For Teachers & Professionals

Epilepsy and Sexuality

Epilepsy is the fourth most common neurological disorder in the world. Epilepsy is a brain disorder that causes recurring, unprovoked seizures. Seizures may relate to a brain injury or a family trait, but often the cause is completely unknown. Seizures involve sudden, temporary, bursts of electrical activity in the brain that change or disrupt the way messages are sent between brain cells. These electrical bursts can cause involuntary changes in body movement or function, sensation, behaviour or awareness. A person with epilepsy is at higher risk for having recurrent seizures. 

The impact of epilepsy on a person varies depending on different factors like the type, frequency and severity of seizures, the areas of the brain affected, the treatment or underlying brain abnormalities.

Sexual dysfunction is a common comorbidity in people with epilepsy (PWE) that adversely affects their quality of life. Nearly one-half of men and women with epilepsy have sexual dysfunction, but in the majority, this often goes unnoticed. Women generally have dysfunction in the domains of desire, while males usually have arousal disorders such as erectile dysfunction and premature ejaculation. Multiple mechanisms including the direct effects of epilepsy, effects of treatments, and psychosocial factors contribute to sexual dysfunction in epilepsy. 

Sexual health in patients with epilepsy is often disregarded by clinicians, including neurologists, though it is a topic of great importance to both the patients and their partners. Too often, it is believed that sexual function is not as important as the illness itself, while in reality sexuality exerts a great impact on a patient's self-esteem and social life. Nonetheless, sexual well-being and disability are rarely discussed while counselling patients and, when the issue is investigated, it is usually in terms of capacity, technique, and fertility without any reference to sexual feelings. Physicians usually report not being comfortable with discussing sexual issues, including sexual desire and orientation, often because of their poor knowledge concerning the intertwined effect of sexuality and medical illness. Discussing and treating sexual problems enters the framework of a holistic approach, which is mandatory in chronic illnesses such as epilepsy to reach a good quality of life. Prevention and sexual education should help with stereotypes, myths, and misperceptions not only in individuals suffering from epilepsy and their partners but also in the clinicians, who may be unprepared for this essential issue. 

What does the evaluation and management of sexual dysfunction in epilepsy consist of?

Keeping with the multifactorial nature of sexual dysfunction in PWE, the evaluation and management requires a multidisciplinary approach. It should target all the followings:

• Assess all patients for sexual dysfunction using a screening questionnaire.

• Detailed clinical interview and counselling of those screened positive and their partner by a clinical psychologist.

• Screening and management for systemic causes such as hypertension and diabetes.

• Detailed drug history for contributory drugs, if any.

• Screening and treatment for local causes in association with urologists and gynecologists.

• Screening and treatment for associated anxiety and depression by a psychiatrist.

• Comprehensive hormonal evaluation for all patients with sexual dysfunction.

• Improve seizure control by optimizing antiepileptic drug therapy.

• Consider epilepsy surgery in drug-resistant patients.

• Consider testosterone supplements in patients with low testosterone levels.

• In men with erectile dysfunction, consider symptomatic therapy with phosphodiesterase type-5 inhibitor drugs.

• Consider paroxetine for premature ejaculation.

Following this article physicians should acknowledge the importance of regularly quizzing their patients about sexual health.

REFERENCES

Rathore C., Henning O. J., Luef G., Radhakrishnan K., (2019). Sexual dysfunction in people with epilepsy, Epilepsy & Behavior, Volume 100, Part A, 106495, ISSN 1525-5050, https://doi.org/10.1016/j.yebeh.2019.106495.

Calabrò R. S. (2016). Discussing sexual health in patients with epilepsy: Clinicians don't ask, patients sometimes tell!. Epilepsy & Behavior, 55(), 69. doi:10.1016/j.yebeh.2015.12.021

Understanding Seizures. (n.d.). Epilepsy Foundation. Retrieved September 17, 2022, from https://www.epilepsy.com/what-is-epilepsy/understanding-seizures