The prevalence of severe sexual dysfunction in women with epilepsy was first reported by Bergen et al. in 1992 . Fifty women with epilepsy in a tertiary epilepsy care centre and a comparison group of women of similar age were queried on how often they had the desire for sex, and how often they actually had intercourse. They were asked to respond whether they had a very frequent, frequent, infrequent or very infrequent desire for sex. Equal proportions of women in both groups reported a frequent desire for sex; however, a much greater proportion of women with epilepsy than comparators had very infrequent sexual desire, with about 20% reporting that they almost 'never' had sexual desire. The investigators found no correlation to age, AEDs used, duration of epilepsy or seizure type. This study revealed that many women with epilepsy have normal sexuality; however, significantly more women with epilepsy have markedly decreased sexual desire than would be expected in the general population. In a separate evaluation of sexuality in 57 women with epilepsy of reproductive age, decreased sexual functioning on self-reported questionnaires was associated with phenytoin use, with mild depression, and with low levels of estradiol and dehydroepiandrosterone sulphate .
Orgasmic dysfunction in women with epilepsy has also been reported in several studies. Jenson et al. in 1990 studied sexuality in 48 women with epilepsy and compared their results with their own previously reported data on sexuality in persons with diabetes mellitus and healthy controls . Sexual desire did not differ between the three groups; however, 19% of the women with epilepsy had orgasmic dysfunction compared with 11% of the diabetes mellitus group and 8% of the controls (P = 0.081). None of the women with epilepsy had out-of-range testosterone levels, either free or total, or testosterone-binding globulin levels
. Women with epilepsy reported inadequate orgasmic satisfaction significantly more than controls in a report by Duncan et al. in their study of 195 women with epilepsy from a hospital-based clinic . In another study of self-reported sexual functioning and sexual arousability in 116 women with epilepsy, anorgasmia was also reported by one-third of 17 women with primary generalized epilepsy and 18 of 99 women with localization-related epilepsy. Compared with historical controls, this group of women did not have reduced sexual experience, but reported less sexual arousability and more sexual anxiety .
Decreased sexual functioning in women with epilepsy may also be related to physiological dysfunction related to epilepsy or its treatment. This possibility is raised by a unique set of experiments in which genital blood flow was measured in women and men with temporal lobe epilepsy as they watched either erotic or sexually neutral videos . Genital blood flow was significantly decreased in persons with epilepsy compared with controls; the authors proposed that disruption of relevant regions of cortex by epileptic activity, specifically limbic and frontal areas, could be the cause of sexual dysfunction. An effect of specific AEDs could not be assessed in these studies because of small numbers of subjects.
Bioactive testosterone correlates with degree of sexual interest in women with epilepsy as in normal women. This may be an important factor for sexuality in women with epilepsy. For example, low levels have been correlated with decreased sexual interest in women with right-sided temporal lobe epilepsy .
Although the issue has not been completely explored, AEDs may have an effect on sexual functioning for persons with epilepsy as well. In one provocative report, changing to lamotrigine was associated with improved sexual functioning in 141 women and men with epilepsy, including those who were initiated on monotherapy or switched to monotherapy from another AED .
Impaired sexual functioning that includes decreased desire and orgasmic dissatisfaction in women with epilepsy is likely contributed to by multiple factors. There is evidence for a physiological impairment of sexual functioning related to epilepsy or its treatments, as well as to low testosterone levels. Treatment approaches include assessment of the quality of sexuality for women with epilepsy, and evaluating free testosterone levels for further intervention.
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