Erectile function, sexual desire, and psychological well-being in men with epilepsy
Introduction
Sexual dysfunction has been reported as an accompaniment of epilepsy since the 1950s [1]. It is often ascribed to the effects of enzyme-inducing antiepileptic drugs, which may cause a fall in testosterone levels [2], [3]. However, this hypothesis ignores the fact that there is not a linear relationship between sexual function and testosterone [4], and some studies have failed to show a significant difference in testosterone levels between men with epilepsy (MWE) and controls [5], [6].
Most studies of sexual function in MWE have concentrated on hormone levels, with a few using questionnaires and interviews to inquire about sexual function [3], [7]. No studies, to our knowledge, have included measurements of self-reported anxiety, depression, and quality of life, all of which play an important part in sexual function. Given that epilepsy imposes a heavy psychological burden [8], [9] on many who have it, this omission is surprising given other studies of sexual function in neurological illness.
Kuffel and Heiman showed women sexually explicit visual material and found that women with depressive mood symptoms reported significantly lower sexual desire than women with normal mood [10]. However, they found no significant difference between the two groups in arousal, orgasm, satisfaction, and pain. Zorzon et al. investigated people with multiple sclerosis with sexual dysfunction and found that relative to healthy controls, they reported significantly more symptoms [11]. The researchers attributed this to both the neurological effects of multiple sclerosis and a significantly lower frequency of depression and anxiety in the healthy control group.
In this study we examined sexual desire, sexual self-efficacy, depression, anxiety, and quality of life in MWE attending specialist outpatient epilepsy clinics who were taking only one antiepileptic drug.
Section snippets
Men with epilepsy
Sixty-nine consecutive men between the ages of 18 and 60 attending specialist epilepsy clinics in the Greater Manchester area were recruited. All had a secure diagnosis of epilepsy, and none had a progressive neurological disorder, endocrine disorder, or other chronic medical condition requiring medication. None of the men were taking antidepressants or drugs for erectile dysfunction. Five men declined to take part: one felt questions about his sexual function were intrusive, one cited lack of
Questionnaires
There were no significant differences between the groups in age, education, or marital status, although there was a trend for more of the control men to be married than the MWE. More control men had children than MWE (Table 1).
MWE had significantly higher HADS Depression and Anxiety subscale scores than controls. As expected, when these two subscales were combined to give an overall psychological distress score, it too was significantly higher than that of the controls, indicating that the MWE
Discussion
Men with epilepsy in this study reported lower sexual desire and rated their ability to become aroused in sexual situations as poorer than that of controls. Their quality of life as measured by the WHOQOL-BREF was poorer than that of controls, and they reported higher levels of anxiety, depression, and overall emotional distress compared with the control group. Interestingly, neither seizure frequency nor marital status appeared to affect how the MWE rated their sexual desire or erectile
Ethical approval
The study had ethics approval from the Salford and Trafford Local Research Ethics Committee for recruitment of MWE and the control group. The authors confirm they have read the journal’s position on issues involved in ethical publication and affirm that this report is consistent with these guidelines.
Conflict of interest statement
Dr. Duncan has received honoraria for speaking engagements from UCB Pharma and Eisai Pharmaceuticals.
Acknowledgments
The authors thank Ms. Melanie Mills and Mrs. Julie McCluskey (medical secretaries) and Mr. Conor Lomas (Neurosciences Service Manager, Hope Hospital, Manchester) without whose administrative skills this study would not have been possible. Hormone analysis was made possible by education grants from Pfizer UK and Sanofi Synthalabo.
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