EPISODE · Dec 16, 2025 · 54 MIN
When Sex Therapy Fails ADHD Brains: What the Research Keeps Getting Wrong
from ADHD Realities · host Dr. Leann Borneman
What happens when sex therapy is built for brains that don’t work like yours? In this episode, I sit down with clinical sexologist, researcher, and former dissertation chair Dr. Erika Miley for an unfiltered, deeply nerdy, and very human conversation about ADHD, sexuality, and why so many people—especially cis women and AFAB individuals—are still being failed by the research and clinical models meant to help them. We talk about the massive gaps in ADHD and sexuality research after puberty, the harm of moralized language in scientific literature, and why traditional sex therapy approaches often increase shame instead of pleasure for neurodivergent clients. We dive into attention, arousal, distraction during sex, performance pressure, and what can help ADHD brains stay engaged—without pathologizing them. This conversation is part research deep-dive, part lived experience, and part call-out to the field: if clinicians aren’t trained in neurodivergence, they’re going to miss the mark. Whether you’re a provider, a researcher, or someone with ADHD who’s been told to “just relax” or “be more present” during sex—this episode will make you feel seen and give you language for what’s really going on. More about Dr. Erika Miley: Dr. Erika Miley, PhD, LMHC, CST, is a sex therapist, sex researcher, whose work centers ADHD, neurodiversity, and sexual functioning for AFAB folks. She founded TwoX Labs and teaches clinicians evidence-based, trauma-informed continuing education. An AASECT Certified Sex Therapist and Supervisor in training, she is currently accepting supervisees. She hosts TwoX Labs as well as The Soft Science, both you can find anywhere you get your podcasts and YouTube. Socials: @drerikamiley (Insta, Tiktok, YouTube)
What this episode covers
What happens when sex therapy is built for brains that don’t work like yours? In this episode, I sit down with clinical sexologist, researcher, and former dissertation chair Dr. Erika Miley for an unfiltered, deeply nerdy, and very human conversation about ADHD, sexuality, and why so many people—especially cis women and AFAB individuals—are still being failed by the research and clinical models meant to help them. We talk about the massive gaps in ADHD and sexuality research after puberty, the harm of moralized language in scientific literature, and why traditional sex therapy approaches often increase shame instead of pleasure for neurodivergent clients. We dive into attention, arousal, distraction during sex, performance pressure, and what can help ADHD brains stay engaged—without pathologizing them. This conversation is part research deep-dive, part lived experience, and part call-out to the field: if clinicians aren’t trained in neurodivergence, they’re going to miss the mark. Whether you’re a provider, a researcher, or someone with ADHD who’s been told to “just relax” or “be more present” during sex—this episode will make you feel seen and give you language for what’s really going on. More about Dr. Erika Miley: Dr. Erika Miley, PhD, LMHC, CST, is a sex therapist, sex researcher, whose work centers ADHD, neurodiversity, and sexual functioning for AFAB folks. She founded TwoX Labs and teaches clinicians evidence-based, trauma-informed continuing education. An AASECT Certified Sex Therapist and Supervisor in training, she is currently accepting supervisees. She hosts TwoX Labs as well as The Soft Science, both you can find anywhere you get your podcasts and YouTube. Socials: @drerikamiley (Insta, Tiktok, YouTube)
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When Sex Therapy Fails ADHD Brains: What the Research Keeps Getting Wrong
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