Emma* expected changes to her life when she started to take the stimulant lisdexamfetamine to help her manage her ADHD: things like being attuned to tasks for longer and feeling more in control of her time. What she was not expecting was ramifications in her sex life.
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition. It can manifest differently in different people, but those affected often report struggling to focus, hyperactivity and impulsivity.
Before going onto medication, the 25-year-old, who lives in Cambridge, would struggle to stay present when getting intimate. 'I’d be super up for it and then after the dopamine rush had worn off, my eyes would glaze over and I’d be drifting off, looking at the details on the walls instead of immersing myself in the moment', she tells Women’s Health. 'It wasn’t that I wasn’t enjoying it – quite the opposite. I was just super distract-able.'
Now, she’s able to remain in the moment from beginning to end of sexual encounters – a fresh focus that has carried into other areas of her life, like work and keeping on top of life admin. But that isn't where the story ends. As she’s got used to the medication, which she’s now been taking for a year and a half, she’s worried that her historically high levels of desire have diminished somewhat.
'Since I started the medication, once I’m having sex I’m able to focus better – but my libido is generally lower than it was. I’m just not naturally up for it anymore unless my partner starts things, and then that gets the fire going. But previously, I’d usually be the one to initiate. My flame has definitely been dimmed a little bit.'
How many people with ADHD report an impact on their sex life?
Emma is not alone in her ADHD impacting how she experiences sex. Whether medicated or not, the condition is understood to have the potential to impact the way things go for those affected in the bedroom.
One 2020 study, published in the Journal of Sexual Medicine, found that people with ADHD report more sexual desire, say that they masturbate more frequently, experience less sexual satisfaction and have more sexual dysfunctions than the general population.
It's also true that, for some, ADHD-related impulsivity can lead to risky sexual endeavours like having unprotected sex, and elsewhere, higher levels of distractibility can render some unable to focus on the moment, whether solo or partnered.
Medication-wise, some research has shown that stimulants used to treat ADHD can dampen desire, with a number of women, like Emma, reporting a lowered libido. Some men have reported that Adderall increases their sex drive, and others have experienced difficulty either getting or maintaining an erection.
The expert view on ADHD medication and sex drive
Dr Rachel Jones works as a consultant psychiatrist and is an expert in diagnosing and treating ADHD. She acknowledges that the impact of ADHD medication on libido will vary from case to case.
'Individuals respond differently to stimulant medication in that some find it reduces their libido and others find it heightened. The effects on libido may be temporary while the individual is adjusting to the medication'. She stresses that changes to people's sex drives may well be temporary. 'Any side effects do tend to wear off.'
As to how all of this impacts the sexes differently? We're not quite sure, yet. 'Some studies have shown that women are more affected by the medication in terms of sexual desire and ability to achieve orgasm and some studies have shown the impact is greater for men', Dr Jones adds.
Lola*, 37, from Derbyshire has also felt the impacts of ADHD meds on her desire levels. After being diagnosed with the condition in November 2020, she’s been medicated with lisdexamfetamine and dexamphetamine. For her, a broad benefit which spills over into her sex life has been feeling that she can navigate her relationship better. 'I’m less anxious and impulsive and can manage enough brain space to process why my partner did or said something before reacting to it', she shares.
Like Emma, her libido has fluctuated, but she’s also experienced episodes of hyper-sexuality. When she is unmedicated, her libido is generally high, though this has had a tendency to drop when she’s feeling emotionally unsettled. During these darker periods, she and her partner will have sex 'maybe once a week', but this could be 'pretty much non-existent during bad spells.'
Medication means her desire levels are more consistent. 'My ADHD medication keeps me more balanced, [and that] means I have quite a high libido the majority of the time as long as I am properly medicated.' (By this, she means taking her medication at a time that works for her, in the correct doses.)
How can you manage changes to your desire?
Changes in libido – whether they swing up or down – can be tricky to manage within a relationship. Working through these is entirely possible, though, says Melissa Orlov, the founder of ADHDmarriage.com and the author of The Couple's Guide to Thriving with ADHD.
She notes that some of the couples she works with have experienced one or both partners dealing with a reduced libido, but others find medication can provide 'the focus needed to better engage in sex.'
Her belief, though, is that it's the hard work of relationships that occur outside of medication which will have a bigger impact on a couple's sex life. 'The two things that an ADHD partner can do that are most likely to improve their sex life in ADHD-impacted relationships are emotional regulation, so that the relationship feels safer to both partners, and working on being more dependable. That might mean following through on promises and not overpromising,' Orlov advises.
'As ADHD symptoms become better managed, the other partner finds space to accommodate ADHD issues more easily and respond more positively. The sexual side effects of stimulants are much less an issue than improving the relationship so that the interactions between partners are healthy.'
Getting support if your sex life has been impacted
If you live with ADHD and are struggling to work with changes to the rhythms of your sex life, it could be a good idea to discuss any impact on your libido with your doctor or pharmacist.
'Seeking support from a therapist with expertise in ADHD may also help an individual or a couple to address any sexual problems', Dr Jones advises. 'If medication is the cause of reduced libido it may be necessary to consider an alternative stimulant, change the dose or consider a non-stimulant alternative. 'Timing when the medication is taken so that it has worn off by the time of sexual activity may also help.'
Much like other implications of working through an ADHD diagnosis, fine-tuning what medication might mean for your desire levels and how you encounter sex might take time. But, as Dr Jones notes, there are ways to figure out a system that works best for you.
*Name has been changed
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