The PGspot - Sexual Desire and ADHD in Women: What Nobody Talks About

Sexual desire and ADHD in women is rarely talked about openly, but it affects far more people than most realize. In this episode, we explore the complex relationship between ADHD, dopamine, sensory processing, emotional regulation, burnout, and intimacy. From fluctuating libido and novelty-seeking to shutdown, overwhelm, and relationship challenges, this conversation breaks down the experiences many women have silently struggled to understand.

We also discuss why ADHD sexuality is not one-size-fits-all, how hormones and stress can intensify symptoms, and what practical strategies may help women reconnect with desire without shame or self-blame.

Whether you have ADHD yourself, love someone who does, or simply want a deeper understanding of women’s sexual health and neurodiversity, this episode opens the door to a conversation that has been missing for far too long.

If you want to learn more about sexual health, sexual dysfunction, or how to improve your sex life, follow me on Instagram at @thepgspot or check out my website at doctorpattyj.com for blogs and resources related to sex positivity and real talk about sexuality.  As as always, stay curious, stay empowered, and stay you.

Transcript

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Welcome to The PG Spot, where our goal is to take the ex out of sex by breaking down the barriers that prevent open communication about sexual health. I'm Dr. Patty Jalomo, a dual certified nurse practitioner, pelvic floor therapist, and certified sexual counselor. I'm here to provide expert insights, debunk myths, and empower you to embrace your sexual wellbeing. Whether you're looking for answers or simply curious, join us as we open up the conversation around sex, intimacy, and everything in between. I want to take this opportunity to acknowledge that some content may not be appropriate for all listeners. I'm a huge proponent of honest and accurate information regarding sexuality, but I'm also mindful that this should be age appropriate. Therefore, if you are under 18, this may not be the podcast for you. Additionally, some of the language used in this podcast may be offensive to some listeners. Please take these things into consideration before going forward with your consensual participation in this podcast. The opinions expressed by myself or my guests are just that, and these opinions are neither expected nor required to be shared by all listeners. The information that is provided is for educational and entertainment purposes only and should not be mistaken for individual medical advice. If you would like to schedule a virtual visit for individual or couples sexual counseling or menopause management, you can contact me via my website at thepgspot.com. Thanks for listening, and let's get on with the show. Hey, everyone. Welcome to the "PG Spot." I'm your host, Dr. Patty Jalomo. Today, we're going to dive into a topic that can be very impactful in regard to sexual function, especially for women. Sexuality requires attention, reward anticipation, emotional regulation, sensory integration, and nervous system engagement, which happens to involve many of the same systems affected by ADHD. Consider this: what if low libido isn't always low desire? What if sometimes it's executive dysfunction which leads to blocked desire? These are very different concepts, and in today's episode, we're going to break this down and look at what the research is saying about ADHD and sexual function. ADHD doesn't affect sexuality in one single direction. It can create both high novelty-seeking sexuality and low desire or desire paralysis, sometimes in the same person across different life stages. That paradox is what makes the conversation compelling. There's a lot to consider, so let's get into it. A 2023 study by Young and colleagues found that women with ADHD experience lower relational and sexual satisfaction, higher divorce rates, lower conflict resolution, increased struggle in holding attention, and increased difficulty in achieving orgasms. Most people think ADHD is mainly about distraction or hyperactivity, but more and more experts describe ADHD as a disorder of executive functioning, meaning the brain systems that help us regulate behavior, attention, motivation, emotions, memory, and decision-making. Once you start looking at sexuality through that lens, a lot of experiences suddenly make more sense. Sex and intimacy require an enormous amount of executive functioning. It's not just about attraction or hormones. Intimacy also requires the ability to shift attention, regulate emotions, stay present in your body, transition out of task mode tolerate vulnerability, anticipate reward, and actually initiate connection. One framework I recently heard at a conference described seven core executive functions that are affected in ADHD, and honestly, every single one of them can show up in intimate relationships. First is self-awareness, that ability to notice, what am I feeling? What do I want? What's happening in my body right now? For some people with ADHD, especially when life feels chaotic or overstimulating, there can be a disconnect from internal cues. what many people experience as low desire may be a brain stuck in survival mode. Instead of noticing their desire for connection, their thoughts are consumed with, "What's next? What did I forget? What still needs to get done?" When the brain is constantly managing tasks and overwhelm, intimacy can become background noise, not because the desire isn't there, but simply because there's no mental space to access it. the second is inhibition or impulse control. People usually think about this only in terms of impulsive behavior or risky sex. It's true that ADHD can sometimes increase novelty seeking or impulsivity, but inhibition also affects the ability to pause mental noise, quiet distractions, and to stay in the moment. Some people describe trying to be intimate while simultaneously thinking about laundry, emails, whether they responded to a text, or what they need to get at the grocery store tomorrow. this is not due to a lack of love or attraction, but rather to the difficulty that people with ADHD have when filtering competing stimuli. The third core executive function is non-verbal working memory, which includes holding mental images, sensory experiences, and internal awareness in mind. This one is fascinating in relationships because some people with ADHD describe an out of sight, out of mind experience with desire. If intimacy isn't actively happening or there isn't some kind of external cue triggering these thoughts, desire altogether, not because of a lack of love or emotional connection, but because of the way attention and reward systems are neurologically wired. Then there's verbal working memory. This affects the ability to hold information in mind mentally, including conversations, emotional context, and relational communication. In the context of intimacy, someone might lose track of what they wanted to say, become distracted mid-conversation, or struggle to mentally stay connected processing sensory input. Over time, some people begin feeling ashamed about seeming checked out or disconnected, even when they deeply care about their partner. The fifth core executive function is emotional regulation, and honestly, I think this one can affect sexuality far more than most people realize. Intimacy naturally involves vulnerability, which can bring up rejection sensitivity, body image concerns, performance anxiety, Fear of disappointing a partner, or even fear that you don't want sex enough. For many people with ADHD, those emotional experiences can become so overwhelming that the nervous system shifts into protection mode rather than connection. And for many people with ADHD, especially those who spent years masking, overcompensating, or feeling misunderstood, intimacy can trigger a significant amount of emotional overwhelm. When this happens, the nervous system may respond by shutting down, avoiding conversations, or emotionally disconnecting, because the brain is already overloaded and struggling to regulate all of the emotional input. Next is motivation regulation. This is a huge one when we talk about low desire. immediate dopamine or stimulation, even things the person genuinely wants. Which can absolutely Which means that someone can absolutely love intimacy, enjoy sex once it begins, feel emotionally connected afterwards, and still have enormous difficulty initiating it. that's why so many people with ADHD say, "I never think about sex until it's already happening." And that experience can look like low libido from the outside, even when it may actually be an issue with activation and access. Finally, the last core executive function is planning and problem-solving. Intimacy doesn't happen separately from the rest of life. It requires time, energy, communication, privacy, mental transitions, and often a great deal of coordination. for some people, that may also include managing childcare, navigating sensory sensitivities, or trying to emotionally decompress after an exhausting day. When an ADHD brain already feels overwhelmed by the demands of daily functioning, intimacy can begin to feel like one more complex task to organize and manage. Unfortunately, partners or relationships may sometimes interpret that struggle as a lack of caring, attraction, or effort, when in reality, it may be a reflection of cognitive overload and limited mental bandwidth. So the question becomes: Is this truly low libido, or is executive dysfunction interfering with access to desire, initiation, presence, and emotional regulation? Because those are not the same thing, and if intimacy depends on all of these systems working together, what happens when they're overloaded? Many people with ADHD don't describe a lack of desire. They describe a desire that's there, but difficult to reach. One of the most important distinctions here is between spontaneous desire and responsive desire. Spontaneous desire is when the desire appears first, while responsive desire is where the desire appears after stimulation or connection begins. Many people with ADHD don't lack desire, they just don't reliably access spontaneous desire. They might love their partner, feel emotionally connected, and genuinely want closeness and intimacy, but when the time comes to initiate, it feels like there's a gap between intention and action Almost like the desire exists in theory, but not in a way that translates into movement. Spontaneous desire is what people often assume desire is supposed to look like. it shows up on its own and leads you toward intimacy without much prompting. But responsive desire shows up after connection has already begun, after stimulation, emotional or physical context, and more importantly, after the nervous system has had time to shift states. For those with ADHD, this requires mental space. It requires a shift out of task mode, stress mode, or overstimulation and into something more embodied and present. So from the outside, what might look like low libido is often something else entirely. It's not that desire isn't there, it's that it doesn't consistently get the conditions it needs to emerge. And that's where things can start to feel confusing in relationships. Internally, the desire may be there, but externally, a partner may only see the lack of initiation, the delay, or inconsistency, and then they interpret that as disinterest. Over time, that mismatch can create pressure, and pressure is one of the fastest ways to shut desire down even further, especially in an already overstimulated or emotionally taxed nervous system. So the experience becomes a cycle. Desire is present in some form, but difficult to access. Difficulty is interpreted as absence. Interpretation creates pressure, and pressure makes access even harder. This gap between wanting intimacy and being able to initiate or access it is where executive dysfunction shows up most clearly in sexuality. So this raises another important question. If desire is still there but access to it is inconsistent, what role does dopamine, novelty, and the ADHD reward system play in how attraction changes over time? When we talk about ADHD, we also have to talk about the brain's reward system. ADHD is heavily connected to differences in dopamine regulation, particularly in the way that the brain anticipates reward, maintains motivation, and responds to novelty and stimulation. This becomes especially important in relationships because many people with ADHD describe a very specific pattern in the early stages of attraction. At the beginning of a relationship, desire can feel intense. There's anticipation, uncertainty, novelty, emotional stimulation, unpredictability, and hyperfocus. The brain is flooded with dopamine from discovery, connection, and newness. the person may think about their partner constantly. They may feel highly motivated towards intimacy, and desire can feel automatic, exciting, and effortless. But over time, as the relationship becomes more familiar and predictable, some people notice that the intensity of that spontaneous desire begins to change. This is where a lot of shame enters the conversation, especially for people in long-term relationships. Many people may start asking themselves why desire is so easy in the beginning or why they still crave novelty mentally, even when they're emotionally committed. It's important to remember that craving stimulation is not the same thing as lacking love or commitment. ADHD brains are often wired to seek novelty, anticipation, and dopamine. That doesn't automatically mean someone wants a different partner. Sometimes it simply means the brain responds more strongly to what's new, stimulating, emotionally intense, or unpredictable. Unfortunately, long-term relationships naturally become more familiar over time. Daily life becomes repetitive, stress accumulates, responsibilities increase, and predictability replaces novelty, which means the ADHD brain may stop receiving the same level of dopamine-driven activation that it experienced early in the relationship. Then when you combine that with executive dysfunction, emotional overload, sensory fatigue, parenting stress, burnout, work demands, or chronic mental exhaustion, desire can start feeling even harder to access. This is also why some people with ADHD describe a disconnect between fantasy and real-life intimacy. Fantasy is often novel and stimulating. It's emotionally immersive and requires very little executive functioning. Real-life intimacy, on the other hand, requires transitions, communication, coordination, vulnerability, sensory regulation, and sustained mental presence. So sometimes people notice that sexual thoughts, fantasy, or even masturbation feel more accessible than partnered intimacy, not necessarily because partnered intimacy is unwanted, but because it requires significantly more cognitive and emotional energy. I think this distinction matters because many people have internalized the idea that desire should always feel spontaneous, effortless, and consistent in long-term relationships. But for the ADHD nervous systems, desire is often highly context-dependent. It may depend on things like novelty, emotional safety, mental bandwidth, stress levels, sensory environment, connection, anticipation, or simply whether the brain has enough capacity left at the end of the day to shift into intimacy at all. The good news is that understanding this concept can completely change the way people interpret themselves and their relationships. Instead of viewing the loss of spontaneous desire as evidence that something's wrong, people can begin asking themselves what conditions are needed to help their nervous system access desire. Asking that question tends to create far more compassion, curiosity, and collaboration than shame ever does. So why does this conversation matter so much? One of the reasons is because many women with ADHD have spent years believing that their struggles with intimacy were personal failings rather than something connected to how their brains and nervous systems function. Part of the problem is that the research, and honestly even public conversation around ADHD and sexuality, has historically focused on men, hyperactivity, impulsivity, and external behaviors. far less attention has been given to how ADHD presents internally, especially in women. This is in part because many women with ADHD are not diagnosed early. In fact, we're seeing more and more women being diagnosed in menopause or perimenopause as hormones start shifting the unfortunate truth is that many women grow up being labeled as too emotional, too sensitive, disorganized, lazy, dramatic, or inconsistent. Meanwhile, they are often working incredibly hard behind the scenes just to keep up with daily functioning. Over time, many women learn to mask by over-performing, compensating, and becoming people pleasers. They may try to appear organized, emotionally regulated, attentive, and capable, even when internally they feel overwhelmed or exhausted. Masking takes a tremendous amount of energy, and when most of that energy is already being used to manage work, relationships, parenting, emotional regulation, and daily life, There may be very little left for desire, embodiment, playfulness, or intimacy. This is one reason that many women describe feeling disconnected from themselves sexually without fully understanding why. And unfortunately, because women are so often socialized to prioritize other people's needs first, many begin to internalize these struggles as personal shortcomings, feeling as though they are failing their partner, not trying hard enough, or somehow fundamentally wrong. These feelings are often intensified by cultural expectations that portray desire as something that should look effortless, constant, and spontaneous. There's also another layer here that I think deserves more attention, and that's the way inattentive ADHD symptoms can affect sexuality in subtle but significant ways. Not everyone with ADHD experiences hyperactivity externally. For many women, ADHD looks more like chronic mental overload, internal distraction, emotional exhaustion, difficulty transitioning between tasks or constantly feeling mentally on. That mental overstimulation can make it incredibly difficult to shift into a state where intimacy feels accessible. It's important to remember that desire rarely emerges easily within a nervous system that feels pressured, overstimulated, dysregulated, or chronically exhausted. Instead, desire is more likely to develop when the body and mind feel safe enough to slow down and be present. For women with ADHD, particularly those who have spent years masking symptoms or functioning in survival mode, reaching that state of calm and safety can be especially challenging. I also think that many women with ADHD carry a significant amount of shame around inconsistency. There can be periods of high desire, hyperfocus, novelty seeking, or intense attraction, followed by periods where desire feels distant or inaccessible. And that inconsistency can feel confusing, not only for the person experiencing it, but also within relationships. Inconsistency and desire is not the same thing as indifference, and fluctuating access to desire doesn't mean that someone isn't capable of intimacy or meaningful connection. The challenge is that many people have never been given the language to understand these experiences. As a result, instead of recognizing the neurological, emotional, or cognitive factors that may be contributing, they often internalize these struggles as personal or character flaws. That is why conversations like this are so important, because understanding how ADHD can affect sexuality has the power not only to improve relationships, but also to transform the way individuals see themselves. It allows people to move away from shame and toward curiosity. So after hearing all of this, I think that one of the most important things to emphasize is the recognition that desire may need different conditions to emerge and be sustained. For many people, simply realizing that these experiences are not personal failures can feel profoundly relieving. Once the struggle is no longer interpreted through the lens of shame, it becomes possible to approach it with understanding and curiosity instead. One of the most important mindset shifts is recognizing that desire does not have to be spontaneous to be genuine. Many people have internalized the belief that if desire is not immediate, automatic, and constantly present, it somehow doesn't count. In reality, responsive desire is still very real. Desire that develops through connection, touch, emotional closeness, novelty, relaxation, Or intentional transition into intimacy is completely valid. For many individuals with ADHD, intentionality is often far more effective than waiting for desire to appear spontaneously in the middle of an overstimulating or stressful day. This is one reason why scheduled intimacy can be incredibly helpful for many couples. Although some people initially view this idea as unromantic, scheduling intimacy is not about forcing connection. It's about intentionally creating protected space for it. Because ADHD brains often struggle with transitions, competing demands, and prioritization, intimacy can easily become overshadowed by work, parenting responsibilities, constant notifications, unfinished tasks, mental overload, and exhaustion. Creating intentional time for connection can foster anticipation, allow for emotional and mental preparation, and reduce distractions, All of which may support desire rather than diminish it. Reducing sensory distractions can also make a significant difference for many individuals with ADHD. in some cases, the nervous system is already attempting to process an overwhelming amount of input at once, such as noise, harsh lighting, clutter, physical discomfort, interruptions, ongoing stress, or constant mental stimulation. When the brain is already overstimulating, accessing intimacy can become much more difficult. Small environmental adjustments, such as softer lighting, reduced noise, minimizing distractions, and creating a greater sense of sensory comfort can help the nervous system feel calmer and safe enough to remain present and engaged. Another important piece is education around responsive desire. Many people spend years assuming something is wrong simply because desire does not arise spontaneously. However, if someone consistently enjoys intimacy once it begins, feels connected afterwards, and experiences desire during the process rather than beforehand, this may not indicate dysfunction at all. It may simply reflect a different design pattern. Recognizing this can significantly reduce shame. Another supportive approach is what can be thought of as bodily doubling style intimacy rituals. while body doubling is often discussed in the context of ADHD and productivity, the same underlying principle can also apply to connection. In some cases, desire becomes more accessible through gradual emotional and physical co-regulation rather than abrupt initiation. Shared activities such as sitting together without phones, showering together, intentional cuddling, taking walks, giving massages Listening to music or creating intentional transition rituals between daily stress and intimacy can help the nervous system shift more gradually mode into desire. Novelty can also play an important role, not necessarily novelty in partners, but novelty within the relationship itself. ADHD brains often respond strongly to stimulation, curiosity, anticipation, creativity, playfulness, and emotional engagement. This may look like shifting routines, trying new experiences together, introducing more spontaneity, exploring fantasy, or breaking out of rigid relational patterns that have become overly predictable or routine. Mindfulness and somatic practices can also be especially supportive, particularly for individuals with ADHD who often report feeling disconnected from their bodies. When the mind is constantly racing, planning, scanning, and problem-solving, it can become difficult to stay grounded in physical sensation or fully experience the present moment. Practices that help reconnect mind and body, such as mindfulness, breathwork, yoga, sensory grounding, or somatic therapy, can support greater access to pleasure, presence, and emotional connection. At the same time, it's important to recognize that sometimes the underlying issue is burnout rather than incompatibility or lack of attraction. When someone is chronically overwhelmed, overstimulated, sleep-deprived, emotionally exhausted, Or carrying a heavy mental load, the nervous system may simply not have the capacity for desire. In these cases, addressing burnout and reducing chronic stress can be just as essential as directly focusing on sexuality itself. Medication can play an important role in sexual desire and functioning, and its effects can vary widely from person to person. can improve emotional regulation, presence, organization, and overall capacity for intimacy. For others, certain medications, including antidepressants may influence desire, arousal, or emotional connection. Because of this variability, it can be helpful to review medications with a knowledgeable provider when noticeable changes in sexual functioning occur. Therapy can also be a key support, particularly approaches that are ADHD-informed, trauma-informed, or focused on sex therapy. These frameworks can help shift the dynamic away from blame and toward greater understanding of what is actually happening beneath the surface. In many cases, the goal is not to force desire, but to create conditions where connection feels safer, more accessible, And less burdened by shame, pressure, or misinterpretation. Even small shifts in communication can make a meaningful difference. For example, concerns could be reframed in a way that centers understanding of what supports a person's capacity for connection rather than focusing on perceived lack of desire or intimacy. Similarly, rather than focusing on a lack of initiation, The conversation can explore the factors that make initiation feel difficult or less accessible. These represent fundamentally different types of dialogue, and they often open the door to curiosity rather than criticism. When people better understand what is happening beneath the surface, they are often able to approach intimacy with more compassion, collaboration, and flexibility. Ultimately, desire does not have to appear spontaneous in order to be real. For many individuals with ADHD, intimacy may simply require more intentionality, more nervous system support, and a deeper understanding of how their brain actually works. As this conversation comes to a close, the key takeaway is that ADHD can influence sexuality in ways that are far more complex than is often recognized. rather than being limited to impulsivity or novelty-seeking, which are the aspects most commonly discussed, it can also be shaped by executive functioning challenges, emotional regulation, sensory processing, motivation, nervous system overload, and the ability to access desire within the demands of everyday life. In review, for many individuals, particularly women with ADHD, what is often labeled as low libido may actually reflect something quite different. It can be the result of mental exhaustion, cognitive overload, difficulty transitioning into intimacy, disconnection from the body, chronic stress, or a nervous system that has spent extended periods in survival mode, where connection is no longer easily accessible. Importantly, none of this suggests an absence of desire for intimacy, pleasure, love, or closeness. It also does not indicate that something is inherently wrong with the person experiencing it. it's also important to recognize that ADHD and sexuality are not a one-size-fits-all. Some people experience high or consistent desire, others experience fluctuating desire, and others may notice patterns of novelty-seeking, shutdown, or avoidance. Many individuals often move between these experiences depending on life stage, relationship context, stress levels, and overall nervous system capacity. What becomes most important is having language for these variations, because language shapes interpretation, and interpretation shapes self-understanding. When people can recognize that neurological, emotional, and cognitive factors may be influencing intimacy, there is often a shift away from shame and towards greater self-awareness. That shift can meaningfully change how people approach relationships, not by trying to force desire into a standardized pattern, but by learning what supports their own brain and nervous system in feeling regulated, connected, safe, and emotionally present enough for intimacy to naturally emerge. Maybe that's the most important thing to leave people with. Desire does not have to be effortless, constant, or spontaneous to be real. For many people with ADHD, intimacy may simply require intention, support, communication, and conditions that allow the nervous system to fully arrive in the experience. Thank you so much for listening, and if this episode resonated with you, I encourage you to continue the conversation, whether that's with a partner, a therapist, a healthcare provider, or even just with yourself from a place of greater understanding and less self-judgment. That's it for today's episode. Thanks for listening, and be sure to rate and review the podcast on whatever platform you're listening from, and share it with your friends. That's a great way to help reach new listeners and make this a more sex-positive world. Until next time, stay curious, stay empowered, and stay you.