. 2023 Jun 2;19:1379–1395. doi: 10.2147/NDT.S319980

Table 1.

Summary of Findings for ASD and ADHD from the Systematic Review

	ASD	ADHD
Sexual Orientation and Identity (psychosexual selfhood)	Most studies report higher rates of non-sexual attraction compared with neurotypical peers. One study found significantly lower rates of young people with ASD identified with their sex assigned at birth. Some evidence for within group differences. Females with ASD may have greater sexual ambivalence and higher rates of bisexuality than males with ASD. References:³^,^18–23	Individuals with ADHD did not significantly differ from neurotypical peers in reporting sexual orientation, but they reported significantly greater history of homosexual experiences (especially females). Females were more ambivalent about their gender identity than neurotypical peers. References:^34–36
Sexual Activity and Satisfaction	Findings were mixed regarding group differences in sexual experiences. Some reported lower rates of sexual activity for ASD, others did not. Age may partly explain differences, with some ASD individuals delayed in experiencing early common partnered sexual experiences. Both males and females with ASD perceived themselves to be less sexually attractive than neurotypical peers. No difference between neurotypical/ASD females for satisfaction in their current relationships and sex life. Males with ASD were substantially less satisfied. References:³^,¹⁹^,²⁰^,^22–27	The majority of studies suggest a significantly higher number of sexual partners compared with neurotypical peers. Mediating factors may be comorbid disruptive behavioral disorders, positive bias towards behavioral competence, and high-quality mother-child relationship. ADHD males were more sexually active than neurotypical peers. Compared with neurotypical peers, ADHD males and females were less satisfied with their sex life. References:³⁴^,^36–40
Sexual Dysfunction	Even when controlling for mediating factors, sexual dysfunction appears to be present for both males and females with ASD compared with neurotypical peers. Females report lower sexual excitation, and greater problems across desire, arousal, orgasm, satisfaction, pain, and lubrication sexual functioning domains. ASD males report higher excitation and problems in erectile functioning. References:²⁴^,²⁷	Mixed results – three studies suggest no difference in sexual dysfunction. One study suggests that, compared with neurotypical peers, both males and females report a broad range of sexual dysfunction. The most common for females relate to sexual desire, orgasm, satisfaction, and pain and lubrication. For males, this was erectile dysfunction, orgasmic function, intercourse satisfaction and overall satisfaction. Comorbid anxiety/depression may mediate differences in sexual function. References:³⁴^,³⁵^,⁴²^,⁴³
Sexual Disorders	No studies met inclusion criteria.	Compared with neurotypical peers, there may be greater hypersexual behaviors at sub-clinical level but not at a level of clinical concern. Within group differences suggest hypersexuality in females is associated with impulsivity, temper, affective liability, emotional over-reactivity, and oppositional symptoms. For males, these relate to social attitudes. One study found females report more atypical desires and behaviors for transvestic fetishism and pedophillic desire (very low base rates). Males did not differ from neurotypical peers. References:³⁵^,³⁶
Risky Sexual Behaviors	Findings were mixed regarding age of onset for sexual behavior. One study indicated that those with ASD were younger at first experience, with another study finding the opposite for neurotypical peers. Other studies indicated no differences in age. ASD boys were less likely to use a condom at first time of sexual intercourse (one study only). No studies met inclusion criteria investigating use of contraception more widely, or other RSBs including pregnancy and STI’s. References:³^,²⁰^,²²^,²⁴^,²⁶	Compared with neurotypical peers, young people with ADHD have sexual relations/intercourse at a significantly younger age. One study suggests younger activity relates to females only, while another study found the reverse for males. Mixed findings for contraception use. Some report people with ADHD rarely use contraception. Other studies have found no direct association between ADHD and contraception use; it appears results may differ dependent on definitions used between and within studies. One study of a male-only sample reported 5 times elevated risk of infrequent use of condoms in ADHD males without ODD or CD. Another study reported females with ADHD were less likely to use condoms than ADHD males, neurotypical males and neurotypical females. Disruptive disorders, IQ and alcohol use may be mediators. Compared with neurotypical peers, there is a significant association between ADHD and younger age of pregnancy. Key mediators may be academic achievement, delinquency, and substance use. Long-term ADHD medication use may significantly lower risk of early pregnancy. Mixed findings for STIs. For males only, ADHD medication use may significantly lower risk of developing any STI. References:³⁴^,³⁵^,^37–41^,^44–50
Sexual Victimization	Higher rates of sexual victimization are reported for ASD compared to neurotypical peers. Females are more likely to experience unwanted sexual contact and coercion; around half of young girls with ASD report negative sexual experiences. They are over twice more likely than neurotypical peers to consent to an unwanted sexual event and be subject to an unwanted sexual experience. Sexual orientation may be an influential factor; risk appears to be substantially greater for homosexual females. Males with ASD are more likely to experience rape than their neurotypical peers. Actual sexual knowledge may partly mediate the relationship between ASD and sexual victimization. References:²¹^,²³^,^28–30	Compared with neurotypical peers, individuals with ADHD have higher rates of sexual victimization, irrespective of persisting/desisting symptoms. One study showed the effect is not mediated by theoretically important predictors such as alcohol abuse, illicit drug use and/or history of child abuse. One study found no significant difference in sexual victimization at first sexual experience compared with neurotypical peers. References:³⁵^,⁵¹^,⁵²
Sexual Perpetration	Inconclusive findings due to small sample sizes. References:³^,²⁴^,²⁶^,^30–33	No studies met inclusion criteria.