Sexual dysfunction in epilepsy: identifying the psychological variables

Souza, Elisabete Abib Pedroso de; Keiralla, Dayse M. B.; Silveira, Diosely C.; Guerreiro, Carlos A. M.

doi:10.1590/s0004-282x2000000200002

Cited by 22 publications

(27 citation statements)

References 19 publications

(24 reference statements)

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“…However, all patients in this study were submitted to psychological and urological evaluations. Previously, Souza et al 35 reported a significant association between sexual dysfunction, anxiety, and depression in male and female patients with epilepsy. Depressive disorders, which are frequently observed in patients with epilepsy 36 , may cause sexual dysfunction.…”

Section: Discussionmentioning

confidence: 97%

Interictal hyposexuality in male patients with epilepsy

Silveira

Souza

Carvalho

et al. 2001

Arq. Neuro-Psiquiatr.

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-The purpose of this study was to compare the serum levels of androgens between hyposexual and non-hyposexual patients with epilepsy. Adult male patients with epilepsy were investigated. Serum levels of testosterone (T) and free-T, estradiol, and sex hormone binding globulin (SHBG) were measured and the free androgen index (FAI) was calculated. While there were no differences between hyposexual and non-hyposexual patients in the serum levels of T, free-T, and estradiol, or to the FAI, the serum levels of SHBG were significantly higher in hyposexual patients than in non-hyposexual patients. Thus, the effects of increased SHBG upon serum levels of testosterone biologically active in patients with epilepsy and hyposexuality were not detected by the methods used in this study. Four (44%) of nine hyposexual patients who were re-evaluated after two years follow-up improved sexual performance. Thus, clinical treatment that results in good seizure control may improve sexual performance in some patients with epilepsy.KEY WORDS: epilepsy, sexual dysfunction, testosterone, and androgens.Hipossexualidade interictal em homens com epilepsia RESUMO -O objetivo deste estudo foi comparar os níveis séricos de andrógenos e estradiol entre pacientes do sexo masculino com e sem hipossexualidade. Níveis séricos de testosterona e testosterona porção livre, estradiol e globulina ligadora de hormônio sexual (SHBG) foram dosados e calculado o índice de andrógeno livre (FAI). Não houve diferença significante de testosterona, porção livre de testosterona, estradiol e de FAI nos pacientes com e sem hipossexualidade. Os níveis de SHBG foram significantemente maiores nos pacientes hipossexuais quando comparados com os pacientes sem hipossexualidade. Deste modo, os efeitos da SHBG aumentada nos níveis séricos de testosterona biologicamente ativa, em pacientes com epilepsia e hipossexualidade, não foram detectados pelo método usado neste estudo. Quatro (44%) pacientes, reavaliados após dois anos de seguimento, tiveram melhora significativa do desempenho sexual. Portanto, o tratamento medicamentoso, com melhor controle das crises epilépticas, pode melhorar o comportamento sexual de alguns pacientes com epilepsia.PALAVRAS-CHAVE: epilepsia, disfunção sexual, testosterona, andrógenos.

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Section: Discussionmentioning

confidence: 97%

Interictal hyposexuality in male patients with epilepsy

Silveira

Souza

Carvalho

et al. 2001

Arq. Neuro-Psiquiatr.

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“…Epilepsy signifies anxiety and depression, low self-esteem and immaturity as a result of the seizure, and this could lead to avoid situations that call for affective sexual involvement. 17,30,31 The prevalence of depression was found to increase among patients having epilepsy with secondary generalization, mainly when correlated with duration of disease, intractability, and polymedication. 17 The high prevalence of performance anxiety (65.9%) among our patients could be attributed to response to the fear of failure and this may result in psychogenic ED.…”

Section: Discussionmentioning

confidence: 99%

“…7,12,14 The resultant neuroendocrine effects with steroid sex hormone alterations may alter epileptogenicity. [15][16][17] Organic etiologies such as vasculogenic erectile dysfunction (ED) were infrequently reported in men with epilepsy. 18 In addition, psychosocial variable can contributed to a great extent as a cause of altered sexual responsiveness in patients with epilepsy.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2005

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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.

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“…The prevalence of depression is increased among patients with epilepsy, mainly when correlated with duration of disease, intractability, and polymedication. 94 Epilepsy signifies anxiety and depression, low selfesteem and immaturity and this could lead to avoid situations that call for affective sexual involvement. 95…”

Section: Hamedmentioning

confidence: 99%