Background: Attention Deficit Hyperactivity Disorder (ADHD) has historically been associated with hyperactive boys, leaving women underrepresented in research, including in sexual and reproductive health (SRH). In this thesis the perspectives of young women with ADHD and health care professionals (HCPs) will be used to explore SRH in young women with ADHD and identify health care strategies that may support informed bodily autonomy, safe sexual experiences free of judgment, healthy relationships and equitable access to SRH services.
ADHD is a common neurodevelopmental condition characterized by inattention, hyperactivity-impulsivity or both, affecting daily functioning. Gender-specific symptom presentation and comorbidities often delay diagnosis and access to care for young women. Compared with neurotypical peers, young women with ADHD are more likely to engage in sexual risk-taking behaviors, experience relationship conflicts, and report sexual dysfunction, contributing to higher rates of unplanned pregnancy, sexually transmitted diseases (STI), and lower relationship quality. Anxiety, depression, low self-esteem, and cultural norms around sexual behavior, may further impact SRH.
Aim: To explore SRH in young women with ADHD and to identify and describe health care strategies that may contribute to SRH.
Method: In the first two studies qualitative interviews were conducted with young women with ADHD (study I) and HCPs (study II) from psychiatric, gynecological, and youth clinics. Both studies were analyzed using reflexive thematic analysis. In study III, phenomenography was used to address a new research question based on data from studies I and II. Study IV was performed as a Delphi study. An online survey, developed from the findings in studies I-III and previous literature, was distributed in two rounds to young women with ADHD and HCPs in psychiatric clinics, school health, youth clinics and sexual health clinics. Data were analyzed using descriptive statistics.
Findings: Impulsively acting on emotions, fluctuating emotions and challenges with maintaining focus could lead to unprotected casual sex, relationship struggles, and difficulty concentrating during sex, while spontaneity and curiosity helped women find partners and expand their sexual knowledge (studies I, II). Low self-esteem, due to living with ADHD, could contribute to difficulties expressing needs in intimate situations and fear of rejection in relationships (studies I, II). Some women reported shame after being judged for breaking sexual norms, which discouraged them from seeking care (studies I, II). HCPs noted that societal expectations could lead to self-blame when women felt unable to manage sexual situations or relationships (study II). SRH experiences varied depending on comorbidity, life circumstances, timing of diagnosis, and support from family and health services (study II). Supportive partners improved acceptance and relationship quality (study I).
To provide reliable support, HCPs needed to facilitate trust through involvement and non-judgmental encounters (studies III, IV). Organizations could enable this by ensuring sufficient time and staffing, continuity, routines for discussing SRH, and training for HCPs on SRH and ADHD (studies III, IV). Accessibility could be assured through targeted information for young women with ADHD, flexible clinic hours, varied appointment formats, and coordinated care (studies III, IV). Structured visits may enhance focus and information uptake. Early ADHD diagnosis was believed to enable treatment and support that could help prevent sexual risk-taking and low self-esteem (studies I, III, IV). Self-knowledge helped with self-acceptance and with developing strategies for sexual satisfaction and risk reduction (study I).
Conclusions: Living with ADHD may contribute to positive sexual experiences and sexual knowledge for young women; however, ADHD symptoms, social norms, and low self-esteem may negatively affect SRH. To individualize SRH support, HCPs need to consider variations in functional ability, existing coping strategies, comorbidity, and life circumstances. Tailored, accessible care; early recognition of ADHD-related functional impairments in girls; and organizational conditions that promote accessibility and trust can help ensure that young women with ADHD receive appropriate support and have equal opportunities to exercise their sexual and reproductive rights alongside their neurotypical peers. The findings may further inform the development of clinical guidelines for SRH promotion in young women with ADHD, as well as emphasizing SRH strategies in existing clinical guidelines concerning ADHD management.