Sexual dysfunction and attention-deficit/hyperactivity disorder: A systematic review of bidirectional associations

BACKGROUND: Sexual dysfunction (SD) and attention-deficit/hyperactivity disorder (ADHD) are both prevalent in adults yet remain underdiagnosed, and their potential association has only recently received systematic attention. Emerging studies suggest a bidirectional link, but findings are heterogeneous across instruments, samples, and definitions. METHODS: We conducted a systematic search of PubMed/MEDLINE, ScienceDirect, and Google Scholar from inception to February 2025. We included observational studies of adults (≥18 years) reporting either SD in ADHD populations or ADHD in SD populations. Two reviewers independently screened and extracted data. Study quality was appraised with the modified Newcastle-Ottawa Scale. The review followed PRISMA guidance and was prospectively registered (PROSPERO CRD42024617591). RESULTS: Thirteen studies met inclusion criteria (sample sizes 64-943). In ADHD cohorts, the highest reported SD prevalences were 67.7% for female orgasmic dysfunction and 39% for premature ejaculation (PE) in men. In SD cohorts, ADHD prevalence reached 34.6% in women with orgasmic disorder and ∼42% in men with PE (versus 3.7-5% in controls). While most studies indicated a positive association, several reported no significant differences. Heterogeneity in measures and designs precluded quantitative pooling. CONCLUSIONS: Current evidence supports a probable bidirectional association between SD and ADHD in adults. Routine, reciprocal screening should be considered in psychiatric and sexual-medicine settings. Standardised, multicentre protocols using validated instruments and structured ADHD assessment are needed to refine estimates and clarify mechanisms.