Sex and Intimacy: A Conversation with Sari Cooper, AASECT Certified Sex Therapist, and Founder of Center for Love and Sex by Scott Shapiro, MD Adult ADHD Psychiatrist NYC

Scott Shapiro (SS): Sari, thank you for taking the time to speak with me. Your work at Center for Love & Sex and your Sex Esteem® framework is very well respected. Let’s start discussing the presenting problems that impact both my clients and yours. Many adults with ADHD struggle with sustaining sexual intimacy. From your perspective, what are frequent sexual disorders you treat when clients with ADHD come in for sex therapy?

Sari Cooper (SC): Thank you, Scott — I’m glad we’re having this conversation. When the symptoms of ADHD impacts the realm of intimacy and sex, several patterns tend to emerge. First, the distractibility, impulsivity or hyper‐focus that characterize ADHD often spill into relational and erotic encounters. In partnered sex, a person’s attention may drift away emotionally and/or physically during sex leaving them without enough erotic energy or physical stimulation to keep them engaged with their partner or the sex going on.

On the flip side, a client with ADHD may shift into hyper-focus so that they are solely interested in increasing the erotic energy of a fantasy in their own mind, focusing on their own sexual ‘performance’, or concentrating entirely on the physical stimulation they’re receiving and subsequently neglecting to ask their partner about their needs. These symptoms can lead to the partner of the person with ADHD to feel like they’re
not emotionally connected to them during sex, just a bystander to the other’s sexual maneuvers,
or that the sex is mechanical and without an authentic give and take. Some of these ADHD
symptoms result in sex therapy disorders like: Erectile Dysfunction, Premature or Uncontrolled
Ejaculation, Delayed Ejaculation or compulsive sexual behavior with partners, sex workers
and/or pornography.

SS: I treat ADHD clients who tend to report a lot of difficulties in their dating and romantic
relationships. What relationship dynamics do you see when working with couples in sex
therapy?

SC: Oftentimes, communication with partners about one’s desire, arousal or sexual needs either
doesn’t happen at all or it is expressed in angry arguments due to repressing one’s needs for a
longer time. The person with ADHD may also miss cues from their partner, interrupt when the
partner is verbally or non-verbally making a request, or offer inconsistent availability, which
their partner could experience as rejection or unpredictability. Over time, sex can become
(unwittingly) a way of managing ADHD symptoms — for example chasing novelty, sensation or
distraction, which works short-term but can at times erode trust and sustained connection with a
dating or primary partner or spouse.

SS: How have you seen ADHD impacting the deteriorating of trust in a couple?

SC: Quite frequently my Center for Love and Sex Associate Therapists and I work with clients
who have broken their monogamy agreements by having sex with outside partners, sex workers
or massage therapists who offer sexual services. Sometimes these clients come in for individual
sex therapy with the hopes to stop their compulsive or hypersexual behavior and other times they
come in with their partner after a betrayal or a pattern of longstanding infidelity has been
discovered.

At my practice, I use the Sex Esteem® model to help clients recover from Out of Control Sexual
Behavior, repair broken trusts, learn the importance of rebuilding erotic consent, body literacy,
and relational erotic communication skills — all of which are crucial for couples when one or
both partners have ADHD and there has been infidelity and/or a breakdown in sexual intimacy
over time.

SS: You’ve spoken frequently about “body literacy” and somatic awareness. How does that translate
for someone whose ADHD brain often leaps ahead, misses internal signals, or is constantly
sprinting from one stimulus to the next?

SC: Exactly. When the ADHD brain is racing, it may not register how the body is actually responding
— arousal, relaxation, tension, shutdown or disassociation. My invitation is: Slow down enough
to feel the body’s responses. Notice your breath, your muscle tone, the quality of contact, the
rhythm of your arousal, and the invitations to pleasure versus avoidance. This isn’t about adding
yet another task to your life; it’s about cultivating the habit of tuning in. As a former professional
modern dancer and current yogi and mindfulness practitioner, I find helping clients notice and
understand what their bodies are experiencing in the moment a key skill for them to begin
identifying the longing, anxiety, ambivalence or a dtraumatic trigger that may be hard for them to
express verbally.

In practice, I’ll ask clients when either their partner or I have asked a question and I see their
body tightening up: “What do you feel in your belly or your chest right now?” Or: “When your
mind jumped ahead to the next thing, did your body stay with you or did it check out?” For
adults with ADHD, building internal awareness becomes a cornerstone for sustainable sexual
and erotic intimacy.

SS: Let’s talk about couples: one partner has ADHD, the other doesn’t. What are the unique
challenges in their sexual relationship, and what interventions do you recommend?

SC: One of the biggest challenges is syncing the erotic rhythm and availability. The ADHD partner
may have bursts of arousal, followed by long periods of disconnection; the non-ADHD partner
may feel rejected or “on hold.” Over time this can lead to resentment, shame, or the non-ADHD
partner giving up on attempting to initiate because they’re tired of frequently being turned down
by their partner, which results in their feeling rejected.

A couple of sex therapy interventions I utilize include:

1. Creating a ritual of connection (e.g., touch or non-sexual playful contact) that precedes
   erotic contact — this builds safety, slows down the brain’s jump ahead mechanisms.
2. Using check-in language: each partner shares what they want and what they need (not
   just in the moment of sex but pre-sex and post-sex).
3. Building mini-arousal windows rather than expecting a big ignition. For instance:
   planned 10-minute connection time five times a week rather than waiting for “the big
   night.”
4. Providing psychoeducation to both partners (if they’re in couples sex therapy) on
   ADHD’s impact on sexual functioning: how it affects time, follow-through, novelty
   seeking, and relational friction — framing it as neurodiversity, not as “you” versus “me.”
   These steps help rebuild erotic trust, communication, and anticipation.

SS: Your work often addresses shame, sexual avoidance and the internal narrative of “I’m broken.”
In the ADHD world, many individuals feel that same “I should be able to do it better” story. How
do you help clients and couples shift that internal narrative in the context of sex and intimacy?

SC: Yes — the sexual shame narrative is like the twin of the ADHD narrative. “If only I could sustain
focus, be available, be the lover I imagine, then I’d feel okay.” I invite clients to adopt a curious
rather than judgmental stance. “What is my ADHD brain doing in this moment? What is my
body doing?” Then we link that to the erotic self-agency model of Sex Esteem®: you are the
expert on your body and your pleasure, you have permission to ask for what you want, you have
the right to shape your erotic life. And, teaching a person skills on how to better listen to their
partner’s desires and needs without taking it so personally if they’re different from yours. If the
ADHD spouse or partner has a partner without ADHD, they may have set up a pattern in
which they’re unknowingly ignoring bids for intimacy, requests for changing the ramp up speed
and subsequently contributing to the non-ADHD partner’s resentment and lower desire.

Shame shrinks you. Curiosity expands you. So I offer exercises like: “Name one thing your
ADHD brain helped you in the bedroom this week. Ask your partner how they would like to get
intimacy started or what they regard as a peak sexual experience with you?” It might be novelty,
spontaneity, creating more romantic dates, exploring one another’s fantasies. Then we reframe
distraction or interruption not as failure, but as a signal: What is my system asking for right now
and how can I express that as a request of my partner?

SS: Finally, for readers and clients dealing with ADHD in their sexual life: what are three concrete
practices you suggest starting this week?

SC: Certainly.

1. Sensate Pause Lite: Choose one five-minute window this week where you and your
   partner (or you alone) engage in non-goal-oriented touch — no orgasm goal, no
   “performance” — just noticing touch, warmth, breath, connection.
2. Arousal Journal: At the end of each day, jot down one moment when your body felt
   alive (even if the mind was elsewhere). What triggered it? How did you feel? This builds
   internal attunement to your body’s cues.
   3. Pre-Erotic Check-In: Before you intend to have sex (or connect erotically), pause and
   ask: “What do I want? What do I need? What might interfere (e.g., distraction, worry,
   shame)?” Then share that with your partner. It invites permission, slows the ADHD
   jump-ahead reflex, and plants erotic intention. Then ask your partner: What did you have
   in mind today? How’s your body and mind feeling? Are there things you’re just not up to
   tonight?

These practices anchor your body-mind system, invite connection, inspire true consent
and begin to shift the pattern from reaction to response.

SS: Sari, this has been fantastic. Thank you for your insights and for helping bridge the fields of sex
therapy and neurodiversity. Any final message you’d like to leave our audience with?

SC: Thank you, Scott. My final message: Whether you’re living with ADHD, you love someone who
is, or simply want richer erotic connection — remember: your sexuality is not a problem to be
fixed; it is a resource to be reclaimed. You deserve to know your body, your pleasure, your
relationship. And with curiosity, communication and compassionate practice, intimacy can
become a space of growth, joy, and mutual vitality.