16. Sexual behavior in ADHD

Women with ADHD have significantly¹

• Earlier their first sexual intercourse
• Earlier her first live birth
• Earlier her menopause

ADHD is associated with riskier sexual behavior.²
One study reported significantly decreased scores in adult women with ADHD in terms of³

• Desire
• Excitation
• Orgasm
• Satisfaction
• Pain
• Lubrication

In adult males with ADHD, the study reported significantly lower levels of

• Orgasm
• Erectile function
• Sex Satisfaction
• Overall satisfaction

Only desire was not affected in men.

Dopamine is associated with erectile function and male sexual behavior, and both too much and too little dopamine can be harmful.⁴ Dopamine seems to stimulate male sexual behavior and inhibit female sexual behavior.

Systemic administration of dopamine agonists by microinjection into the paraventricular nucleus of the hypothalamus (PVN) induces penile erection in male rats via dopamine D2 receptor activation. When microinjected into the medial preoptic area, they facilitate copulatory behavior. This is an activation of the inzertohypothalamic dopaminergic system, whose neurons originate in the A13 and A14 catecholaminergic cell groups of the hypothalamus.⁴ Unlike sildenafil, D2 agonists act directly in the CNS. The erectile response to D2 agonists is markedly reduced by the oxytocin antagonist d(CH2)5Tyr(Me)2-Orn8-vasotocin when given intracerebroventricularly or into the VTA.
In the 1990s, a D4 agonist was introduced for the treatment of erectile dysfunction. However, success was limited, partly because oral phosphodiesterase type V inhibitors were more effective and partly because the D4 agonist induced vomiting.