ADHD, Autism, and Painful Sex

What do ADHD and autism have to do with pelvic pain, vulvovaginal pain, and painful sex? Believe it or not, a lot! 

Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are two of the most common types of neurodivergence (an umbrella term encompassing ADHD, ASD, OCD, bipolar disorder—often affectionately termed "neurospicy").

ADHD, a neurodevelopmental disorder characterized by inattention, hyperactivity, and/or impulsivity, is thought to affect about 6.76% of adults globally.

Autism is also a neurodevelopmental disorder, affecting how people communicate, learn, behave, and relate to others. Autism prevalence, however, is a little trickier to nail down because of diagnostic changes, access to health care, and how it's surveyed. Given more recent data, an estimated 0.63% or up to 2.21% of US adults have autism. When we look at recent CDC data, up to 3.2% of 8-year-olds in the US have autism. Then, when it comes to global prevalence, .72% of adults worldwide have ASD, with lower income countries reporting lower rates of autism.

Research on these conditions have revealed myriad ways that they impact brain function. They’ve also revealed a phenomenon that researchers and medical professionals have struggled to explain: neurodivergent people are more likely to have chronic physical health problems than neurotypical people. 

In the 1990s and early 2000s, researchers began identifying health patterns in children with autism and ADHD. Namely, they found associations between:

• Autism and chronic gastrointestinal issues (like GERD, diarrhea, constipation, abdominal pain, and bloating)
• ADHD and asthma
• Autism/ADHD and allergies
• Autism/ADHD and developmental coordination disorder (also known as dyspraxia, a chronic condition where movement and coordination is more difficult)

Research conducted within the past decade has revealed that the connections between neurodivergence and chronic health issues a) can persist into adulthood and b) are even more plentiful than previous research indicated. 

A study published in 2023 reported that autistic people may experience higher rates of chronic conditions in every single organ system than their neurotypical peers (from PCOS/PMOS and endometriosis to Ehlers Danlos Syndrome and Chronic Fatigue Syndrome to IBS and eczema).

Unfortunately, there's no singular study looking at common comorbidities across all organ system for adults with ADHD. But we do know that ADHD is may be associated with a whole host of other chronic conditions, including: mental health conditions (like anxiety and eating disorders), sleeping disorders, eczema, EDS, and there's some evidence to support a link between ADHD and PCOS/PMOS and endometriosis. 

It's about to get a little complicated — so stick with us!

While the research still has a ways to go, the studies we have tell us that women and people with vaginas who have autism fare worse across all domains of the FSFI (desire, arousal, lubrication, orgasm, satisfaction, and pain). Meanwhile those with ADHD are more likely to report difficulty with orgasm, lubrication, satisfaction, and pain.

Quick aside: Autism and sexuality have largely gone unstudied both because of under-diagnosis and the notion that people with disabilities don't have sex. ADHD, on the other hand, has had a fair bit of attention in sexual health research—but only in regards to sexual risk taking, "hypersexuality," and paraphilias. 

Multiple studies have reported that autistic people and people with ADHD are more likely to experience menstrual issues including dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder. As previously mentioned, they’re also more likely to have endometriosis or PCOS/PMOS, both of which can contribute to chronic pelvic pain and pain during sex. 

If you've been on the internet lately, you've probably heard about hypermobile Ehlers Danlos Syndrome (hEDS) and/or Hypermobile Spectrum Disorder (HSD)—connective tissue disorders that contribute to joint instability with varying degrees of severity. Unlike HSD, EDS encompasses more than a dozen different genetic conditions that all impact the body’s connective tissue through collagen production. Both conditions cause chronic pain throughout the body and are often associated with autonomic nervous system (ANS) dysfunction—otherwise called dysautonomia. 

And, since you're reading this, you've probably also heard about their connection to autism and ADHD. But how did we even figure that out?

A 2024 study that included 74 women seeking treatment for genitopelvic pain found that almost 33% of those women also fit the criteria for hypermobility syndromes. A study published in 2025 found that pelvic floor disorders were far more common in women with EDS than women without the condition. A small 2026 study found that the participants with hEDS all had provoked vestibulodynia (pain at the vaginal opening that is provoked by something like insertion of an object, sex, or even wearing tight clothing). This pain is thought to be due to a hypertonic pelvic floor or Mast Cell Activation Syndrome (MCAS), a kind of mast cell activation disorder (MCAD), which are also quite common among people with HSD or hEDS. 

TLDR; neurodivergent people are more likely to be hypermobile, and hypermobile people are more likely to experience pelvic pain and pain during sex, probably because of pelvic floor dysfunction caused, at least in part, by hypermobility. 

Several studies have demonstrated that when inflammation sticks around for a lot longer than it's meant to, the body’s inflammatory response begins to overreact. This leads to even more inflammation, which in turn, leads to chronic pain and illness. 

Emerging research is exploring the possibility of a connection between neurodivergence and increased levels of systemic inflammation. A study published in 2023 found that children with Autism and ADHD both had higher inflammatory markers in their bloodstreams than neurotypical children. In a 2025 study, researchers discovered that blood samples taken from adults with ADHD showed signs of chronic inflammation. 

And remember when we talked about mast cell disorders earlier? Well, mast cells are a kind of immune cell that help us fight infections and are involved in allergic responses, often responding to bodily invaders with something called an inflammatory cascade (which is a good thing, unless of course the mast cells are freaking out over nothing—thanks, allergies). 

Mast cells have been implicated in the development of autism as well as some of its comorbidities, like GI issues. People with MCAS have also been found to be more likely to have a variety of conditions, including ADHD.

Though the research is still too new to draw any definite conclusions, if neurodivergent people are more likely to have chronic inflammation (which could be related to hypermobility), then that could be part of the reason why so many neurodivergent people have chronic health issues (including pelvic and genital pain).

Sensory issues, like sensory dysregulation, is common among autistic people. In a small, qualitative study, it was found that sex can be painful for some people because the sensations (like texture or sound) can be overwhelming. People reported having more enjoyable sex when they were able to manage overstimulation and sensitivity—but it's not always so easy, as emotions can be difficult to identify in real time and sensory needs can change throughout a sexual encounter.

A similar experience has been reported in adults with ADHD—including both hyposensitivity and hypersensitivity, to the point of pain or disgust.

According to Mastrocola, several neurodivergent traits can contribute to disrupted bladder habits, including:

• Reduced awareness of bladder signals
• Hyperfocus that delays bathroom trips
• Stimulant use
• Low fluid intake
• Frequent holding of urine

Over time, these habits can increase the risk of UTIs, urge incontinence, and pelvic floor hypertonicity.

Mastrocola added that neurodivergent people’s bathroom habits can lead to pelvic floor issues in other ways as well. If you’re neurotypical, you’ve probably never thought about all the social cues you need to navigate to find and use a bathroom when you’re not at home. For neurodivergent people, these situations can be so overwhelming that they just don’t use the bathroom. Of course, this means holding it until they get home, which involves prolonged tensing of the abdominal and pelvic floor muscles. Over time, this can contribute to an overactive pelvic floor. 

In addition to difficulties interpreting the body’s natural signals, many neurodivergent people also have trouble coordinating how they move and use their bodies. This can show up as trouble with balance or frequently bumping into things, and neurodivergent people often adjust the way they move their bodies to compensate. 

Mastrocola noted that neurodivergent people are more likely to experience:

• Gait variability
• Toe walking
• Reduced abdominal stability
• Increased anterior pelvic tilt (APT)

“These biomechanically can overload the pelvic floor and increase the likelihood of hypertonicity.”

The unsteadiness of their movement patterns often causes excessive tensing and gripping through the core muscles. Over time, this can change breathing patterns, shorten the muscles, and create even more strain on the pelvic floor. 

To sum up, neurodivergent folks are more likely to have issues with body mechanics that contribute to pelvic floor dysfunction and they’re more likely to have chronic health conditions that also contribute to pelvic floor dysfunction. 

Even with all this research that points to a strong connection between neurodivergence and chronic health conditions like pelvic pain and/or pain during sex, we still don’t understand where all the pieces fit. 

Is there a common underlying factor that could cause neurodivergence and connective tissue disorders like HSD and EDS? 

Are higher levels of chronic inflammation a causal factor in neurodivergence and chronic pain/illness? Or are the co-occurring conditions neurodivergent people are more likely to have (HSD, EDS, PCOS/PMOS, endometriosis, allergies, asthma etc.) causing chronic inflammation? Or is there a secret third thing? 

People with many more letters behind their names than us are going to have to keep working to figure all that out!

What we can say is that if you’re neurodivergent and dealing with pelvic pain or pain during sex, it’s worth talking to a medical professional about the potential connection between those things.