Sexual dysfunction can be a part of several chronic medical disorders and epilepsy is one of them. Epilepsy has been reported to be associated with an increased rate of sexual problems as compared to general population. The exact prevalence of sexual dysfunction reported in patients with epilepsy (PWE) is not well studied. Epilepsy has been linked to a decline in sexual function in a number of epidemiological and clinical investigations. It often takes deliberate efforts as part of the screening and therapy process to identify this sexual dysfunction in epileptic individuals. As a result, accurate assessments of the prevalence of treatment-related sexual dysfunction in patients with epilepsy are currently available. Sex may be affected by hormone levels, anatomical changes in the brain, and drugs for epilepsy. Epilepsy anxiety may also affect a person’s sexual life.
The mechanism by which epilepsy contributes to sexual dysfunction is complex. It can be a result of the changes in the brain networks which cause epilepsy. It may also be a result of changes in sex hormones and due to anti-seizure medications. Psychiatric disorders like depression, anxiety that are commoner in these patients can also cause sexual dysfunction.
The degree of sexual problems may also vary including loss of libido, problems with interest and arousal, orgasm , pain during intercourse in women and the common problem of Erectile dysfunction in men.
Patients with refractory /poorly controlled epilepsy, usually report less satisfaction with their sex life than general population. The older generation antiepileptic drugs have been shown to be be associated with little higher rates of sexual dysfunction as compared to the newer drugs.
However apart from these problems mentioned, there is no data to suggest lower rates of fertility in men/ women , no negative impact on sperm quantity and quality in PWE , implying they can lead a normal healthy married life .
The following are a few potential causes of issues with epilepsy and sex:
· Anti-epileptic medicines: Some anti-seizure drugs are known to have an impact on a person’s libido. Consult your doctor if you think your sexual drive has diminished while starting a new seizure medication.
· Hormones and seizures: Our brains release hormones when we feel sexually arouse. Epileptic seizures, according to some researchers, may alter the way these hormones are released in the brain.
· Types of seizures: Sexual issues are more common in people with certain types of epilepsy. Sex problems are more common in people whose epilepsy begins in the temporal lobe because it can interact with areas of the brain that control sexual desire.
· Factors psychological: The sex drive of epileptics may also be affected by psychological issues. Having epilepsy can make you feel depressed and anxious, which makes you less likely to want to have sex. People’s sexual desire and self-esteem may also be affected by epilepsy.
Management of these issues requires an active participation and accurate reporting of these symptoms by the patient to the treating doctor. Various approaches which might be helpful include:
· Behavioral approaches to enhance sexual performance, involving a clinical psychologist in the management.
· Dose reduction of current medications as per the need/ shifting to newer safer anti epileptic drugs
· Daily exercise including yoga/ meditation
· Avoid of smoking/ alcohol
· Oral medications and even some procedures can help patients with ED , under supervision of a urologist
To conclude sexual dysfunction is common in epilepsy and can impact overall quality of life. Proper reporting and management can help these patients lead a fuller healthy life. The pathophysiology of epilepsy and the administration of AEDs have an impact on sexual function. The status of the patient’s sexual function should be discussed as part of the initial routine assessment and with any treatment-related follow-up in order to maximise the quality of care for patients with epilepsy and those with other disease conditions who get AEDs. Raising patient awareness, educating and training clinicians about sexual dysfunction, and getting a baseline sexual history from the patient are critical recommendations for minimising the impact of AED-related sexual dysfunction. In order to investigate the risk and mechanism of such treatment-related side effects on sexual function, systematic studies are also required.
Source: mirchi.in, Dr. Amit Batra