Erectile function, sexual desire, and psychological well-being in men with epilepsy

doi:10.1016/j.yebeh.2009.04.028

Epilepsy & Behavior

Volume 15, Issue 3, July 2009, Pages 351-357

https://doi.org/10.1016/j.yebeh.2009.04.028 Get rights and content

Abstract

Objective

The aim of this study was to explore the effects of anxiety, depression, and self-reported quality of life (QOL) on sexual function of men with epilepsy (MWE).

Methods

Sixty-nine MWE taking one antiepileptic drug and 50 controls were recruited. All completed sexual function questionnaires, the Hospital Anxiety and Depression Scale (HADS), and the World Health Organization Brief Quality of Life Questionnaire (WHOQOL-BREF). Blood was taken to analyze testosterone and dihydroepiandrosterone sulfate levels.

Results

Compared with controls, MWE reported higher levels of anxiety, depression, and psychological distress; lower overall quality of life and health; and lower levels of sexual desire and erectile function. Seizure frequency did not affect any of these variables, and testosterone levels did not correlate with sexual desire or erectile function. Simple linear regression showed a significant negative correlation between sexual desire and indices of anxiety, depression, and psychological distress. Multiple linear regression using overall QOL as dependent variable showed that anxiety, depression, psychological distress, and the Psychological Well-Being subscale of the WHOQOL-BREF predicted 48% of its variability. Interestingly, sexual function and seizure status did not.

Conclusion

MWE reported lower levels of sexual desire and were more likely to report erectile dysfunction than controls. But the most important determinant of QOL was psychological status, not seizure frequency or sexual function.

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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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. The wide variation in the reported prevalence of sexual dysfunction in PWE is due to the significant heterogeneity among the studies with regard to patient population, type and severity of epilepsy, number and type of antiseizure drugs (ASDs) used, and the tools used for assessing sexual dysfunction. Generally, patients with uncontrolled epilepsy, longer duration of epilepsy, focal epilepsy, higher seizure frequency, and those receiving enzyme-inducing and multiple ASDs are more likely to have sexual dysfunction. Women generally have dysfunction in the domains of desire, while males usually have arousal disorders such as erectile dysfunction and premature ejaculation. There is limited evidence to indicate that sexual function improves in patients rendered seizure-free following epilepsy surgery. Multiple mechanisms including direct effects of epilepsy, effects of ASDs, and psychosocial factors contribute to sexual dysfunction in epilepsy. Circumstantial evidence indicates that seizures and interictal epileptiform discharges can directly affect the hypothalamic–pituitary axis as well as production of gonadal steroids. Enzyme-inducing ASDs cause sexual dysfunction by affecting the metabolism of gonadal steroids. Limited data suggest that newer ASDs including oxcarbazepine, lamotrigine, and levetiracetam cause no or minimal sexual dysfunction. Depression and anxiety significantly contribute to sexual dysfunction in PWE. A multipronged and multidisciplinary approach is essential for optimizing the sexual functions. Every effort should be made to identify and treat reversible causes including changing to nonenzyme-inducing ASDs and to provide symptomatic relief. Large, prospective studies are required to improve our understanding on prevalence and mechanisms of sexual dysfunction in PWE.
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View full text

Erectile function, sexual desire, and psychological well-being in men with epilepsy

Abstract

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Men with epilepsy

Questionnaires

Discussion

Ethical approval

Conflict of interest statement

Acknowledgments

J Steroid Biochem Mol Biol

Epilepsy Res

J Psychosom Res

J Sex Med

Étude du Comportement sexuel chez les epileptics psychomoteurs

Ann Med Psychol (Paris)

Differential effects of anti-epileptic drugs on sexual function and hormones in men with epilepsy

Neurology

Circulating hormones and pituitary responsiveness in young epileptic men receiving long term anti-epileptic medication

Epilepsia

Sexual function in men with epilepsy: how important is testosterone?

Neurology

Sexual dysfunction in male and female patients with epilepsy: a study of 86 outpatients

Arch Sex Behav

Anti-epileptic drug therapy and sexual function in men with epilepsy

Epilepsia

The psychiatric co-morbidity of epilepsy

Acta Neurol Scand

Effects of depressive symptoms and experimentally adopted schemas on sexual arousal and affect in sexually healthy women

Arch Sex Behav

Sexual dysfunction in multiple sclerosis: a case–control study. I. Frequency and comparison of groups

Mult Scler

The hospital anxiety and depression scale

Acta Psychiatr Scand

World Health Organisation WHOQOL-BREF quality of life assessment: psychometric properties and results of international field trial. A report from the WHOQOL group

Qual Life Res

The sexual desire inventory, factor structure and evidence of reliability

J Sex Marital Ther