Sexual function and epilepsy

©Michail Petrov - stock.adobe.com

A study in Epilepsia evaluating sexual problems in patients with well‐controlled and mostly refractory epilepsy found that these individuals report a significantly higher frequency of problems with orgasm, dyspareunia and feelings of sexual deviance (not defined in the study), compared to the general population.

In contrast, the study concluded that rates of reduced sexual desire, climax and vaginal dryness were similar in both groups. “The potential impact of epilepsy on sexual function is important for patient welfare, but often neglected,” wrote the Norwegian researchers.

The study consisted of 221 adult inpatients and outpatients, mostly with intractable epilepsy, from the National Centre for Epilepsy in Norway, and 78 outpatients with well‐controlled epilepsy at Lillehammer hospital. Of the mostly refractory epilepsy cohort, 130 (58.8%) were female, with a mean age of 39.1, whereas 47 (60.3%) of the well-controlled epilepsy group were female, with a mean age of 43.3. Between 2015 and 2017, patients filled out a questionnaire on sexual function, plus information on their individual epilepsy.

The results were compared to equivalent data on sexual function among 1,671 adult Norwegians in the general population. In the general population group, 776 (46.4%) were women, with a mean age of 42.6.

No epilepsy‐related factors could be identified as specific predictors of sexual function. For example, after controlling for gender, the investigators found no significant association between sexual problems and seizure control or use of enzyme‐inducing antiepileptic drugs (AEDs).

Regardless of gender, significantly fewer patients with epilepsy were satisfied with their sex life versus satisfaction among the general population.

In women with epilepsy, being over the mean age (odds ratio [OR] 2.762; confidence interval [CI]: 1.122 to 6.802; P = .027) and having quality of life (QoL) under the mean (OR 2.777, CI: 1.027 to 7.518; P = .044) were two significant independent variables associated with feelings of sexual deviance.

Feelings of sexual deviance were connected to lower QoL as well, which the authors pointed out is “a rather nonspecific type of sexual problem and may simply reflect that psychological factors are involved in perceptions of sexuality, rather than indicating a specific problem.” But the perception of sex as an important part of daily life was comparable between women with and without epilepsy

Another finding of the study is that patients with refractory epilepsy asked more often for professional help to address sexual problems than those with well‐controlled epilepsy. As for other risk factors associated with sexual dysfunction, in women with epilepsy, being over the mean age (OR 2.744; CI: 1.308 to 5.757; P = .008) and having a Neurological Disorders Depression Inventory for Epilepsy (NDDI‐E) score over 14 (OR 3.904; CI: 1.692 to 9.009; P = .001) were significant independent variables associated with reduced sexual desire.

 “A decreased physiological response to sexual stimuli in women with epilepsy has been suggested as a possible explanation for vaginal dryness,” the authors wrote. Besides the effect of AEDs on the neuroendocrine regulation, sexual dysfunction might be caused by the epilepsy itself.