Hyposexuality has been long recognized as a feature of epilepsy in both men and women. Between 30 and 60% of men with epilepsy have reported lack of desire and impotence, and in one study 21% of men with chronic epilepsy had not experienced sexual intercourse. Among women, self reports of dyspareunia, vaginismus and arousal insufficiency are common, and also dissatisfaction with sexual experience. There are a number of potential mechanisms. Clearly the psychosocial difficulties encountered by people with epilepsy could play a part, including stigmatization, lack of self-esteem, restricted life styles, parental over-protection, and depression and anxiety. Biological changes including altered levels of sex hormones (especially free levels) are found in epilepsy, owing to the seizures and to the drug therapy; these too could contribute to sexual difficulties. Seizures involving limbic structures too might be expected to alter sexual behaviour, and there is evidence (albeit inconclusive) that those with temporal lobe epilepsy have a greater degree of sexual dysfunction than those with generalized epilepsy. Antiepileptic drugs can alter the metabolism of sex hormones and affect their protein binding. Epilepsy surgery can also profoundly change, usually lowering, sexual drive. Treatment should begin with a careful analysis of potential causes (some of which may, of course, be quite independent of the epilepsy or its treatment). Psychosexual counselling can be very helpful. Control of seizures and reduction of antiepileptic therapy (including the withdrawal of sedative drugs) may improve sexual functioning, as can individual or couple sexual therapy.
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