ADHD and Sex: Post-Orgasm Irritability, Jerkiness

post-orgasm irritability

What does post-orgasm irritability have to do with ADHD? And, could it be damaging your relationship?  Maybe not. Or maybe a great deal. As with all things concerning this highly variable condition, “your mileage may vary.”

But think about it. Lovemaking, shopping, and videogaming. What do these three activities have in common? Answer: They all carry the potential to send human dopamine levels on a wild roller coaster ride, creating negative side effects that can linger for weeks. Irritability. Poor focus. Restlessness. You name it.

Yes, you understood that correctly: Sex, specifically orgasms, can make some people with ADHD cranky.

Lynn, married to man with ADHD, explains her experience this way:

I have definitely observed this problem. I have pointed it out to my husband, who denies that it happens. But it’s like clockwork, the next day he’s a jerk.

And he wonders why I’m not so motivated anymore. Maybe because I feel like there’s punishment involved?

From the ADHD partner’s perspective, it might be one of the contributing factors to rarely initiating sex with a partner. (I wrote in my first book about the too-much sex marriage and the sexless marriage in the context of Adult ADHD. At the end of this post, I’ll include a link to a post about it.)

What This Means for the “Dopamine Vulnerable”?

Here’s the simple explanation: What goes up must come downand then drop lower than it was before.

That is, when we perform these highly pleasurable activities, the brain floods with dopamine. Then, when those activities stop, so does the dopamine flow.

Moreover, those dopamine spikes (during highly rewarding activities) can result in a tamping down of the dopamine system altogether. Think of it as the brain’s effort to stay balanced.

The bottom line: It takes even more intensely rewarding activities to enable the person to feel pleasure again.

Consider people with ADHD, who are already “dopamine vulnerable.” It is easy to see how flooding the brain with dopamine, and then restricting dopamine flow, can pave the way to a predictable next step: irritability and even intensified ADHD symptoms. This effect can last for days, if not weeks.

The science behind this is complex, and it is still unfolding. My goal in this brief post to simply to emphasize the importance of at least recognizing this neurobiological phenomenon. That way, you are less likely to be thrown off by it in yourself or an ADHD partner—or attribute it to other causes. Especially when it comes to sex. More about that shortly.

post-orgasm irritability

“Start Out Laughing, End Up Crying?”

I know this sounds weird. But this phenomenon of post-sex irritability brings me back to childhood. Let me explain.

My friend’s father regularly issued a warning when we started getting too “wound up” laughing:  “Start out laughing? End up crying!”

Quite simply, it explains the dopamine spike-drop phenomenon on a basic level. But only now do I fully appreciate the neurobiological implications.

As a child, I accepted, empirically, that he was right: When we neighborhood kids dissolved into contagious hilarity, it wasn’t long before one or two of us were crying.

To be clear: Out of 6 or 8 of us, only one or two children predictably started crying or getting angry first. Why didn’t we all? Different brains; different reactions? Perhaps.

Yet, there might have been a particular implication for the children with ADHD, virtually unheard of in my youth, especially in less-than-severe forms.

Videogaming: Start Out Engaged, End Up Addicted?

Consider another example: the “grown-up play” of videogaming.

Even after my husband was diagnosed with ADHD and began medical treatment for it, I used to observe this happy-then-cranky phenomenon where he played Starcraft. When he’d end a gaming session, he’d behave like a complete jackass for hours—mean, demanding, short-tempered, and imperious.

In truth, he was grouchy a lot then, but post-videogaming brought grouchy to new heights, complete with a cold-eyed imperious stare aimed in my direction.  He would then treat me as if I’d just wronged him somehow.

Fortunately, he finally believed me when I emphatically pointed out this withdrawal phenomenon. I think the change scared him, too. Out went Starcraft. Taking that step didn’t resolve all ADHD-related challenges, but at least it stopped making them worse.    Read more of our adventures here: Breaking Out of ADHD Relationship Dysfunction — After Not Breaking a Fall

post-orgasm irritability

Post-Coital Tristesse—After-Sex Sadness

So, guess what? For some people, a similar phenomenon presents around sex—at least the kind that involves orgasm. There’s even a term for it: Post-coital tristesse (PCT), or after-sex sadness.

Keep in mind: “sadness” or “depression” manifests in some people as irritability, perhaps especially men. Hence, my using the term post-orgasm irritability.

This very phenomenon came up in conversation among some female friends of mine—all partners of adults with ADHD. As one said:

You’d think my husband would be nicer to me after sex.

Instead, he acts like a jerk, almost as if he’s punishing me for having sex with him!

Neither she nor her husband recognized that the behavior was not intentional but neurochemical.  His denial of this behavior only hurt her more—and motivated her plans to leave the marriage.

ADHD symptoms can conspire to create various types of challenges to intimacy and relationships. I detail a few in Is It You, Me, or Adult A.D.D.?.

For an expanded examination of the topic, see my Kindle book: ADHD and Sex: What You Need To Know (That Sex Therapists Cannot Tell You.

Along with all the other ADHD-related domestic challenges, this kind of post-sex Dr. Hyde-into-Mr. Jekyll turnabout can put the death knell to a couple’s sexual relationship. It also can add a whole other layer to existing resentments in other areas of life.

Early Writings on The Phenomenon

PCT is not a new phenomenon. It actually has been documented for centuries, with one reference from the famed Greek physician Galen, around the first century AD:

Every animal is sad after coitus except the human female and the rooster.

We know now that the phenomenon also happens with women. And we also know that PCT is not universal. Just as only a minority of my neighborhood pals “ended up crying,” some people experience PCT more than others, and some hardly at all.

The 17th Century philosopher Spinoza, wrote an apt description:

For as far as sensual pleasure is concerned, the mind is so caught up in it, as if at peace in a [true] good, that it is quite prevented from thinking of anything else.

But after the enjoyment of sensual pleasure is past, the greatest sadness follows.

If this does not completely engross, still it thoroughly confuses and dulls the mind.

Most likely, the causes of post-sex sadness/irritability are variable among individuals. Causes include:

1. The Psychological

For example, individuals experiencing PCT might feel remorse at having allowed lust to lead them into an unwise pairing. Or, by contrast, they might feel an overwhelming sense of loss when the enveloping sense of connection ends.

2. The Physical

It is with the physical that science is beginning to shed some light, with specific implications for people with ADHD.  Read on.

Orgasm as “Heroin Rush”

During orgasm, one research team reported it this way (Holstege et al. 2003): The dopamine flooding the brain’s reward pathways resembles a “heroin rush” to the brain: overwhelming feelings of well-being and pleasure. Just as with heroin and other substances, “withdrawal” can be a problem. It follows that sex addictions and other types of addictions go hand-in-hand, indicating poor regulation in this part of the brain.

After the dopamine-flood accompanying orgasm, dopamine levels drop below baseline—that is, lower than they were before orgasm. (The term for this is “rebound.”) Essentially, the same thing happens during withdrawal from substances. So, it’s highly possible that orgasmic sex can intensify ADHD symptoms for some people, especially if they are not taking medication.

Could it be that orgasms, simultaneous to ejaculation, are good for the species but bad for the brain?

Evolutionary biologists argue that we might be “hard-wired” to act in ways that propagate the species but that simultaneously jeopardize harmonious intimate relationships.

In other words, orgasmic sex is a “win” for reproduction but a “lose” for the kind of steady brain function that enhances and stabilizes a relationship.

So,  What To Do About Post-Orgasm Irritability?

To be clear: Orgasms do not cause ADHD. 🙂

Yet, some people with ADHD might be more vulnerable to this phenomenon. And there are good neurophysiological reasons why this is so.

That makes it important to understand: Post-sex problematic behaviors might have a biological basis.

Step One: Understand the Neurobiology

Again, PCT and other post-sex reactions are nothing new. They have been observed in humans for centuries.

A physician practicing in the 19th Century promoted a remedy, perhaps based on ancient texts, called Karezza. Adapted from the Italian for “caress.”  Alice Bunker Stockham, a gynecologist and obstetrician, had larger societal goals with the introduction of Karezza, which resembles Tantric sex without the cultural references.

Alice Bunker Stockham, an early proponent of the Karezza method

Simply put, Dr. Stockham’s method is a form of sexual intercourse without orgasm, focusing instead on the “plateau phrase” of intercourse. The practice includes bonding activities that reportedly enhance oxytocin. It’s often called the “bonding” hormone, thought to promote connection and feelings of love (though in recent years we’re learning there can be a dark side to oxytocin, too).

Bottom line; By avoiding orgasm, it is thought, dopamine levels remain more balanced.

Will this be a realistic practice to experiment with, especially if ADHD symptoms are causing chaos in the rest of life? Probably not. But it provides interesting food for thought and perhaps worth some experimentation, especially if ADHD symptoms are well-managed to the point of having the patience and focus required.

Step Two: Counter the Dopamine Flood—and Rebound

Two medications might help but in different ways:  SSRI antidepressants and stimulants.

1. SSRI Antidepressants:

Some psychiatrists have treated PCT in their patients with an SSRI (a type of antidepressant, such as Prozac, Zoloft, etc.). The medication might blunt their sexual arousal and delay orgasm (or minimize the intensity), but it also pre-empts the post-orgasmic depression.

2. Stimulant medications:

Many individuals with ADHD have reported to me more satisfaction around sex once they began taking stimulant medications. For some, they were able to prolong sexual intimacy instead of racing to the finish line. Others were better able to linger and cuddle afterward—instead of bolting off to the next activity—in doing so perhaps boosting oxytocin levels thought to aid bonding and relaxation.

Perhaps the stimulants also helped to keep dopamine on a more even keel. That is, instead of going from 0 to 60, they perhaps went from 30-60, a slower buildup and less precipitous drop-off.

The Karezza Method

From the Archives: The Karezza Method

Books from 100 years ago are hardly informed by neuroscience. Still, they sometimes make for compelling reading.

To learn more about the ideas behind Karezza, click here to download The Karezza Method. published in 1931 by J. William Lloyd, an “individual anarchist” born in 1857. Here is the last paragraph of his book:

To sum up: The orgasmal school is honest but mistaken. Its fault is that it is a doctrine of the strong, only for the strong.

Just as a wealthy man may spend money recklessly for a while and still not be poor, so a man rich in thyroxin and adrenalin may spend recklessly in orgasms for a while and not seem any the worse.

And the method, taught by the orgasmal school is such that it creates a demand, by congestion, for the orgasm, which must then occur or bad results follow. But for a weak man to follow their advice is very dangerous and courts a nervous breakdown, while my method builds him up.

That orgasms are weakening is easily proven. Just as the way to get real facts about alcohol is to consult life-insurance companies, so to get facts about the orgasm go to the stockbreeder. Business has no sentiment or prejudice. Every stockbreeder will tell you that to permit a bull or stallion to serve too many or too often is to devitalize him.

Links To Read More:

Read more about ADHD and sexless marriage—and maybe-too-much sex marriage: ADHD and Sex: Peaks and Valleys in the Bedroom

This article first posted in Feb. 2015

I’d love to hear your thoughts on this topic. Please share them in a comment.


115 thoughts on “ADHD and Sex: Post-Orgasm Irritability, Jerkiness”

  1. Rackbad Snuffline

    This doesn’t really answer my own question – the article talks mostly about the “next day” effects. But in the more immediate sense, I was wondering if anyone has noticed a reduction in the effectiveness of their medication (for me, specifically methylphenidate) in the moments-to-hours following orgasm? Even if I redose shortly afterwards, it seems there is a very impaired (if not entirely negated) response to my typical dose.
    The following day (or morning, even), however, I’ve returned to equilibrium and don’t experience the same negative effects you mention. My problems are more apparent in the far shorter time-scale.

    1. Hi Rackbad,

      I’m not sure why you think this article mostly talks about the “next day” effects. Am I missing something? The effects can be immediate — and lasting. It just depends.

      Perhaps you return to equilibrium faster because you do take medication. Perhaps an extended-release stimulant, if you’re not already taking it, might avoid the drop-off. Or …not waiting until the dose is past peak.

      Maybe others will have suggestions.

  2. Thank you, Gina 🙂

    I shall check out the link. 🙂

    I have anxiety, overthink, I don‘t take medication. Did not like the side-effects.

    Kind Regards from the UK.


    1. Hi Paul,

      Just FYI. If you were given anti-depressants or anti-anxiety medication when the core issue is ADHD, no wonder you didn’t like the side effects.

      ADHD is far too often misdiagnosed as “anxiety.” But it’s not an anxiety disorder. Not the same at all.

      The anxiety is a cognitive anxiety that often improves when the stimulants help the brain to be better “organized” in terms of thoughts, plans, etc.


  3. Thank you for your article. It was very helpful and confirmed what I was thinking. I have been in a committed marriage for 15 years, but have noticed a pattern of being very tired/depressed/irritable the day after a strong orgasm. I feel fine the next day after sex if my partner orgasms and I don’t.
    I have ADHD so this makes a lot of sense now. Thanks for explaining! This is really helpful and makes me feel less weird about myself.

    1. Thank you so much for letting me know. That’s the kind of topic I dig around for… that explains a long-running mystery and takes folks out of isolation in feeling personal “weirdness.”


  4. Hi Gina

    It was good to find this article.

    I was diagnosed with ADHD 2 years when I was 42. My first experience with sexual fixation started at 7 when I was exposed to pornography for the first time. It was like a bomb went off in my head.

    Now here I am, almost 40 years later, seemingly sexually dysfunctional.

    It wasn’t so bad in my early twenties…I was young, very fit etc but from about the age of 30, my need for sex went up as my ability to actually have it went down.

    This started a long uphill battle with compulsive visits to sex workers and landing up in an addiction clinic in my mid 30’s. The only way I could have sex was with a sex worker and I started to suspect that it wasn’t that I really loved sex with prostitutes so much as it was the only way it could work for me.

    Sometimes, the intensity of the high was so extreme, I wouldn’t know how I got home afterwards…..I used to call them white outs.
    The drop off, restlessness and depression after sex was so severe that grew to hate it and naturally distanced myself from it. As I had not yet been diagnosed, I could not understand why I would get no honeymoon period with a new partner, my mind was all over the place while trying to have sex more than twice with anyone new and was consumed by guilt because I couldn’t find any pleasure in it.

    Relationship after relationship just died and even though I crave a deep bond with someone, it has been impossible as I always know what is waiting for me when I try.

    I have researched this phenomenon before that you described but I didn’t realise how much it can affect people with ADHD. My post orgasm experience goes so much further than irritability though. I’m definitely going to check out some of your books.

    Keep well

    1. Dear David,

      Thanks for your comment.

      Sometimes I feel like we’re living in the Stone Age.

      We’re both with a body, including a brain, for which we have no operating instructions. Are we more inclined to allergies? Do we have a genetic predisposition to chronic nutritional deficiencies? Are our dopamine molecules ready at a moment’s notice to go chasing the next shiny?

      It would be nice to know before we suffer all the damage from not understanding.

      Maybe by 2122. 🙂

      As to your post-orgasm experience going further than irritability…this might be just the most well-observed effect. There might be more.

      If ADHD is part of the picture, I would imagine an intensification of ADHD symptoms overall perhaps.

      Good luck in learning more,

  5. The day after the grumpy happens to me as well. Im in 50’s and have dealt with it all my mature life. Im male though. Early years it was day of, but several hours later. Now with same clockwork it happens next day. I become very irrational and enter a Mr Hyde rage. Life appears to be coming to an end. The more I suppress the longer it lasts. The sooner I let it rip the sooner calm sets in…all regretful.
    SSRI’s help, but it still exists. Havent found cause, but I know its not religious guilt or other canned mental ailments that are regurgitated by 95% of doctors/therapists. It appears to be chemical/hormonal because my skin becomes oily and breaks out with acne if I ejactulate two or more days in row. I’ve considered that i might be allergic to sex haha. The only fixes for the anger I’ve found is either obstaining or intense work out the days afterward or to some degree SSRI.
    Good news is that in later age sex no longer rules.

    1. Hi Mr. Hyde,

      Yes, it’s so much easier to attribute psychological motive, isn’t it. Easier but WRONG.

      Is it possible that you might have ADHD, even in mild form? Might be worth thinking about.


  6. Hei Gina Pera, Din forklaring om ADHD
    sykdom er veldig nyttig. Det er imidlertid et alvorlig problem om psykisk helse, men artikkelen din er veldig imponerende. Hvis du vil vite mer om ADHD, vennligst besøk vårt nettsted “”

  7. Wow, yet again I never knew this was something that other people with ADHD suffered. I was a member of the Pornfree and NoFap movement because of PCT during my unmedicated years. Adderall has definitely helped me with the post-orgasm depression but it has made my masturbatory habit worse. It’s a lot harder to not do something when you have a pill that cancels the worse of the effects.

    1. Hi Devon…..interesting. I recall another reader making a similar comment.

      Maybe Adderall is not the best option for you. Might increase self-regulation and minimize “tunnel vision.”


  8. This happened with my soon-to-be-ex wife. The next day was horrid.

    It took a long time to recognize the pattern, and even longer to be sure of it. But when I finally googled it, I did not find much that talked about the _next day_ so I wasn’t sure I had it right. Thank you for confirming it.

    Even though I could not confirm it online, it was so strong a pattern that, after sex, I would swear to myself “if she gets weird tomorrow, I will know why and will not let it get to me”. But, sure enough, the next day, the attacks, if they were not initially successful, would get so viscous and deranged that I eventually did take the bait and fought back. A sad pattern. More stark in retrospect, especially having read this post.

    The worst part is that the sex was awesome, and frequent. So the nasty fights were also frequent. Which is why she is my soon-to-be-ex wife.

  9. I initially wrote to this blog in January earlier this year, I would like to State I have since changed medication Vyvanse. I still struggle with p c t and a very high level sex drive. I have considered using a chastity device to change habits and do some self-locking I want to introduce that to my wife and she seems like she would be against it I don’t want to ruin our marriage I do want it to work for both of us I just feel like that’s a way I could not be so hard driven sexual and not always behave looking at a way to get a release for a dopamine fill by consulate or masturbating or looking at pornography. I love my wife and I want our marriage to work workout and continue to grow. I need to change my focus and put my energies into different things and I figured it’s a great way to do it. At the same time it would also reduce my drive I’ve got rid of weight I’ve learned how to exercise better I was injured for two years and I’ve done a lot of other things mentally and spiritually to change who and what I do. I would like to know what your advice is on using it such a device? I’ve been told that they really work I’ve done research on it and I have worn them before. Do the Cove in and many other stressful things in our life it’s difficult to figure things out? And where life is going? I’m going to be 60 this year and very close to retirement. I would really like to know what your feelings are on such a device? Please advise.

    1. Hi Paul,

      For reference, I’ll add here your previous post, from 9/1/21

      Hello there. Would like to expand on the other areas of impairment.

      I’ve struggled with it many times by not be able to maintain long term relationships.

      I utilize cognitive behavioral therapy, the thing is I hyper-focus on many things that are wrong instead of the things that are right.

      I’m currently taking adderal I also use exercise to a fault, meditation and many other practices including spiritual applications.

      We’re beginning to look at using karizza as a method. Sexual tension works best for me, it places me back into a balance, a bit of a shock to my system, certain methods, hardcore for me for sure, vanilla (applied) from my wife, work currently. It’s a work in progress. Off and on long term therapy has helped yet still what I have is persistent.

      Any other directions, options would be helpful.
      Thanks Paul


      Because it seems your wife is not entirely open to the chastity-belt idea, maybe it’s best to explore other options first.

      First, it would be important to know:

      1. You were diagnosed with ADHD? What are your other symptoms and how is Vyvanse helping — or not?
      2. What dose are you taking, when do you take it, and how long does it last?
      3. Have you ever taken an antidepressant SSRI (e.g. Prozac, Zoloft, Celexa, Luvox, etc.)? It might be that serotonin is the neurotransmitter to target.
      4. Depression and anxiety can also lead some people to “self-medicate” with sex. The antidepressant can help reduce that impulse.

      So, these are all important questions.

      I know nothing about using chastity devices, and I would encourage seeking an “internal” solution rather than external. That is, address brain issues that are creating these problems for you.

      I’ll await your response.


  10. Thank you for writing this article, it is a breathe of fresh air to know I am not alone in this.

    Just to share how I connected this post-orgasmic irritability to ADHD which led me on a random google search that led me here. After 1.5 years of bi-weekly visits to an experienced CBT (issues with procrastination, motivation, trust), a friend of mine with ADHD noticed I had quite a few symptoms (particularly impulsivity) and I pursued diagnostic testing that led to a conclusive ADHD-combined diagnosis (@ 36 years old) . My coping mechanisms and scholarly success was a mask that even the CBT missed.

    I decided to go the medication route (Concerta, and just recently Vyvanse) and it has been nothing but a positive life changing experience in all facets of my life – emotionally, socially, professionally. Upon learning about ADHD and the way it affects executive functioning – I began to understand that my lifelong hypersexual behaviors could possibly be related to it. This hypersexuality has taken over my personal life and absolutely taxed my long term relationships many times. The medication has helped me control these impulsions – but has ironically become a bit of a double edged sword: see below.

    I have always had a severe orgasmic ‘hangover’ that was expressed as fatigue/depression/brain-fog/headaches/isolation after chronic masturbation, and typically extreme-irritability after sex with a ‘flight’ response (which often just led to more masturbation). I could literally ‘feel’ my brain – like there was a glitched circuit or a void.

    So the reason I have connected this to ADHD and the medication – is that I have absolutely virtually no ill effects after masturbation while on medication. Very very minor and short lived fatigue, but no depressive or self-deprecating thoughts, and I can still enjoy socializing the same day- even shortly thereafter. I had always thought everyone had these side effects, but now I understand it to be related to my ADHD brain.

    So the double edged sword is this – the medication allows me to control my hypersexual impulsivity, but if I indulge and go down that route – I become hyperfocused on the hypersexuality behaviours and they can become even more dominant. Prior to medication, that ‘brain-fog’ and depressive feeling would act as the catalyst to force me to stop – because there was a psychically/emotionally drained sensation that my brain just wouldn’t get any sort of thrill or reward from it anymore and after an extended period of time I would literally get a headache and tap-out, and/or almost always wake up with one the next day (yes, I kept up on my hydration).

    Now, on medication, it allows me to control my hypersexual impulses, but there are no negative-reinforcements that promote me to stop if I do indulge.

    Despite being open to hear your explanatory thoughts on this, I’m not necessarily sharing with the intent on acquiring any guidance on how to deal with the issue. Just sharing for the sake of sharing in the event someone can resonate with the experience.

    Thanks again.

    1. Thanks for detailing your experience, Blane.

      My favorite comments to my posts are the ones that begin, “It is a breath of fresh air to know I am not alone in this.”

      Seriously, that’s why I do what I do. And I love that others will benefit from your shared insights.

      As for any explanatory thoughts…. 🙂 … your guess is as good as mine.

      But in general, in case you or anyone else is interested, I’d offer this:

      1. Old habits can die hard, especially if there is not an active behavior-change strategy. (1.5 years of CBT….yes, that’s going to do little for ADHD but maybe now, in habit change…)

      2. Given that most prescribing is sub-par, it might be that continuing to optimize Rx and other supportive strategies (sufficient sleep, cutting out any cannabis/alcohol habit) might be worthwhile.

      3. Masturbation, I think, falls in a bit of a different category. For many people with poorly managed ADHD, it’s a poor coping response — to difficult feelings around poor initiation, disorganization, a lifetime of alternate explanations for ADHD-related challenges, etc.. And it’s always right there.

      Perhaps as you continue to improve functioning (you don’t mention how long you have been in treatment, but it can definitely take some time to get the full benefit), you will find less need for that escape.


  11. Interesting.
    I would like to add that simply adding medications doesn’t solve this complex issue.

    For instance, my husband has a lower sex drive. I prefer to have an orgasm every night before bed, while he likes one every month or two. If he is hyper in the morning and I am still sleeping, we can have sex, where he orgasms and I do not. THEN, our moods are balanced. I have energy to get up, and he feels more relaxed and not hyper.

    If we have sex before bed, he is usually exhausted before it starts. But in the end, I am happy and relaxed after I orgasm.

    He says I am always mad after sex. This is not about needing medication. I am mad because I know he isn’t going to have sex with me again forever. I do not mean to feel this, but I hate begging for sex. I hate being told “no” about it. I hate not being physically desired on a regular basis.

    I love how an orgasm makes my mind wipe clean, like a needed computer reboot.

    I am angry if I can’t sleep after an orgasm. Let me lie there with an empty mind.


    P.S. I probably have ADHD, but this is easy for me to manage without medication. I take lithium for schizoaffective disorder, along with using a sedative, maybe 3 weeks a year to prevent psychosis.

    1. Hi ADHD is Fine,

      Sure, this issue doesn’t affect everyone.

      Every individual — and every couple — is unique. But part of what you describe definitely sounds common to ADHD.

      In fact, I wrote about it in my first book, in the chapter on sex.

      Another common complaint is constantly being awakened from a
      sound sleep—when they have to be at work early the next morning—
      because their ADHD partners come to bed late and can’t get to sleep
      without sex. As one member sums it up, “Who wants to feel like little
      more than someone’s sleeping pill?”

      I certainly cannot speak to your situation or how your husband feels. But some partners of adults with ADHD in this situation come to feel a bit exhausted from the nightly demand….a demand that isn’t about connection but about being their ADHD partner’s “sleeping pill.”

      I understand that you have complicating factors (e.g. schizoaffective disorder), so treating your ADHD might not be a possibility. And it might be unrelated to the situation you describe.

      But just fyi….in the past, schizoaffective disorder was one of the fairly common misdiagnoses for ADHD. Though the two do tend to co-exist.

      Here’s a study on the topic:

      thanks for your comment,

  12. Hi Gina,

    Thank you for writing this article, it’s a very enjoyable read! I’ve often wondered if I’ve just been imagining changes in my cognition after an orgasm. I don’t tend to notice any particular change to my mood but I’ve found that my mind is cloudy and l focus is seriously impaired the day following an orgasm. I’ve previously asked my friends if they experienced anything similar but they haven’t and just kinda laugh at the idea of it. Your article is a bit of reassurance that I’m not the only one!

    I’m 22 and was diagnosed with childhood ADD exhibiting some hyperactive symptoms. I used to take ritalin when I was younger but it left me feeling empty. I’ve found self medicating with modafinil on days where I need to complete work is much more beneficial, makes me feel uplifted and gives much more sexual gratification.

    I was wondering if you knew of any papers or ongoing studies looking into the effect of orgasms on focus in people with ADD/ADHD?


    1. Dear Louis,

      Thanks for writing. I’m grateful to know my post helped explained some mysteries for you!

      As far as I know, I’m the only ADHD expert who knows about this phenomenon. So, no it’s not being studied (last I checked the literature on research related to ADHD and sex).

      If Ritalin left you feeling empty, it might have been too high a dose.

      It might be you’d benefit from trials of other stimulants, starting with very low doses. My book explains the basic process.

      But your diagnosis should have been based on more than “exhibiting some hyperactive symptoms.” In fact, you might want to get re-evaluated, but pro-actively. Not just trusting a random mental-healthcare worker.

      Generally speaking, using any kind of stimulant medication (or related, such as modafinil) is not a great idea. The body (including the brain) likes homeostatis. Not constant roller coasters of chemical reactions up and downstream.

      It might be that taking a steady, longer-lasting stimulant leaves you with a firmer foundation, so to speak — so that the dopamine flood post-orgasm doesn’t create the sadness/irritability/etc..

      good luck!

  13. Hi Gina
    I have been on this rollercoaster for years… tried to find answers for years.. your article..sums up what im feeling perfectly… I am grateful you wrote the article because now I know Im not being a spoiled demanding brat, nor am I codependent, nor do I have attachment issues, nor is it borderline etc.. it is a chemical reaction and the huge drop in dopamine that has me feeling completely and utterly washed out.. like you said… lower than before.. Im late 50s.. and was diagnosed with ADHD a few weeks ago. I was given medication but don’t want to take it at this stage of my life. But this has been and currently is.. a massive problem in my life. The crash after is extremely disturbing both for me and for the people who I affect. I just couldn’t name the feeling.. the huge anxiety and agitation and the massive drop in energy.. the tears and deep sadness.. and the inability to function for days after… thank you for bringing it to light.. im very distressed with reading this..because i am so deeply affected and it has caused massive problems in my life abd has the ability to ruin relationships. I am not prepared to go onto medication. The amphetamines frighten me… I have a tendency to addiction and do not want to start something at this stage of my life that will likely become a problem.

    1. Dear GM,

      Thanks for letting me know that my work helped you. Sometimes I get a bit tired — and need a boost. 🙂

      It is indeed a revelation, isn’t it? Especially when considering the “alternate explanations” such as “attachment issues”….oh boy….sometimes the field of psychology has a narrative for everything but often with little evidence. I do wish that psychologists were required to take more biology courses.

      As for the medication….so I assume you were prescribed an amphetamine…probably Adderall. It’s too bad you didn’t feel you could talk with the prescriber about your concerns.

      If it is Adderall, it’s important for you to know that it is chemically different than the other stimulants. Basically, it releases neurotransmitters from the neuron in addition to slowing re-uptake, whereas the other stimulants just slow re-uptake.

      Adderall works well for many but presents big problems for others; this is my most popular blog post:

      Adderall is also more likely to make you feel “speedy.” The other stimulant choices typically are more subtle, increasing focus but not acting like a booster rocket.

      I encourage you to read the medication chapters in my first book for guidance:

      ALSO: your “tendency to addiction” might in itself be ADHD. Research has shown that children with ADHD who receive medication treatment are less likely to develop substance-use problems later.

      I hope this helps. Good luck!

  14. I have struggled with pct after orgasm for years, it has been a real struggle.

    I have attempted to reduce my orgasm frequency to 9 a year, once around every 42 days. It is difficult to create an agreement between my wife and I.
    It seems to work wonders for me, I have realized my sexual pleasure for years took a priority over my wife’s, within our 36 year marriage. As a man with adhd, and sexual issues, I begun a deal within myself that a healthier dosage of dopamine from pleasuring my wife, and remaining highly aroused without orgasm, except in the “window ” of 42 days works for me immensely. I want to make a contractual agreement, not written in stone, yet mainly determined by my wife’s “decision ” of should he, or should he not?

    The tease aspect feeds me yet does not flood me?

    My question is “how” can we make it work like this, we have fantastic intimacy, she has “mind” blowing multiple orgasms, I want, we need resolution for cause to correct this imbalance.

    We love each other, and I would like some help, or some great advice.
    Thanks Paul

    1. Hi Paul,

      You mention that you have ADHD but you didn’t mention anything about treatment. Being diagnosed with ADHD requires experiencing impairment in at least two areas of life. So I presume that ADHD creates struggles elsewhere, beyond sex.

      It might be the medical treatment will make it so much easier to coordinate a mutually satisfactory approach.

      I encourage you both to read my first book — especially the Success Strategies section (the third), which includes details on how to get the best results from medication.

      I expanded on this ADHD and sex topic in Kindle book — at 99 cents, this is another public service. It contains information that most therapists, including sex therapists and even many ADHD specialists, just don’t understand.

      I hope this helps.

    2. Hello there. Would like to expand on the other areas of impairment.

      I’ve struggled with it many times by not be able to maintain long term relationships.

      I utilize cognitive behavioral therapy, the thing is I hyper-focus on many things that are wrong instead of the things that are right.

      I’m currently taking adderal I also use exercise to a fault, meditation and many other practices including spiritual applications.

      We’re beginning to look at using karizza as a method. Sexual tension works best for me, it places me back into a balance, a bit of a shock to my system, certain methods, hardcore for me for sure, vanilla (applied) from my wife, work currently. It’s a work in progress. Off and on long term therapy has helped yet still what I have is persistent.

      Any other directions, options would be helpful.
      Thanks Paul

    3. Hi Paul,

      Just to be clear: I do know a lot about ADHD-related patterns with sexual intimacy, but I’m in no way a sex therapist. 🙂

      If your sex life were the only concern here, that’s one thing. But it doesn’t seem to be the case. Right?

      So your current treatment consists of:

      1. Taking Adderall
      2. “Exercise to a fault”
      3. Spiritual practices

      Let’s start with #1. That could be the linchpin.

      Have you read THE most popular post on my blog:

      The Tragic Truth of Prescription Adderall—or Madderall

      If you’ve tried no other stimulants or combination stimulant/non-stimulant, I believe you owe it to yourself to “hyper-focus” on re-evaluating your medication strategy. 🙂

      Adderall works best, out of all the choices, for a minority of people with ADHD. For others, it can create irritability, anger, tunnel-vision, and a big crash when it wears off.

      If I wrote the rules, Adderall would be the LAST resort, not the first that so many knucklehead prescribers have made it.

      If that’s all you’ve tried, who knows how much better life could be with a more effective approach. That post ends with an excerpt from my first book’s guidance on medication. You can follow an Amazon link for my book.

      I’m not sure what you mean by CBT — you mean “talking back” to your counter-productive thoughts?

      CBT in general is not a recommended approach for ADHD. That’s because it doesn’t take into account ADHD neurobiology.

      The CBT models for ADHD do take that into account. The developers are psychologists J. Russell Ramsay and Mary Solanto.

      I hope this helps.
      good luck,

  15. Kyle Watson
    Age 22

    Gina Pera,

    I think Zach actually had a great point, delivered by the means of a joke(I’m referencing the doritos bag comment). I’m 99 .99 percent certain Zach was not insulting you. He is on your side lol. Kind of disappointed that you insulted Zach’s empathy and reading compression, a rather unprofessional act, after writing such a thought provoking and professional article. At the same time I can understand why you reacted the way you did though. That seems like an obvious deeply rooted insecurity. I’d bet money on it stemming from you being the butt of jokes in grade school(been there done that).

    I digress. I loved this article you wrote. It resonates perfectly with the cause and effect relationship of my life. I always intuitively knew that extremele pleasure neurochenically releasing activities had these results, but it is refreshing to have that intuition reaffirmed by semi-science.

    I’ve always struggled with extreme worsining of focus and well being from masturbation, gaming, and all other pleasure nerochemical inducing activities. It has been I life long struggle of trying my damndest to live life a minimally as possible whilst constantly doing with compulsively self-destructive behaviors.

    It also explains why I am so deeply addicted to amphetamines and methamphetamines. These 2 stimulants in particular alleviate all issues with focus, patience, and brain fog, however at the expense of my future mental and physical health due to my extreme abuse of these substances( I am “tweaking” pretty hard as I write this comment). What I find most addictive about these stimulants is the drastic change in others perception of me. When I am sober people think that I’m an idiot( I have serious issues forming and maintaining linear thought while sober). In absolute contrary popular belief, my addiction to these substances took me from a 2.5 GPA average my first 3 years of university, to 2 semester of 4.0s my senior year. Going from the polar opposites of people thinking poorly of me to people thinking highly of me is meaningful in a way I will never be able to put into words.

    I want with all of my soul to get sober, but the sober me is the epitome of uncessess.

    1. Hi Kyle,

      If you’re trying to bait me into a stimulating argument, it won’t work. I don’t take the bait.

      Your projection onto me — and to Zach, for that matter — is misguided and inappropriate.

      I wish you all the luck in the world in pursuing more steady, legitimate treatment. Amphetamines/meth are not the way to go. (Assuming you mean amphetamine abuse.)

      Self-regulation is the core challenge of ADHD, and as you state it, your “treatment” swings you from one extreme to the other. Who knows what effect that is having on your neural pathways.

      Your brain is still developing. I encourage you to take care of it.

      It might not be easy, finding a medical professional who can understand the “self-medicating” aspect of ADHD (and other psychiatric conditions). But I’m sure you’re smart enough to pull it off.


  16. Interesting. I (F, 48) was diagnosed with ADD 5+ years ago. It explained so much. I’ve experienced this post-coital tristesse for … um, always-? I thought of it as the icky guilty sad orgasm feeling. I also suffered from D-MER (dysphoric milk ejection reflex) when breastfeeding my children. I feel like I need a dopamine monitor, something like diabetics use for insulin.

    1. Hi Piper,

      I’m glad you solved a major life mystery on my blog. I love when that happens.

      Still, I’m sorry the explanation wasn’t readily available, oh, 20 years ago, or so.

      A real-time dopamine monitor — that would be fantastic.

      Let me know when you have the prototype ready. 🙂


  17. To be fair Starcraft is a very competitive game with a lot of tension. You have to play against 1 or more opponents, usually three. The competitive side of the game often depends on how many commands you can give to your army and logistics units per second. Every second you don’t out coordinate your opponent(s) is another second they may be pulling ahead of you.

    I can fully understand the husband’s reaction. He just spent an hour or more locked in a race building up an army and watching it be destroyed by somebody faster than him. Afterwards he’s going to be feeling mentally exhausted, full of tension and probably frustration.

    I’d never play an RTS game against another player. It’s just too much tension for a “Game”

    1. Hi Kyle,

      Thanks for interpreting for the non-gaming public what it might feel like.

      But just to be clear….this was the FIRST Starcraft…back in the 1990s. No multi-player gaming then, at least not that I knew of! 🙂

      He was playing against no opponents.

      At any rate, he recognized that sending his neurotransmitters on this roller coaster was not a good thing for him. Some people might transition better from gaming to life. But some folks with ADHD have enormous trouble with transitions.


    2. Obviously, Starcraft is going to lead to depression in the real world. The game is a masterpiece while real life is anything but. Imagine leading a Protoss Air Force against an army of Terrans, only to be eaten alive by some opportunistic Zerg ne’er-do-wells. Then you log off and some woman is telling you to clean up your Doritos bags? I’d be upset too! She should check her attitude at the door.

    3. Hi Zach,

      This was not about a Doritos bag. I was not “some woman.” Perhaps if you’d read a little more closely—with less personal projection—you’d have understood that.

      I was the wife that he’d asked to let him know when it was a certain time — so he could watch the new Star Trek, if you must know.

      In the “real world,” my husband has richly rewarding scientific work. He will tell you he enjoys his work infinitely more than any attention-baiting videogame.

      That blame-shifting chip on your shoulder just might be…..poorly managed ADHD — and addiction.

      I find it’s your attitude “that should be checked at the door.”



  18. This article has been very helpful in reaffirming the already suspected. I have always been aware of the irritability I feel the next day after sex. I have even gone so far to say, “tomorrow I’m going to be so sweet to her” only to be disappointed in my own behavior. I was recently joking with her about how great it would be for our health if we had sex all the time. She joked back implying that I’m always grouchy after sex! Immediately, I agreed with her and said I don’t know what to do about it. This article has given me a new place to launch from. Thanks!

    1. Dear Kevin,

      I’m grateful to know this article might help solve a long-running puzzle.

      Good for you, for seeking explanations.

      Good luck!

  19. I haven’t finished reading it, but so far, I find your article extremely interesting.

    My wife and I have been married 17 years and been together for a total of 25. I don’t know if my wife has ADHD, but I often refer to her as “the most unorganized organized person I know”.

    The last few years I have taken note of the fact that whenever we have sex, the next day is almost unbearable as she typically has a short fuse and is extremely cranky.

    I finally did a Google search and your article was the first thing to pop up… Sounds like I need to do some research of my own.

    1. Apparently, you have no empathy for the men who have written comments here, about their struggles with irritability/depression post-sex.

      Why would you imagine it’s only straight men? Curious.

  20. Thank you SO MUCH for this article. It FINALLY puts a name to what I’ve been experiencing for the past 15 years with my husband. I’ve tried over the years to understand just why his demeanor changed so suddenly the day after sex. He becomes extremely short tempered, glares at me, is extremely annoyed by just about everything, and in general treats me and the kids as though we’re all doing something wrong (additionally, he does this around all special occassions). It COMPLETELY started to feel like punishment for sleeping with him, and has put me off sleeping with him altogether many times, and has impacted our marriage pretty hard.

    He was diagnosed with severe ADHD 5 years ago. He tried medication, but none of it really helped so he stopped taking it. Personally, I believe it’s because he never followed up with behavioral therapy along with the medication, or even just accepting the wide spectrum of things in our lives influenced by his ADHD and taking responsibility enough to do something about it.

    I’ve been trying to tell him about this issue for about 10 years, but I’ve been dimissed each time. Finally I see this article, and I immediately send it to him with relief, because I think “finally he will see this is real and he’ll do something about it”.

    Long story short, hell no he still doesn’t believe me. He says I’m just extra sensitive the day after, because he just doesnt agree with me. Instead of talking about it, he starts talking AT me all the reasons why I’m wrong. Well, it’s severe enough the kids notice, and our love life and my regard for him is affected. What else does it take for him to take me seriously? Instead he sits back blaming me for not wanting to sleep with him. His dismissiveness towards every concern I have with him has pushed our marriage to the brink, and if I wasn’t so worn down by years of pain in our marriage, I might be strong enough to leave. As is, I’m just tired of trying. I hate that our family is falling apart, but I can’t fix it alone. I’m just so tired.

    Anyway, sorry for the vent! This article was extremely validating, and I thank you for it.

    1. Hi Renae,

      Vents always welcome! They are an important part of finding one’s way to truth.

      I’ll offer a bit of feedback:

      1. Your husband “tried medication but none of it really helped so he stopped taking it.”

      Unfortunately, the standard of medical care for ADHD is largely appallingly BAD.

      Very often, it takes self-education and self-advocacy to optimize the approach to medication.

      AND, a team effort can really help speed the process.

      Honestly, behavioral therapy typically does little until “severe ADHD” is medically treated.

      ADHD is a neurobiological issue that requires, in many cases, neurobiological treatments.

      2. He doesn’t believe you that this article applies to your situation.

      Maybe he believes you. Maybe, though, he feels guilty about it, so guilty (and powerless) that he becomes overcome with anger, anger that spills out onto you and the children.

      He’s tried medication. It doesn’t work. His back is up against the wall. That must mean he’s truly “messed up” — and that makes him angry and defiant.

      Or maybe he doesn’t believe you. Maybe ADHD symptoms themselves obscure his self-observation and clarity.

      Here is a basic truism: The same brain that is causing him problems in life is limiting his ability to see the nature of the problems, know what to do about them, and organize/follow-through on the effort.

      I encourage you to read my first book. It will explain all this and much more — and explain how to proceed.

      Good luck!

  21. I’m a 28yr old woman that has never been diagnosed with ADHD or ADD but what you describe here depicts what happens to me perfectly. I recognize the connection between sex and following day irritability. I do my best to control it. I am glad to know I’m not alone, but I’m still not sure what to do about it.

    1. Hello,

      Was good to see this Post. At the age of 50 I was diagnosed with ADHD. For years I have felt so depressed after sex or masturbation. I know the effects last about 3 days before I start feeling any better.

      I get sad, cranky, tearful and feel really tired. Additionally, there are headaches. I find the act more enjoyable than the orgasm as I guess I probably link the aftermath subconsciously and explicitly.

      Thank you for your post. I at least feel that I am not alone.

      Any tips to get back on an even keel faster?

      Kind Regards,

      P 🙂

    2. Hi Paul,

      Yay! You found my post. Thanks for letting me know it helped you to feel less alone.

      As for tips to get back on an even keel faster….that really depends. What are your issues with ADHD, and what are your treatment strategies? You’re in the UK. Are you able to find competent medication prescribing?

      Being better able to regulate impulses (such as turning to masturbation in order to cope with feelings) is one step. But so is doing all you can to improve ADHD-related functioning (getting regular sleep, exercise, good diet).

      My first book explores Adult ADHD from angles, including the “emotional baggage” from late-diagnosis, the evidence-based treatment strategies, and getting an idea of how poorly managed ADHD can affect loved ones.

      You can find it at Amazon US and UK.

      There is a chapter in that book about ADHD & Sex. My shorter Kindle book expands on that topic.

      take care!

  22. Hi ,

    Thanks a lot for this article. In this lockdown time, I can sense that, I am definitely suffering from it (I don’t have ADHD, not that I know of). At least earlier, one would have a challenging day at work the next day which would induce some form of fullfillment and calmness.

    But these days , after weekend sex, I am angry the next day and beyond. She is suffering from this and I absolutely feel sad about it. Adding to all this is my 3YO son who constantly on high energy and sucks up all our energy. I can’t be mad and angry to my wife always as that might affect him adversely as explained in “I’m OK , You’re OK” book.
    I feel angry and sad about it all the times. Thanks for this article. It atleast made me realize that I am not alone.

    1. Hi AD,

      You are definitely not alone. Knowledge is power — though I know, in itself it’s not a solution.

      I would imagine that depression/anxiety might have a similar effect.

      I hope things get better for you.


  23. THANK YOU for this info.

    I’m not crazy, its a thing! ugh. another thing. its definitely true for my husband with ADHD and has all but eliminated our sex life.

    I don’t sleep with jerks. and on the rare occasion that I do (silly me), I protect my heart for a good couple weeks afterward. Sadly, being vulnerable seems like an invitation for him to be one.

    1. Hi Susan,

      I’m grateful for your comment — and that my work has helped to validate your perceptions.

      I hope the situation improves for you — and your husband.


    2. hi thanks for this.
      I have only been diagnosed 12months ago. now aged 33…

      I was just courious, after sex/self pleasure – I get depressed, sad, anxious/stomach cramps… not sure what is the stronger factor, but it seems to be amplified if I do this in the morning and then take my adhd medication (Ritalin) shortly after. I feel like crap all day sometimes. like a gut renching feeling.

      just wondering if others have experienced something similar. it’s not as bad if I skip my meds. but then I get nothing done..

      thanks in advance.

    3. Hi Jon,

      Sounds like an awful feeling.

      I wonder what would happen if you took the Ritalin first.

      —How does the Ritalin work for you in general?
      —Do you have signs of an anxiety disorder or depression the rest of the time?

      The stimulants can exacerbate an underlying anxiety/depression disorder. Some folks do best on a stimulant and another 24-7 medication such an antidepressant or Strattera (at a low dose, 25-40 mg).

      I hope others have stories to share.

  24. Pingback: After-Sex Sadness: ADHD Sex Life – J {A} N

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