in the same spot or using a digital calendar for EVERYTHING. It takes time, but those little systems can make a big difference.
Hang in there! Managing ADHD is def a journey, but there are lots of strategies out there to try. you got this :)
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u/Popular_Meringue4675 1d ago
Yeah very true, from my experience; I was in a long term relationship with a woman who was older than me and had quite a few bodies before me, which she brought up often, (almost like she wasn’t over her exes) and even sometimes mention guys size she had before, because of this sex became a performance, don’t get me wrong, I performed and she admitted it was the best she had, but it took so long for me to orgasm and sometimes I couldn’t, because I was in my head, orchestrating a sex scene to somehow ‘compete’ with other lovers. I still enjoyed our sex life. Whereas now, I meet people, and because they either have few to no bodies, or I never hear of other guys, I can orgasm so quick, I still perform and put on my best show, but I find I can achieve orgasm and multiple rather quick. I think it all comes down to our mind in the moment. Anyway just my experience.
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u/Popular_Meringue4675 1d ago
Also just add, for new partners I had trouble reaching erection, (im a young healthy male who can achieve on my own easily) and it usually was because my mind was racing to plan out a performance and be the best, so for a while I had to take the little blue pill to help, once I had a few encounters with someone and we got comfortable i didn’t need it anymore though.
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u/GeenVerstand 1d ago
ADHD symptoms are not ADHD, these assumptions are made up by a third party like a lot of ADHD stuff because psychologically you can’t change your neurophysiologic system that causes ADHD.
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u/mellowmushroom67 1d ago
You are correct, just reread the study. It's correlation ADHD symptoms, they did not include participants with a diagnosis
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u/MrBeerbelly 1d ago
The authors also say that on the flip side, some of us might come too quickly because of impulsivity. I’m not sure how that line made it through the publishing process
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u/hanzkafka 1d ago
What's wrong with it though?
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u/MrBeerbelly 1d ago edited 1d ago
Well, to me it implies a degree of will behind orgasm that I don’t think is there. I’m trying to think of how tendency to act too quickly, with little thought could actually serve as an explanation for an entirely unconscious process like premature ejaculation, and I got nothing.
If you’ve got a better potential explanation for what they mean, I’m down to hear it, but it seems like a wild suggestion to make without evidence.
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u/hanzkafka 1d ago
Yeah, i don't know how they arrived at that conclusion, but during sex, i imagine people can decide to delay gratification and ride it out, or just come fairly early and have a botched orgasm. Perhaps people who are more impulsive do more of the latter. Coming at the first hint of pleasure.
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u/MermaidPigeon 1h ago
You need dopamine for everything, even tasting food, “seeing things in the beauty they’re in”. My adhd is rampant atm and it’s like being a AI. I can see what’s in front of me but it might as well not be there. No feeling of any nostalgia, being present, nothing
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u/BlackPrinceofAltava 1d ago edited 1d ago
I can confirm that a lot of the time when I was having sex, especially with new partners, I didn't get much out of it.
It was nice to be touched and get it out of my system, but it wasn't all that satisfying. It felt like the end of a performance. Everyone else in the room got to enjoy what you did, but you're just thankful you didn't flub a line or make a fool of yourself. Genuine enjoyment isn't really what I let myself feel most of the time.
It's either, "Am I doing a good job?" or "How long do I want to go at this for?".
I hated hookups for this exact reason, the only way for me to enjoy myself is to feel free. Free to be goofy, free to let loose, free to finish when it feels right and be able to trust that we can just do it again later, for longer.
Edit: and I should mention that I'm chronically unmedicated