Abstract
This narrative review aimed to provide a synthetic overview of current knowledge on the relationship between attention-deficit hyperactivity disorder (ADHD) and sexual functioning in adults, with a particular emphasis on neurobiological mechanisms, comorbid disorders, and the impact of pharmacotherapy. Six independent researchers conducted a comprehensive literature review using the PubMed, Scopus, and Google Scholar databases, encompassing publications available as of May 2024. Original research papers, reviews, and meta-analyses in English and Polish concerning adult populations with ADHD were included. Pediatric studies and papers published before 2014 were excluded. Data indicate that a substantial proportion of men and women with ADHD experience sexual dysfunctions. Their nature is heterogeneous and dependent on the individual manifestation of the disorder, encompassing both hypersexuality and hyposexuality. Predisposing factors include sensory integration disorders, attention deficits, hyperfocus, and a need for frequent changes. An important role is also played by rejection-sensitive dysphoria (RSD), which is associated with a high prevalence of risky sexual behaviors and difficulties in maintaining relationships. Epidemiological studies suggest an increased prevalence of compulsive sexual behavior disorder (CSBD) and problematic pornography use in individuals with ADHD, particularly men. Some authors emphasize the importance of neurobiological mechanisms such as "dopaminergic craving" or novelty-seeking, while others indicate that hypersexual behaviors may be treated as a form of self-regulation. Concerning pharmacotherapy, psychostimulant drugs (e.g., methylphenidate and lisdexamfetamine) and nonstimulants (e.g., atomoxetine and clonidine) demonstrate both beneficial and adverse impacts on sexual functioning, although empirical data are limited. ADHD shows a significant correlation with the occurrence of a wide spectrum of sexual disorders, which requires consideration in diagnostics and treatment planning. The high prevalence of hypersexuality, CSBD, and RSD highlights the need for an interdisciplinary approach combining pharmacological interventions with psychotherapy focused on emotional regulation, improvement of interpersonal relationships, and reduction of risky behaviors. Further research should focus on identifying neurobiological mechanisms, the role of psychosocial factors, and evaluating the impact of pharmacotherapy on the sexuality of patients with ADHD.