Does ADHD cause erectile dysfunction?

If you’re a guy with ADHD and you’re struggling with erectile dysfunction, you may wonder whether these conditions could be related. Can ADHD cause erectile dysfunction? The short answer is yes, there are some ways that ADHD can uniquely contribute to ED. The good news is that sometimes ED can be reversed, even when it coexists with ADHD.

Attention-deficit/hyperactivity disorder (ADHD) and erectile dysfunction (ED) are both conditions that can affect men. ED becomes more common with age, with roughly half of men between the ages of 40 and 70 having some level of ED. 

Below, we’ll explore the connection between ED and ADHD, give examples of some of the common sexual dysfunction issues related to ADHD, and share expert-backed treatment options for managing ED when you have ADHD.

ADHD can be very misunderstood in adults, especially if you’ve only heard of it in reference to unruly children in classrooms. But it’s fairly common in adults, affecting about 5% of adults, and more commonly affecting men than women. 

While it’s not always widely discussed, yes, ADHD can contribute to ED and other sexual health concerns, says Ashley Warren, MA, LPC, NCC, a licensed professional counselor who has supported many individuals with ADHD who also struggle with intimacy and sexual dysfunction. “Research supports what we often see in clinical practice: a study published in The Journal of Sexual Medicine found that men with ADHD had significantly higher rates of ED and other forms of sexual dysfunction compared to neurotypical men.” 

The TLDR? There are several ways ADHD may cause ED, including: 

• ADHD can affect someone’s ability to stay in the moment during intimacy, leading to a loss of erection 

• It can cause low libido 

• Some ADHD meds can cause ED 

• ADHD can be linked to depression and anxiety, both of which can lead to ED

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ADHD can affect more than just focus — it can also interfere with your sex life. For some, that means difficulty getting or staying aroused, including erectile dysfunction. 

Here’s more detail on how ADHD might play a role:

• ADHD symptoms can disrupt several aspects of being intimate. Warren says ADHD impacts the nervous system, emotional regulation, impulse control, and the ability to remain present—each of which is crucial to healthy sexual functioning. Symptoms like difficulty sustaining attention and sensation seeking can also distract from the sexual experience, creating a disconnect that may lead one to lose an erection.

• ADHD is linked to low levels of dopamine. This may explain the reduced libido or difficulty with arousal and orgasm that some men with ADHD experience, says Ryan Sultan, MD, an expert in ADHD and the Founder & Medical Director of Integrative Psych. The so-called “feel-good hormone,” dopamine, plays a major role in how we process motivation and reward, not just generally but also in relation to sexual arousal. Research done in rats suggests that lower levels of dopamine can lower the amount of pleasure someone gets from having sex.

• Some medications that treat ADHD can cause ED or sexual dysfunction. Some of the stimulant medications commonly prescribed for ADHD can contribute to ED, especially when used in conjunction with SSRIs. SSRIs (such as sertraline and fluoxetine) are commonly prescribed for depression and anxiety. Their side effects can be sexual in nature, including unwanted effects like loss of libido (sex drive) and difficulty orgasming. 

• ADHD can coexist with other conditions that also overlap with ED, such as depression or anxiety. Warren says that many clients with ADHD also experience performance anxiety, low self-esteem, and relationship challenges. Other diagnoses that overlap with ADHD, such as anxiety and substance use disorders, can also play a significant role in an individual’s ability to attain and maintain an erection.

Sexual dysfunction can be a common frustration for people with ADHD, affecting nearly 40% of men and 43% of women with ADHD. Even if you’re not having trouble getting hard, ADHD can still disrupt various aspects of sexual wellbeing that can make it more challenging to enjoy your sex life.

Difficulty focusing during sex

People with ADHD have predisposed distractibility. In other words, they have impaired attention, which can make it difficult to focus during sex and achieve orgasm. 

“Neurotypical people are usually motivated to complete a task by its importance relative to other things they may need or want to do,” says Jana Scrivani, PsyD, a licensed clinical psychologist with expertise in anxiety and related disorders.. “It's difficult to imagine what could be more rewarding than the sexual activity you're engaging in at that moment.” 

But for people with ADHD, their distractibility may disrupt their ability to maintain an erection. Here’s how: If their attention shifts to something unrelated to sex, they may find they lose interest in having sex, and their erection goes away as a result. Or, if they become distracted by something else in the environment, like a noise, or something internal, like a thought, they may lose their erection.

Lower sexual satisfaction

Because dopamine is underactive in people with ADHD, it may take more reward or stimulation to activate their brain’s reward system and get them going during sex, Dr. Scrivani says. “Someone with ADHD who seeks out more intense sexual experiences or pornography may have difficulty achieving and maintaining an erection if the sexual activity they are engaging in is not sufficiently stimulating to activate the reward circuitry in their brains.”

Indeed, research surveys have found that people with ADHD tend to send more sexts, be more sexually adventurous, and masturbate more often than those without ADHD. They also report more sexual desire than neurotypical folks. At the same time, they report less satisfaction from the sex they do have and may have difficulty with orgasm and maintaining an erection. 

Increased risk taking

Some research has found that both men and women with ADHD tend to engage in riskier behaviors surrounding sex. At the same time, other research has found that while people with ADHD are more likely to be hypersexual, they’re not necessarily more likely to have riskier sex. 

While researchers continue to explore the link (or not) between riskier sex and ADHD, they think it may be due to the emotional dysregulation and impulsivity associated with ADHD, although the risk seems to be higher for women with ADHD. “[Some studies have linked stimulants] to increased libido and hypersexual behaviors, especially in males, who also reported higher rates of erectile dysfunction,” Dr. Sultan says. 

Less partner satisfaction

Not only do people with ADHD find sex to be less satisfying, they also report greater levels of dissatisfaction with their partners—both overall and specifically concerning sex.

People with ADHD are also more likely to have a fear of intimacy. People who experience more ADHD symptoms report higher levels of fear of intimacy, as well as lower expectations for the closeness of their relationships. A fear of intimacy can make it challenging to connect emotionally and physically with another person, leading to relationship issues and sexual dysfunction (or dissatisfaction).

Comorbid depression or anxiety

ADHD commonly overlaps with depression and anxiety disorders, which in turn can contribute to issues in the bedroom by causing low self-esteem and performance anxiety. One study found that among men with depression:

• 26% reported difficulty getting aroused

• 65% reported low desire for sex

• 37% reported poor lubrication

• 34% reported difficulty orgasming

• 23% reported low sexual satisfaction

Living with anxiety can make it particularly challenging to achieve, or maintain, an erection, Dr. Scrivani says. “Once someone starts to feel anxious, and worry about their erection (e.g. is it firm enough, will I last long enough, will I lose my erection?), they are likely to create a self-fulfilling prophecy, whereby they now experience ED, and then feel increased anxiety around achieving and maintaining an erection, which can further perpetuate ED. It becomes a vicious cycle.”

The medications that are commonly prescribed for ADHD, as well as anxiety or depression, may cause sexual dysfunction, says Dr. Sultan, especially stimulants and SSRIs. 

When it comes to treating ED caused by ADHD, often the first goal is to alleviate the symptoms of ADHD, with the gold standard for treatment being a combination of behavioral therapy and medication management. 

• Therapy: When ED is driven by anxiety, cognitive behavioral therapy (CBT) can help men with ADHD address the thoughts and behaviors that are contributing to and maintaining their anxiety around sex and erections, Dr. Scrivani says. If the ED is caused by a reward system issue due to ADHD, more specific sex therapy interventions can be helpful, she says. 

• Medication management: Different stimulants, SSRIs, and other antidepressants that may be prescribed for mental health conditions can produce various unwanted sexual side effects, including ED. Finding the right mix of medication is important, and working with your healthcare provider is key. 

• PDE5 inhibitors: Until your medication situation gets sorted out—or in case it doesn’t completely resolve your ED—oral PDE5 inhibitors like Viagra (sildenafil) and Cialis (tadalafil) are the first-line treatment for ED. Generally taken about 30–60 minutes before having sex, with effects lasting for between 4 and 36 hours (depending on the medication), these medications are both safe and effective at treating ED, including in people taking SSRIs. You can also find the same active ingredients in newer formulations, such as Ro Sparks and Daily Rise Gummies.

• Lifestyle changes: Lifestyle habits can also contribute to ED. If you have an unhealthy diet, follow a sedentary lifestyle, or smoke, now might be the time to start making some changes. Adopting a healthier diet, exercising more, and getting more regular sleep can all help relieve symptoms of ED.

Treatments for ADHD-related sexual dysfunction can vary depending on the specific issues you’re having, but Warren recommends a multidisciplinary approach that includes:

• Therapy: Therapy can help people identify emotional triggers, reduce shame, build communication skills, and reframe negative sexual beliefs. Working through these patterns in treatment can help relieve some of the contributors to premature ejaculation and other forms of sexual dysfunction, such as performance anxiety. 

• Lifestyle interventions: Similar to ED, making positive lifestyle changes can also improve sexual dysfunction issues. Many of the experts we spoke to recommend regular movement, mindfulness-based stress reduction, and consistent sleep routines. 

• Medication management: Depending on the medications you’re currently taking—whether for ADHD, depression, or something else—a different mix may be able to equally treat your current conditions while relieving any sexual side effects you’re experiencing. For example, SSRIs have been shown to be helpful at treating premature ejaculation, as well as depression and anxiety, while switching from an SNRI (serotonin/norepinephrine reuptake inhibitor) to an SSRI may reduce the odds of experiencing ED.

If you’re experiencing challenges in or out of the bedroom and you have ADHD, contact your healthcare provider. Whether you’re dealing with depression, performance anxiety, or trouble orgasming or getting hard, they can help by reviewing your current medications and recommending lifestyle changes or psychotherapy to address what’s going on. 

It is important to let your healthcare provider know if you’re experiencing symptoms of ED. ED is a common problem, and your provider is there to help.

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ADHD doesn’t just affect focus and impulsivity—it can impact your sex life, too. From dopamine imbalances to difficulty staying present during intimacy, ADHD can lead to erectile dysfunction and other forms of sexual dissatisfaction.

• ADHD can interfere with intimacy. Difficulty focusing, emotional dysregulation, and being easily distracted can disrupt arousal during sex and the ability to achieve an erection or orgasm.

• Low dopamine levels may play a role in the relationship between ED and ADHD. ADHD is associated with lower levels of dopamine, which is a big part of sexual motivation and pleasure.

• Medications can have side effects. Many of the stimulants used to treat ADHD, anxiety, or depression can sometimes cause or worsen ED and sex drive issues.

• Comorbid conditions like anxiety can complicate things. Many people with ADHD also experience anxiety, performance fears, or low self-esteem, all of which can contribute to ED.

• Treatment is available. While there is no quick-fix for ED, addressing the root cause—whether it’s ADHD, medication side effects, or anxiety—can improve ED. Therapy, medication adjustments, and PDE5 inhibitors can all help.

• Let your healthcare provider know if you’re experiencing symptoms of ED. The right support can improve not just your sexual health, but your overall well-being and relationships, too.