The sexual and reproductive health in men with generalized epilepsy: a multidisciplinary evaluation

Abstract

EgyptThis study was specifically aimed to evaluate the sexual and reproductive health in a group of men with generalized epilepsy. In total, 44 men with generalized epilepsy were included in this study, their ages between 18 and 48 years (29.279.9) and duration of illness between 2 and 35 years (11.277.4); 34 patients were treated with conventional antiepileptic drugs (AEDs). Sexological and psychological interviews together with serum total testosterone, E 2 , FSH, LH and prolactin were determined. Hyposexuality was diagnosed in 61.4%. Erectile dysfunction (ED) and premature ejaculation represented 70.4 and 66.7%, respectively. Variables such as hyposexuality, seizure duration and its poor control on AEDs were significantly associated with depressive symptoms. Compared to the normal control group, all patients reported elevated E 2 levels (Po0.001), 10 had FSH (n ¼ 4) and LH (n ¼ 6) levels exceeding that of the normal range for controls and two had hyperprolactinemia. Although the patients' mean value of total testosterone remained within the normal range, but it was significantly lower in hyposexual men compared to nonhyposexual (Po0.002), only two epileptic patients had markedly reduced level of total testosterone beyond normal control levels. This study strongly supports that: (1) The risk of hyposexuality and reproductive disturbances is high in epileptic patients with GTC convulsions despite the AEDs utilized. The risk for SD is further increased by poor seizure control and the frequently accompanied depressive manifestations. (2) It is possible that elevated E2 could increase the risk of SD by reducing active testosterone through negative feedback and the reduction of active testosterone could increase seizure intractability to antiepileptic medications.

Seminal fluid analysis and testicular volume in adults with epilepsy receiving valproate

“…Reproductive hormonal and sexual dysfunction occur frequently in men with epilepsy (28-71%) and manifest as decreased libido, erectile difficulties and infertility [2][3][4]. Chronic epilepsy, long-term use of antiepileptic drugs (AED) and psychosocial stresses [2][3][4][5] have all been identified as causes of reproductive and sexual dysfunction in epilepsy. Repetitive seizures may result in disturbed hormonal input from the hypothalamic-pituitary-gonadal (HPG) axis.…”

Sexual Behaviour of Epileptics- A Biopsychosocial Study in Rural South India

“…None of the patients suffered from significant depressive symptoms. [8] Clinical impression during interviews that onus of responsibility for sexual behaviour was mostly vested with men was proved by the statistical differences between men and women. Voluntary reduction in frequency, total abstinence and pattern of sexual behaviour were decided by the male members.…”

“…[5] Interictal sexual abnormalities include hypersexuality, paraphilias and hyposexuality [6] [7] and were associated more often with temporal lobe foci, poor seizure control and depressive symptoms. [8] Hormonal changes, particularly those due to AEDs were related to subclinical hypogonadotropic hypogonadism. [8] [9] But Jensen et al [10] using a biopsychosocial approach concluded that epilepsy did not increase the risk of sexual dysfunction in males or females.…”

“…[8] Hormonal changes, particularly those due to AEDs were related to subclinical hypogonadotropic hypogonadism. [8] [9] But Jensen et al [10] using a biopsychosocial approach concluded that epilepsy did not increase the risk of sexual dysfunction in males or females. Sexual dysfunctions might result from social and psychological factors disturbing sexual responsiveness.…”

Hormon- und Sexualstörungen bei Epilepsie

“…Epileptiforme Entladungen bei Männern sind von einer akuten Prolaktinerhöhung begleitet [56] und können auch von akuten Veränderun-gen der LH-Sekretion begleitet sein [6]. Quigg et al [57] [4,63].…”