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 climax, 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 down—and 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.
“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-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.
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.
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.
133 thoughts on “ADHD and Sex: Post-Orgasm Irritability, Jerkiness”
Can we just call this what it is for many of us — post-coital abusiveness? My ADHD partner is definitely emotionally abusive after sex with the rage, sulking, withholding, angry outbursts, etc., but is the same way even after much smaller sexual activities — like any touch and intimacy that feels at all erotic/sexual/too close, when my partner will almost immediately have outbursts and often storm out of the room in a rage, but then is even more of a jerk the next day (often much longer). Stopping my partner from orgasms won’t stop this — so what are the alternatives when all touch/intimacy seems to push someone into this loop of lashing out at a partner?
I really admire those here who figured out that one of you suspending orgasm would stop the Hyde/monster reaction after sex, but what if just stopping orgasm doesn’t seem to work? My partner also tries to prevent my orgasm as well, because it seems like when I have an orgasm and my partner doesn’t, they’re even less bonded, more angry, and more awful toward me, so they’re trying to prevent that by making sure we’re both living in a coitus interruptus hell. My partner obviously knows on some level that they are mean and lashing out at me from both mild activities like kissing, from actual sex, and from basically anything that gives me (the non-ADHD partner) pleasure. It quickly became an absolute no-win for me.
Needless to say, the sex death knell for us happened a long time ago, but I do wonder if the above is both a dopamine drop and some kind of oxytocin drop that maybe would be helped by nasal oxytocin so that my partner wouldn’t have this post-coital attacking thing just from my pleasure and even from kissing or barely-intimate touch?
You can call the phenomenon you experience whatever you like. But the topic here already has a name. And it manifests differently in the individuals who have it.
Perhaps you want to read the post again. I did point to some potential strategies.
Oxytocin is a complex hormone. The early claims for nasal applications have not panned out.
Again, read the post. You don’t have to “wonder if it’s a dopamine drop.”
Gina, thank you for replying, but are you saying that my partner having the same “jerkdom” after just barely kissing, talking about sex, or mild touch (and not orgasm) would also be dopamine drop? It actually happens in my partner’s case from just witnessing me getting at all turned on (this too causes the jerkdom, even if neither of us have an orgasm so it’s not orgasm-related) — my partner is pretty much always a jerk the next day if there is even a sexy feeling in the air. So is all of that dopamine drop? I have read this article several times now as it’s very validating, I just wanted to clarify this point since it seems like you’re advocating these types of non-orgasmic touch to prevent dopamine drop, but I have even tried things like reading a paragraph from a sex book together and still, my partner has the same jerkdom symptoms the next day.
I can’t possibly speculate on what is happening with you and your husband in these situations.
Nothing is ever as simple as a “dopamine drop”.
And I am NOT advocating anything but awareness on these issues. I am NOT recommending the non-orgasmic touch.
What you are describing sounds like a different thing. Many various things, fact. Each having their own causes?
Being irritable after sex — and being resentful of one’s partner for experiencing any kind of pleasure….two different things.
I encourage you to check out my ebook on sex and ADHD. It might shed light on some issues.
Great article, just wanted to point out that the link to your Kindle book goes to a Daily Mail news article reporting a graphic fatal car accident — definitely not what I was looking for.
Good grief! lol! Thanks so much! I’m a one-person shop here, and sometimes I get tired!
Here is the correct linkP. https://amzn.to/3tv6Z8m
Oh my. I wondered why I felt like he did a Jekyll and Hyde after especially great sex. I couldn’t help feeling like well, he was so very “done” with me and I should just leave the room, or perhaps his planet. I would physically leave, feeling very hurt, used, etc. He was always surprised when I expressed how I felt, and pretty much made me feel stupid or “making up things to be upset about” for “acting like he doesn’t love me” when the sex was great according to him. Whew. I’m not nuts, he just doesn’t see himself.
I’m glad you found my post! Seems it explained a lot.
And yes, it’s quite possible he does not “see himself.”
If he has ADHD, it might be this is part of the “low insight” that often comes with poorly managed symptoms.
Wow I am blown away by all this, its as if I am seeing things in a completely new light. Recently my wife had been been diagnosed with ADHD and everything that has happened since she has stopped smoking, due to health reasons 4 years ago, and before that time just makes so much more sense. The post orgasm sadness relating to a dopamine drop (she can also get a massive migraine after multiple orgasms), the irritability the next day with statements such as ” I shouldn’t have given you sex” which always surprises me, as I’m in a much better mood why isn’t she? Then to one day just to tell me that she doesn’t want to have sex anymore. It all has an explanation.
At this stage she is still in denial about the diagnosis and refuses to read up or listen to more than 1 podcast on the topic and will not take medication.
I remain hopeful.
I’m glad you found some validation in my post.
Hope is a good thing. To help a partner out of “denial” about having ADHD sometimes takes a little more. 🙂
Thanks for replying Gina
I have joined the blog but hasn’t been approved yet, Im hoping to find some strategies on communicating as now my way of being direct, brings on long and intense emotional outburst that can last for days.
I get to applications as soon as I can. The influx thanks to COVID has been overwhelming.
Yes, many people want to learn better “communications.” That can be part of it. But really, a lot of it can be ADHD symptoms themselves, decades worth of poor coping responses, and misinterpretations all around.
Ah thankyou Gina! That makes sense. I think there’s lots going on. Hopefully I can suss out what’s happening for me. The medication process is most def a rollercoaster!
Yes, and if you’re in the UK, self-advocacy is especially important.