16. Sexual behavior with ADHD

Author: Ulrich Brennecke
Review: Dipl.-Psych. Waldemar Zdero

Women with ADHD have significantly¹

• Used to have their first sexual intercourse
• Her first live birth earlier
• Her menopause earlier

ADHD is associated with riskier sexual behavior.²
One study reported significantly reduced scores in adult women with ADHD in relation to³

• Desire
• Arousal
• Orgasm
• Satisfaction
• Pain
• Lubrication

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

• Orgasm
• Erectile function
• Sexual satisfaction
• General 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 appears 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 catecholaminergic cell groups A13 and A14 of the hypothalamus.⁴ Unlike sildenafil, D2 agonists act directly in the CNS. The erectile response to D2 agonists is significantly reduced by the oxytocin antagonist d(CH2)5Tyr(Me)2-Orn8-vasotocin when it is administered intracerebroventricularly or into the VTA.
In the 1990s, a D4 agonist for the treatment of erectile dysfunction came onto the market. However, its success was limited, partly because orally active phosphodiesterase type V inhibitors were more effective and partly because the D4 agonist triggered vomiting.

People with ADHD reported⁵

• very sexually arousing paraphilic fantasies 43% more frequently (58.2% to 40.5%)
• 58% more frequent paraphilic behavior (44.9% to 28.4%)

In ADHD, paraphilic sexual masturbation fantasies, like paraphilic sexual behaviors, correlated significantly with hypersexuality.⁵

One study reported that the Sexual Boredom Inventory (SBI), a 6-item questionnaire that assesses sexual boredom as a transient, context-dependent state, correlated with attention deficit disorder and impulsivity, suggesting a link between sexual boredom and ADHD.⁶