Sex, intimacy, and ADHD

How might ADHD affect your sex life? Host Laura Key chats again with sex therapist Catie Osborn, this time about how executive function challenges can affect sex and intimacy. Spoiler: Sex is a task, and people with ADHD can struggle with task management.

Related resources

• ADHD and hormones (Catie’s story)

• ADHD, loving intensely, and impulsivity (Ange’s story)

• 8 dating trouble spots for teens with ADHD

Episode transcript

Laura: Hi, everyone. Laura here with a bonus episode. On our last episode, I had a great time talking with sex therapist and neurodivergency specialist Catie Osborn about her ADHD "aha" moment. So check that out if you haven't already.

But there was more to our interview than that. Catie and I also talked about ADHD and sex, and we're sharing that part of the interview here with you now. Our conversation isn't graphic in any way, but we do speak openly about how ADHD symptoms can create challenges around intimacy and sex. So there's your heads-up. Catie shares some great insights that I hadn't considered before. I really enjoyed this conversation, and I hope you do, too.

I'd love to hear you talk about how ADHD can affect someone's sex life.

Catie: Oh, God, how long do you have?

Laura: Big giant question.

Catie: I'll say here — I'll do, like, my little mini introductory elevator pitch. So as ADHD is often affected or affects executive function, things like task management, task prioritization, finishing tasks, starting tasks, emotional regulation, remembering stuff, all of these sort of things that like your brain does get you through the day. Well — spoilers: Sex is a task.

Sex is a thing that you have to remember exists. Sex is a thing that is often linked to focus and emotions and that kind of stuff. And so, yeah, about 40 to 50 percent of people with ADHD struggle with sexual disappointments and/or "differences" is what I'm going to say. Because I think, like a lot of people are used to hearing like "sexual dysfunction." But the reason why I like to distinguish between disappointment and dysfunction is because dysfunction is often like something medical, like there's something prohibiting like climax or something like medically. Whereas sexual disappointments are more like, oh, my neighbor just started mowing his lawn and it's taken me completely out of the moment. And now I am not going to be able to focus on this intimate exchange that I'm having with my partner. Now I am sad and disappointed. You know what I mean? So it's not like medically anything happened. It's just that your focus and your attention got pulled in that direction and it's going to be disappointing.

Laura: That's a great reframing. That's really helpful.

Catie: Right? It's really helpful. And that's something that I actually learned while I was working on getting my certification as a certified sex educator. And really like how that journey came about — and this is, I think, maybe a really good sort of like framing of this entire conversation — is, so I had to take a lot of classes. And I was in a lot of different classes talking about sex and sexuality and stuff.

Because I didn't go into becoming a certified sex educator to specifically talk about neurodivergency. That happened because of the lack of education that was happening in that training basically is what happened. I just wanted to educate about sex and sexuality because I think it's fascinating. But then I started realizing in all of these classes, the conversation always sort of was like, nobody here is struggling with executive function. Nobody in this conversation is struggling with memory issues or time perception issues or rejection sensitivity or whatever it may be.

And that really came to a head during this one class where I had this professor who was extremely neurotypical, and he was talking about like something that a lot of clients will come in and talk about is when sex gets interrupted. And isn't it so awkward and strange when sex gets interrupted? And he was like, just reassure them, just tell them it's no big deal, you know? And then he said this — and this is the part that has been seared into my consciousness — is he said, the moment is not precious. If you have to pee, if the neighbor starts mowing his lawn, the moment isn't precious. Just jump right back into what you were doing. Just remind him the moment is not precious.

And I was in the back and I like raised my whole ass hand and I was like — and that. But that was when I realized. I was like, every moment of living life with ADHD, that moment is precious because at any moment you — like and I don't want to speak for the group, but at least in my experience, I live on this like razor's edge precipice of "Am I going to finish the thought? Am I going to stay on task? Am I going to get distracted? Am I going to notice that the dog bowl needs water or the neighbor is going to mow the lawn or whatever?"

And I was like, where is that conversation? Where is that conversation for the people who every day that moment is precious, and you might not even realize that moment exists? Like, where is that conversation? And so then I was like, well, I guess I'm going to have it.

Laura: Good for you.

Catie: And so, yeah, I mean, I'm not like — and I want to be very clear, I'm not the only person doing this work. There are so many incredible educators and people who are doing it. I just have the honor and privilege of, I think, being good at talking about it. So I get to do this, you know. And there has been thankfully like a lot of great work done in the past decade or so. Again, just in terms of like, even just studying ADHD and sex is kind of a new thing. And so there's like new information coming out all the time about it and just like there's so much good stuff happening.

But yeah, I mean, sex is so complicated and it's so big and I don't think we think about it in terms of how much physical and emotional stuff has to go right just to get to that moment of intimacy. And then when you add ADHD on top, holy cow, it can be challenging.

Laura: This is a very random thing to compare it to. But I mean, when we're talking with parents about trying to build empathy about what kids with ADHD may be going through, and like when we say "Go get dressed," that seems like it's just so simple. Just go get dressed. But then when you break it down into a set of visual instructions? Oh wow, there are like seven steps in here that are involved, right?

Catie: Yeah. Exactly. Exactly. Sex is a series of tasks. You know, the joke that I always make is like, especially in ADHD brains, like, your brain doesn't really make a distinction between, you know, remembering that sex exists and remembering to make a chicken salad sandwich. Like it's just information. The emotional weight that we ascribe to that, that is a separate process in the brain, you know.

But even more than that, like past just the initial complication of ADHD, you also have to remember that about 40 to 60 percent of people with ADHD also struggle with depression and anxiety. Ninety-five percent of people with ADHD, give or take, struggle with sleep issues. People struggle with rejection sensitivity. They struggle with food issues, sensory issues, all of these different things. And so it's like not only is it just the ADHD effect on sex, but then it's like most people who have ADHD are also dealing with other co-morbidities at the same time that also go into their sex life, that also affect things.

You know, if you're dealing with anxiety or depression, you might be less likely to want to engage in intimacy. If you're dealing with sensory issues, you might be less likely to find a intimate activity that you enjoy. If you've got sleep issues, you know, and you're having trouble sleeping with your partner, that can build, you know, a sense of being disconnected and far away. Like it just keeps getting bigger and bigger and bigger the more you sort of like pull the thread, you know.

Laura: I'm sure you give different types of advice to all different types of people with different struggles and whatnot. But like, is there one top piece of advice or piece of information to keep in mind, in addition to sex is actually a series of tasks.

Catie: I have two pieces of advice. And the first one sounds like a little bit like a flowery speech, but I promise it has a point. But one of the other things that many people with ADHD deal with is this idea of all-or-nothing thinking, where if it's not worth doing perfectly, it's not worth doing at all. But there is also interesting — and it's I think one of the most counterintuitive ideas that has ever been introduced into society — is that there is this prevalent idea, I think, due to how we present love and romance and intimacy in movies, of "if they love me, they would just know." If they really love me, if they really were the perfect partner, they would know, you know, that I need to hear "I love you" every day. Or they would know that I want to be touched in this way. Or they would know if I've come to climax during sex.

And there's no kind way to say this. But all of that is a lie. Like real intimacy, real communication between partners comes when you get rid of that idea that "if you loved me, you would know." You are allowed to advocate for your own needs. You are allowed to look at your partner and say, "I need you to tell me you love me every day before you leave for work. It is really important to me that I hear those words of validation." It is OK to show your partner on your own body how you like to be touched, how you enjoy being touched. It is OK to look at your partner and say, "I have sensory issues and I really don't enjoy kissing, but here are some other things we can do instead."

But when we take that idea of like mind-reading, "if they love me, they would know," and tie it in to that idea of all-or-nothing thinking, I think sometimes there's this lie that we tell ourselves that there is this perfect way to have this conversation, that there's this one perfect speech that you have with your partner and it magically fixes all the issues and, you know, you tearfully hug each other and everything is fixed. And what I always say is that the biggest part of neurodiversity is that things are always in flux. Things are always changing. You're going to wake up and you're going to have more energy one day than you did the next day. You're going to have more focus one day than you do the next day.

And so letting go of that, letting go of the idea that there has to be this perfect conversation. It can be imperfect, it can be clunky, it can be awkward, it can be weird and uncomfortable. But isn't that moment of being uncomfortable — isn't that moment of vulnerability in which you really look at your partner and you give them the gift of telling them what you need, what you want, what you like, giving them that information in order to support you, in order to really give you the opportunity to be loved and appreciated and cherished in the way that you need. Isn't it worth that conversation?

And that conversation can be ongoing. It doesn't have to happen all at once. It can change month to month, day to day, whatever. That is my biggest piece of advice, is that you have to be willing to communicate. And you have to be willing to be vulnerable in a way that might be scary. Because a lot of people that I work with have never done that before. They've never sat down and say, "Actually, when you do this, it feels terrible. Can you please never do that again?" And this is people who've been married for 30 or 40 years, you know, and that can be a big conversation to have. But I think giving yourself the grace and kindness to have that conversation, to open that dialog with a partner, it can be life-changing, you know, it can be absolutely life-changing.

Laura: That's really powerful. I know when I go into — my husband and I communicate constantly, but whenever I feel like there's something that needs to be quote unquote fixed, I'm like, OK, we're going to jump into this conversation and we're not stopping until it's resolved. And I get like very stuck on it. I kind of perseverate on it, right? And that is something that has taken me a lot of time to even a tiny bit like pull back and be like, no no, we can continue to talk tomorrow. Like, let's move on. Let's watch a movie, you know.

Catie: Exactly like, right. You don't have to do it all at once. It can be minute, especially if it's a big change, you know.

Laura: That's hard. That is really — it sounds so simple, but it's so hard for a lot of folks with ADHD, right? All right. What's your second thing?

Catie: Oh, don't make orgasm the goal. That was way easier. It's much less flowery. But so many people go, it's not sex if there's not an orgasm at the end. Right? It's not worth it unless we both, quote unquote, finish, you know. It's so funny to me how like revolutionary the idea of like, just don't worry about orgasm, just worry about being there with your partner and connecting with them and, you know, finding ways to, like, give each other pleasure. You don't have to make orgasm the goal.

And for a lot of people with ADHD, sometimes just taking away that pressure, that is like, again, it's life-changing of like if it doesn't happen, it doesn't and that is OK. But this is still a valid, intimate experience in which I got to share a connection with my partner. That is — that's extremely basic but I think extremely valuable advice.

Laura: It's not basic, though. I think people have been trained that that is the goal.

Catie: Yeah. And it's like, you know, it has to happen at the same exact — again, it's sort of like media of, you know, everybody's going to always like finish at the exact same time. It's going to be perfect, it's going to be like doves flying around. And Céline Dion is there for some reason. Like, I just like, no. It's like sex can look like whatever. You know, intimacy can look like whatever you need it to be. It doesn't have to be sex. It does not have to be a sex act. It can be as simple as, you know, lying on the couch and doing like dopamine-giving activities like a backrub or head scratches or, you know, like I'm like, for whatever reason, I love, like, hand massage, you know. It's like that's not sex, it isn't even close — in the room with sex, but it's still intimate. It still connects you with your partner, you know.

Laura: Thank you. Even just that — I know that you probably have like encyclopedias' worth of great information and tips that you could share. But even what you just shared was really interesting, really helpful.

Catie: This is secretly my pitch to have a sex podcast on Understood.

Laura: I mean, you're selling me. We're going to talk more.

Catie: This whole thing has just been a secret audition.

Laura: You've been listening to "ADHD Aha!" from the Understood Podcast Network. If you want to share your own "aha" moment, email us at ADHDaha@Understood.org. I'd love to hear from you. If you want to learn more about the topics we covered today, check out the show notes for this episode. We include more resources as well as links to anything we mentioned in the episode.

Understood is a nonprofit organization dedicated to helping people who learn and think differently discover their potential and thrive. We have no affiliation with pharmaceutical companies. Learn more at Understood.org/mission.

"ADHD Aha!" is produced by Jessamine Molli. Say hi, Jessamine.

Jessamine: Hi, everyone.

Laura: Briana Berry is our production director. Our theme music was written by Justin D. Wright, who also mixes the show. For the Understood Podcast Network, Scott Cocchiere is our creative director, Seth Melnick is our executive producer, and I'm your host, Laura Key. Thanks so much for listening.