The Things We Do Not Talk About Enough: Sex, Intimacy and Neurodivergence
- Jun 2
- 18 min read
Updated: Jul 3
Naming what I see in clinic, what the evidence suggests, and why understanding is never the same as excusing.
A note before you read This piece discusses sexual health, exploitation, abuse and sexual violence. Please read it at your own pace, and only if it feels right for you today. Support details are at the end. |
Although sexual health is not my specialist field, it is something I have come to care about deeply, through the people I support and through a longer personal interest in the parts of neurodivergent life that tend to go unspoken. In my clinics the subject surfaces again and again, usually awkwardly, usually wrapped in shame and guilt. People rarely arrive to my clinics wanting to talk about sex. They arrive talking about a relationship that keeps breaking, a pattern they cannot explain, a memory they have never told anyone. Underneath, so often, is something about intimacy, safety and worth.
I felt it important to write about it this sensitive and often painful human experience plainly, because the silence does harm. When no one names a thing, the person living it often concludes that they are the only one, and that the fault is theirs alone. Neither is usually true.
Why a neurodivergent lens
I look at this through a neurodivergent lens because it is the lens of my work and of my own understanding. That choice is not a claim that difficult sexual and relationship experiences belong to neurodivergent people alone, or that they are worse, more real, or more deserving of attention than anyone else's. They are not. Painful, frightening and shaming experiences of sex and intimacy are widespread, and neurotypical people carry them in great numbers too. Nothing here is meant to diminish those experiences or to suggest they matter less.
What a neurodivergent lens offers is not exclusivity but specificity. Some of what follows, the role of impulsivity, of difficulty naming one's own feelings, of masking, of a particular kind of social vulnerability, shows up in distinctive ways when a person's brain works differently, and those specifics are too often missed by services and by the people themselves. Much of what I describe will also be recognised by readers who are not neurodivergent at all, and they are welcome here. If anything in this piece is useful to you, whoever you are, then it has done its job.
One principle before anything else
Understanding why something happens is not the same as excusing it. I want to be clear about this from the very start, because the rest of this piece tries to explain mechanisms, and an explanation can be misread as permission. It is not. A reason is not an excuse. If a person causes harm, cheats, lashes out, or crosses a line that was not theirs to cross, the harm is still real and the responsibility is still theirs. Neurodivergence may help explain, in part, how something came about. It never makes it acceptable, and it never removes accountability. I hold both of these at once, and I would ask you to hold them with me.
Two truths that sit side by side
There are two separate stories here, and they are easy to confuse. The first is about harm done to neurodivergent people. The second is about harm that neurodivergent people sometimes cause. Both are real. It is worth saying clearly, and early, that the research consistently finds neurodivergent people are far more often the ones who are hurt than the ones who do the hurting. Keeping the two stories distinct matters, because the response to each is different. To harm suffered, the honest response is that it was not your fault. To harm caused, the honest response is that it is your responsibility, and that help and accountability belong together.
What may be going on underneath
None of what follows is destiny, and none of it applies to everyone. These are tendencies described in the research, offered to help make sense of patterns, not to label anyone. They also rarely act alone. In real life they overlap and feed one another, so a single difficulty in a relationship often has two or three of these threads running through it at once.
Gaps in knowledge, and who fills them.
Many autistic adults receive less of their sexual education from friends and peers and more from impersonal sources such as the internet and pornography, and report less practical knowledge than their peers. One study found this gap partly explained a raised risk of sexual victimisation (Brown-Lavoie et al., 2014). The problem is not only how much a person knows, but where the knowledge came from. Information absorbed from pornography or from people who do not have your interests at heart teaches a distorted picture of what is normal, what is expected, and what you are allowed to refuse. When a person has not been given clear, trustworthy information about boundaries, consent and what a healthy relationship looks like, they are easier to mislead, and slower to recognise when something is wrong. That gap is not a flaw in the person. It is a failure of the education that should have been offered, and it is one of the few things on this list that can be put right at any age.
Reading people in real time.
Difficulty reading subtle social cues, and a difficulty many neurodivergent people have in identifying and naming their own feelings, can make the unspoken parts of intimacy hard to navigate. Around half of autistic people experience alexithymia, a difficulty putting inner states into words (Kinnaird et al., 2019). If you cannot easily tell what you feel, comfort and consent become harder to track in yourself, not only in someone else. A person may not register that they are uncomfortable until well after the moment has passed, which makes it harder to say no in time, and harder afterwards to trust their own account of what happened. Add difficulty reading another person's intent, and the ordinary, hint-based choreography of dating becomes a guessing game with high stakes. This is also why clear, explicit conversation is such an asset rather than a loss of romance. It replaces guesswork with something a neurodivergent person can actually use.
The pull of the moment.
Impulsivity, a core feature of ADHD for many, can tilt decisions towards the immediate and away from the long view. The research on ADHD and sexuality points to higher rates of risk-taking and to lower relationship satisfaction, with some findings suggesting the impact falls harder on women (Young et al., 2023). A choice that looks reckless from the outside can feel, from the inside, like simply following the strongest signal in the room. The same wiring that can make a person spontaneous, passionate and present can also make a consequence that is hours away feel abstract and weightless next to a feeling that is here now. Understanding this does not remove the consequence, but it does point towards the kind of help that works, which is less about willpower and more about reducing how often the high-stakes moment arises unplanned.
When feelings arrive at full volume.
Emotional dysregulation is now widely regarded as a core part of adult ADHD (Soler-Gutierrez et al., 2023), not a side issue. Feelings can arrive quickly, large, and hard to slow down. Connected to this is what is often called rejection sensitivity, an intense reaction to perceived criticism or rejection. The formal evidence for it as a distinct condition is still thin, and I hold the label loosely, but the experience it describes is one I hear about constantly: a small slight landing like a catastrophe, and the storm of feeling that follows. In relationships this can drive withdrawal, conflict, or a desperate effort to avoid abandonment that paradoxically pushes a partner away. It can also make ordinary relationship friction, the negotiation and occasional disappointment that every couple navigates, feel unbearable, so that a person either avoids closeness altogether or clings to it too tightly. There is also a quieter possibility worth naming. Sex itself can become a way of managing difficult feeling. Some recent research suggests that where ADHD is linked to a very high or preoccupying sex drive, the driver is often not simple impulsivity but distress, low mood and the search for relief, with sex used as a way to self-soothe (Doroldi et al., 2024). Understood this way, what can look from the outside like recklessness or excess may be, on the inside, an attempt to regulate pain. Naming the pattern is often the first relief, because it turns a bewildering overreaction into something with a shape and, therefore, something that can be worked with.
The cost of hiding.
Many neurodivergent people, women especially, learn to mask, to perform a version of themselves that passes as typical. Masking is linked to exhaustion, to poorer mental health, and to a loss of contact with one's own needs (Cook et al., 2021). It also carries a quieter cost in intimacy. It is hard to be truly close to someone while concealing who you are, and it is hard to know your own wants when you have spent years overriding them. A person who has masked for a lifetime may genuinely not know what they like, what they need, or where their limits are, because attending to those things was never safe. In a relationship this can look like compliance, going along with what a partner wants and only later feeling the cost, which is its own quiet route into experiences that were never truly consented to.
A note on identity and orientation
It is worth naming something the research is now fairly clear about, because it is so often misunderstood. Autistic and ADHD adults are, as groups, more likely than their peers to describe their sexual orientation as something other than straight, and autistic people in particular are more likely to identify as asexual, bisexual, or with an orientation outside the usual categories (Weir, Allison and Baron-Cohen, 2021). This is not a symptom, a confusion, or a phase. It is part of the ordinary diversity of human identity, and it does not need fixing or explaining away. Where distress arises around it, the distress tends to come from a world that expects everyone to fit one template, not from the identity itself. Naming this matters, because a neurodivergent person who is also working out their orientation can too easily be told that one is causing the other. They are simply two true things about the same person.
When neurodivergent people are harmed
The same features that make intimacy harder can also make a person more vulnerable to those who would exploit them. Autistic adults, and autistic women in particular, report strikingly high rates of unwanted sexual experiences and sexual violence (Cazalis et al., 2022). Some of this traces back to the knowledge gap described above. Some of it is the work of people who recognise difference and deliberately target it.
It helps to see how the threads from the previous section combine, because vulnerability is rarely about one thing. A person who was never given clear information about consent, who finds it hard to read intent, who may not register their own discomfort until late, and who has learned over years that going along with things keeps the peace, is not naive or weak. They are someone navigating intimacy without the tools most people are handed quietly along the way. Predators are skilled at finding exactly these gaps. A strong wish to belong, after a lifetime of feeling outside, can make the early attention of an exploitative person feel like the acceptance a person has always wanted, which is part of why grooming and coercive relationships can take hold and last.
There is also a painful loop worth naming. Being harmed often deepens the very things that raised the risk in the first place. After an assault or an exploitative relationship, a person may mask more, trust their own judgement less, and withdraw further from the relationships and conversations that might have rebuilt their sense of what is normal and safe. Shame does its quiet work here, keeping the experience unspoken, and unspoken experiences cannot be corrected. This is one reason these patterns can repeat across a life, and it is not evidence of a flaw in the person. It is evidence of an injury that was never given the chance to heal.
One further finding is worth holding in mind, because it cuts against an easy assumption. In the general population, violence tends to fall along familiar gendered lines, with men more often reporting physical violence and women more often reporting sexual violence. Among autistic adults, one study found that this neat pattern did not hold (Gibbs et al., 2023). Autistic men and women alike reported high rates across the full range, including sexual violence, and often more than one kind. The lesson is not to assume who is at risk of what. Vulnerability here does not respect the usual categories, and support should not either.
If this is part of your story, I want to say the thing that so often goes unsaid. It was not your fault. Not because you were too trusting, not because you missed a sign, not because of anything you did or did not understand at the time. Responsibility for harm sits with the person who chose to cause it, every time, without exception. The shame belongs to them, not to you. That shame has been sitting in the wrong place, sometimes for many years, and with the right support it can be set down. Healing is not about becoming harder to fool. It is about being given, often for the first time, the clear information, the affirming relationships and the practised words that let you recognise and refuse what is not right for you. Disclosure has no time limit. Support for something that happened decades ago is as valid as support for something that happened last week.
When neurodivergent people cause harm
This is the harder half to write, and the more important, because it is the part most easily misused. Before anything else, two boundaries. Neurodivergence does not make a person dangerous, and the great majority of neurodivergent people never harm anyone. And nothing in this section reduces the responsibility of anyone who does. I write about it not to explain harm away, but because pretending it never happens helps no one, certainly not the partners and families on the receiving end, and least of all the neurodivergent person who wants to do better and has never been offered an honest non-judgemental conversation about how.
Some of the same mechanisms described earlier, impulsivity, emotional dysregulation, a flooding sense of rejection, can show up as behaviour that hurts other people. An affair begun on impulse with little thought for the person it will wound. Something cruel said in a moment of overwhelm that cannot be unsaid. Controlling behaviour that grows out of a terror of abandonment. In some cases, aggression. Research on ADHD and intimate relationships finds raised rates of conflict and, for some, of partner violence. Notably, the same research tends to find that neurodivergent people are more likely to be on both sides of harm, more often victims and somewhat more often perpetrators than the general population (Merscher et al., 2025), which fits a picture of dysregulation and difficulty rather than of malice, but does not change what is owed to the person who was hurt.
Here the principle from the very start matters most. An explanation is not a defence. Knowing that your emotions run hot, or that an impulse felt overwhelming, or that rejection lands like a physical blow, does not undo the harm and does not move the responsibility elsewhere. Two people can feel the same flood of rage or the same impulsive pull and only one of them acts on it in a way that frightens or betrays someone. The feeling may not be chosen. The response, over time and with support, can be. That is precisely where accountability and responsibility lives.
What the explanation does offer is a map of where the work lies, and that work is real. It tends to mean learning to notice the early physical signs of dysregulation before they crest, building in pauses between impulse and action, treating the underlying ADHD or co-occurring difficulties properly, and, crucially, repairing harm already done rather than explaining it. Seeking that help is not a way of excusing the past. It is one of the most concrete ways a person takes responsibility for it. A genuine reckoning sounds like "I did this, it was mine to control, and here is what I am changing," never "my brain made me, so it does not count." If you recognise yourself here and feel defensive, that is worth sitting with. The wish to be understood and the duty to be accountable are not enemies, but when they compete, accountability has to win. Recognition is a beginning, not an exoneration, and the people you have hurt are not obliged to wait for you, or to forgive you, while you do the work.
Two different kinds of weight
Much of my work in this area comes down to helping people tell apart two kinds of weight they carry. There is shame that was never theirs, handed to them by people who harmed them, or by a world that had no place for them. That weight can be put down. And there is responsibility for harm they have caused, which cannot be put down, but can be faced, repaired where possible, and changed going forward. Confusing the two keeps people stuck. Some carry guilt for things that were done to them. Others avoid accountability for things they did. Healing, in my experience, usually begins with getting these the right way round.
What can help
None of what follows is a cure, and none of it replaces working with someone who knows you. But each of these maps onto one of the difficulties described earlier, and together they tend to move things in the right direction. Pick the one that matches where the trouble actually is, rather than trying to do all of them at once.
For the knowledge gap, get the information that was missed, from a source that is not pornography.
It is never too late to learn about consent, boundaries and what a healthy relationship actually looks like. Neurodivergence-affirming resources, a trusted clinician, or a good book on relationships can replace a distorted picture with an accurate one. Knowing the difference between a healthy and an unhealthy dynamic, in plain and explicit terms, is one of the strongest protective things a person can have.
For difficulty reading the moment, make the implicit explicit.
Direct conversation about wants, limits and consent is, for many neurodivergent people, a genuine strength rather than a loss of romance. Agreeing out loud and in advance is reasonable and kind. Some couples find it genuinely useful to name a pause word, or to agree that either person can stop at any point with no explanation or apology needed. Checking in directly during intimacy, rather than relying on subtle cues, removes the guesswork that causes so much harm. Spelling things out protects everyone in the room.
For knowing your own wants, rebuild the signal slowly.
Where years of masking or alexithymia have buried a person's sense of what they feel and want, the work is patient and low-pressure. Noticing physical sensations of comfort and discomfort outside of any sexual context, learning the early body signs of yes and no, and giving yourself explicit permission to change your mind, all help reconnect a person to information they were trained to ignore. A therapist who understands this can help, and there is no rush.
For impulsivity, build systems, not just intentions.
Willpower in the heat of the moment is the least reliable tool there is, especially for an ADHD brain. It works far better to reduce how often the high-stakes unplanned moment arises. That can mean keeping contraception genuinely to hand rather than relying on remembering, booking regular sexual health checks as a standing routine instead of a decision, and, with a partner, agreeing some things in calmer moments so they are not being decided in the heat of one. The aim is to make the safer choice the easy default.
For emotions at full volume, learn to catch the wave early.
Dysregulation and rejection sensitivity are most workable before they crest. That means learning your own early warning signs, the tight chest or the racing thought, and having a practised plan for that moment: stepping away before responding, a delay rule before sending the message or making the accusation, a way of soothing the body before the storm makes a decision for you. Proper treatment of the underlying ADHD often takes the volume down across the board, which makes everything else easier.
For everyone, find people who understand.
A clinician or therapist who works in a neurodivergence-affirming way will treat these as differences to understand, not faults to be fixed, and that stance alone changes what is possible. Peer community matters too. Hearing other neurodivergent people describe the same experiences is often where shame first loosens its grip (Ginapp et al., 2023).
If you are worried about your own behaviour, ask for help, and mean it.
Doing so is not weakness, and it is not a confession that condemns you. It is the responsible thing to do, and support exists for exactly this, including the services listed below. The measure of that step is whether it comes with changed behaviour and genuine repair, not whether it earns you forgiveness. Asking for help is the start of accountability, not a substitute for it.
If you need support
The most pressing services are listed first. If you are in distress or have been harmed, please start there. The general information and community resources follow.
Urgent and specialist support
Your GP can also refer you to local services. None of these conversations commit you to anything you do not want. |
Information, community and signposting The organisations below offer information, community and signposting. Please confirm the current details on each site, as services change over time.
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What the evidence does, and does not, tell us
I want to be honest about the ground this piece stands on, because it is less solid than the confidence of any single article might suggest. This is a young and uneven field. Much of the research relies on small samples, on people who volunteered for online surveys and may not represent everyone, and on self-report and memory, all of which shape what gets found. There is also a particular gap worth naming. A great deal of older research focused on autistic men and boys, so what we know about autistic women, and about how all of this plays out across genders, is thinner and more recent. These are signposts, then, not certainties, and some of the signposts are newer than others.
What the evidence supports reasonably well.
That autistic and ADHD adults, as groups, report poorer psychosexual wellbeing than their peers, including less satisfaction and more difficulty (Young and Cocallis, 2023). That autistic people experience higher rates of sexual victimisation, and that limited access to trustworthy sexual education is part of why. That difficulty naming one's own emotions is common in autism, affecting around half of autistic people. That emotional dysregulation is a genuine and central part of adult ADHD rather than an optional extra. These findings recur across different samples and different research groups, which is what gives them their weight.
What is suggested but not settled.
That impulsivity drives specific sexual risk-taking, and that the impact falls harder on women. That ADHD raises the likelihood of conflict and harm within relationships, in both directions. That masking damages mental health over time. There is also emerging work suggesting that where sex becomes excessive or preoccupying, distress and low mood may matter as much as impulsivity, with sex used to manage difficult feeling. These findings point in plausible directions, but the studies are mostly correlational, which means they can show that two things travel together without showing that one causes the other. Lower relationship satisfaction and ADHD may both be driven by something else; masking and poor mental health may feed each other in a loop rather than one simply causing the other. The direction of the arrow usually cannot be read from the data we have.
What is still largely unknown.
Rejection sensitivity, as a defined clinical phenomenon, rests on clinical description and lived experience rather than robust trials, and does not appear in the diagnostic manuals, which is why I have been careful to hold it loosely. Almost nothing here has been tested in long-term studies that follow the same people over years, which is what we would need to understand cause, direction and what actually helps. We know very little about what works, as opposed to what goes wrong. And much of the research treats autistic and ADHD people as single groups, which can flatten enormous individual variation and tells us little about any one person, who may recognise all of this, some of it, or none.
Two things follow from this, and I hold them together. The patterns are real and consistent enough to be worth naming, and acting as though they did not exist would leave people without language for their own lives. But they are not precise enough to be applied to an individual like a measurement. So I offer them as a lens for making sense of experience, never as a verdict on a person, and certainly never as a prediction of what someone will do. Where the research is genuinely thin, the honest answer is that we do not yet know, and a person's own account of their life carries more weight than a group average ever could.
A closing thought
If you have read this far, perhaps because some of it felt familiar, I hope you take away two things. You are not the only one. And the shame you may be carrying can almost always be sorted into what was never yours and what is genuinely yours to put right. Both are workable. Neither is best carried alone.
References
Brown-Lavoie, S.M., Viecili, M.A. and Weiss, J.A. (2014) 'Sexual knowledge and victimization in adults with autism spectrum disorders', Journal of Autism and Developmental Disorders, 44(9), pp. 2185–2196. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4131130/
Cazalis, F., Reyes, E., Leduc, S. and Gourion, D. (2022) 'Evidence that nine autistic women out of ten have been victims of sexual violence', Frontiers in Behavioral Neuroscience, 16, 852203. Available at: https://www.frontiersin.org/journals/behavioral-neuroscience/articles/10.3389/fnbeh.2022.852203/full
Cook, J., Hull, L., Crane, L. and Mandy, W. (2021) 'Camouflaging in autism: a systematic review', Clinical Psychology Review, 89, 102080. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10060524/
Doroldi, D., Jannini, T.B., Tafa, M., Del Casale, A. and Ciocca, G. (2024) 'ADHD and hypersexual behaviors: the role of impulsivity, depressive feelings, hypomaniacal symptoms and psychotic prodromes', Journal of Affective Disorders Reports, 16, 100730. Available at: https://www.sciencedirect.com/science/article/pii/S2666915324000155
Ginapp, C.M., Greenberg, N.R., Macdonald-Gagnon, G., Angarita, G.A., Bold, K.W. and Potenza, M.N. (2023) 'The experiences of adults with ADHD in interpersonal relationships and online communities: a qualitative study', SSM - Qualitative Research in Health, 3, 100223. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10399076/
Gibbs, V., Hudson, J. and Pellicano, E. (2023) 'The extent and nature of autistic people's violence experiences during adulthood: a cross-sectional study of victimisation', Journal of Autism and Developmental Disorders, 53(9), pp. 3509–3524. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10465381/
Kinnaird, E., Stewart, C. and Tchanturia, K. (2019) 'Investigating alexithymia in autism: a systematic review and meta-analysis', European Psychiatry, 55, pp. 80–89. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331035/
Merscher, J., Barra, S., Xander, A.M., Patrasc, P.G., Retz-Junginger, P. and Retz, W. (2025) 'Adult ADHD predicts intimate partner violence perpetration and victimization irrespective of gender and age', Scientific Reports, 15(1), 4914. Available at: https://www.nature.com/articles/s41598-024-74222-w
Soler-Gutierrez, A.-M., Perez-Gonzalez, J.-C. and Mayas, J. (2023) 'Evidence of emotion dysregulation as a core symptom of adult ADHD: a systematic review', PLOS ONE, 18(1), e0280131. Available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0280131
Weir, E., Allison, C. and Baron-Cohen, S. (2021) 'The sexual health, orientation, and activity of autistic adolescents and adults', Autism Research, 14(11), pp. 2342–2354. Available at: https://docs.autismresearchcentre.com/papers/2021_Weir_The-sexual-health-orientation-and-activity-of-autistic-adolescents.pdf
Young, S., Klassen, L.J., Reitmeier, S.D., Matheson, J.D. and Gudjonsson, G.H. (2023) 'Let's talk about sex... and ADHD: findings from an anonymous online survey', International Journal of Environmental Research and Public Health, 20(3), 2037. Available at: https://www.mdpi.com/1660-4601/20/3/2037
Young, S. and Cocallis, K. (2023) 'A systematic review of the relationship between neurodiversity and psychosexual functioning in individuals with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD)', Neuropsychiatric Disease and Treatment, 19, pp. 1379–1395. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10243356/
This piece is general information and reflection, not personalised clinical advice. It is written for adults.
A topic often left unspoken. Bringing this to light is so important to the ND individual- when clinicians fail to address, or shy away from this, the ND person continues to feel the shame and uncertainty they often feel in relation to these topics, further perpetuating the negative self concept and perception of being different or broken. Thank you for talking about this in a safe and non judgemental way.