Self‐Reported Sexual Function and Sexual Arousability in Women with Epilepsy

Morrell, Martha J.; Guldner, Gregory

doi:10.1111/j.1528-1157.1996.tb00554.x

Cited by 87 publications

(48 citation statements)

References 29 publications

(22 reference statements)

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“…Women with primary generalized epilepsy reported decreased arousal, more anorgasmia, and dissatisfaction. There was no correlation with coexisting depression, sexual experience, AED use, seizure frequency, or prepubertal onset (28).…”

Section: Fertility and Sexuality In Women With Epilepsymentioning

confidence: 82%

The Effects of Epilepsy and Its Treatment on Sexual and Reproductive Function

Penovich

2000

Epilepsia

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Summary: Male and female sexuality and reproductive functions are complex systems with cortical, limbic system, hypothalamic, pituitary, and end organ interactions. Sexual steroids are produced in the sexual glands, the adrenals, and the brain. They undergo interconversion in the brain, bind to different brain areas, and have multiple effects behaviorally and neurophysiologically. Progesterone, estrogen and testosterone have neuroendocrine effects that alter epileptogenicity. Seizure frequency may change throughout the life cycle as a result of hormonal status. Changes in central control, peripheral hormone levels, and/or medication effects may all contribute to decreased libido, potency, and fertility. Antiepileptic drugs (AEDs) interact with hormone-binding metabolism, resulting in altered human reproductive function. AEDs alter contraceptive hormone treatments. Information on the effects of new AEDs is being gathered by the National Pregnancy Registry. Catamenial epilepsy and some sexual dysfunction in men may be treatable. Key Words: Epilepsy-Women-MenSexuality-Reproduction.The quality of human life is a summation of many factors. Male and female sexuality, relationships, and successful reproduction are paramount in the accomplishment of a meaningful life for most individuals. Evaluation of these measures for our patients with epilepsy has revealed a disparity between their experience and that of the general population. Human sexuality is a psychological and physiological experience. To understand the problems our patients encounter, we will briefly review the human hormonal sexual system and what is altered in the experience of the individual with epilepsy.Steroids are hormones that are released into the circulation. At target tissue membranes, they are taken into the cell and bind to an intracellular cytosolic receptor. This complex is then transported into the nucleus and binds to DNA, which results in increased RNA polymerase activity and eventual polypeptide formation. These are long latency effects. Steroids have short latency effects as well (1) ( Table 1). FEMALE SEXUAL FUNCTIONThe sexual steroids are 17p steroids. The primary female compounds are estrogen and progesterone (Figure

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Section: Fertility and Sexuality In Women With Epilepsymentioning

confidence: 82%

The Effects of Epilepsy and Its Treatment on Sexual and Reproductive Function

Penovich

2000

Epilepsia

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“…Mulheres com epilepsia apresentam maiores índices de infertilidade, com maior número de ciclos anovulatórios e diminuição da libido. 8,10,11,18 No entanto, o conhecimento adquirido com as adultas tem sido extrapolado para as adolescentes, pressupondo-se que elas também sofram influência semelhante.…”

Section: Conclusãounclassified

“…A sexualidade nas adolescentes com epilepsia Portanto, no que diz respeito à sexualidade e seu exercício, embora na mulher com epilepsia haja diminuição de libido e satisfação sexual, 8,10,11,18 os dados encontrados nesse estudo sugerem que as adolescentes, a despeito da síndrome epiléptica, da freqüência de crises ou da terapêutica instituída, tenham a libido e a satisfação sexual preservadas.…”

Section: Conclusãounclassified

“…Na adolescente com epilepsia, o conhecimento da sexualidade é, na sua maior parte, extrapolado do conhecimento dos efeitos da epilepsia na mulher, descritos na fase adulta, 17 Portanto, concebe-se que a adolescente apresente uma diminuição da libido comparada a adolescentes da mesma idade, como observada na mulher com epilepsia. 8,10,11,18 Contradizendo esta premissa, alguns estudos populacionais mostraram que os adolescentes com doenças crô-nicas têm vida sexual ativa, não havendo diferença na idade da primeira relação sexual, na freqüência da atividade sexual, uso de contracepção e história de gravidez. 2,3,14,16 Este estudo teve como objetivo avaliar aspectos relacionados à sexualidade em um grupo específico de adolescentes do sexo feminino com doença crônica -as adolescentes com epilepsia.…”

Section: Introductionunclassified

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A sexualidade nas adolescentes com epilepsia

Vincentiis

Febrônio

Silva

et al. 2007

J. epilepsy clin. neurophysiol.

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RESUMOObjetivo: Mulheres com epilepsia apresentam com maior freqüência alterações relacionadas à sexualidade. O conhecimento adquirido com as adultas tem sido usado para as adolescentes, pressupondo-se que elas também sofram influência semelhante. Este estudo teve como objetivo avaliar aspectos relacionados à sexualidade nas adolescentes com epilepsia. Métodos: Foram estudadas 35 pacientes do sexo feminino, com epilepsia, com idades entre 10 a 20 anos. Os critérios de exclusão foram: pacientes que ainda não apresentaram a menarca, com doença crônica associada, ou deficiência mental moderada a grave. As informações sobre a função sexual das adolescentes foram avaliadas através de um questionário padrão. Resultados: Não foi observada diferença entre a idade da primeira relação sexual, atividade sexual, libido e orgasmo entre as adolescentes com epilepsia e o grupo controle. Observaram-se índices de gravidez superiores entre as adolescentes com epilepsia. Conclusão: Adolescentes com epilepsia têm vida sexualmente ativa, não apresentando as mesmas disfunções que a mulher adulta. Nesta série, nós observamos freqüência elevada de gestação, sugerindo a falta de aconselhamento adequado. Os aspectos relacionados à sexualidade requerem atenção especial por parte dos profissionais de saúde que atendem adolescentes com epilepsia.Unitermos: adolescentes, epilepsia, doenças crônicas, sexualidade. ABSTRACT Sexuality in adolescents with epilepsyObjectives: Women with epilepsy have higher rates of sexual dysfunction. However, knowledge acquired with adult populations has been extrapolated to teenagers, by surmising that these patients are submitted to similar factors. This study aims to evaluate aspects related to sexuality in female adolescents with epilepsy. Methods: We studied 35 female adolescents, with epilepsy, ages from 10 to 20 years. The criteria of exclusion were: patients that had not yet presented a first period, patients with previous endocrine or clinical chronic disorders, and patients with moderate to severe mental deficiency. Information on sexual behavior of adolescents with epilepsy was evaluated by use of a standard questionnaire. Results: No differences were observed between age at first sexual intercourse, sexual activity, libido and orgasm of adolescents with epilepsy when compared to controls. Higher rates of pregnancy occurred in adolescents with epilepsy when compared to controls. Conclusion: Adolescents with epilepsy have an active sexual life, without the dysfunctions presented by adults. In this series, we observed high rates of pregnancy suggesting lack of proper counseling. Therefore, aspects related to sexuality require special attention by health professionals when attending to adolescents with epilepsy.

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“…Although women and men with epilepsy may often experience disorders of sexual desire, disorders of sexual arousal are at least as common. One-third to one-half of men with epilepsy experience erectile difficulties (52,53), and female outpatients with epilepsy describe a high frequency of dyspareunia, vaginismus, and lack of vaginal lubrication, with normal sexual desire and experience (54). Physiological sexual dysfunction is further suggested by studies showing abnormalities in penile tumescence and rigidity (55,56) and reduced genital blood flow response with sexual arousal (57).…”

Section: Sexualitymentioning

confidence: 99%

Maximizing the Health of Women with Epilepsy: Science and Ethics in New Drug Development

Morrell

1997

Epilepsia

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Summary:Issues of unique concern to women with epilepsy largely arise from gender-based physiological differences. Female sex steroid hormones may alter the expression of epilepsy and the efficacy of antiepileptic drugs (AEDs). Seizures and AEDs in turn affect the hypothalamic-pituitary axis and can adversely impact reproductive function and bone health. Maternal seizures and exposure to AEDs may compromise fetal development. At this time, women with epilepsy and their medical caretakers do not have access to all the information necessary to formulate a treatment plan that will have the least impact on reproductive and general health. In part, this is because reproductive aged women are excluded from the earliest phases of drug testing and pregnant and lactating women are excluded from all aspects of new drug development. Therefore, as new AEDs enter the marketplace, women with epilepsy must decide whether a new AED is appropriate for therapy based on very limited information. Postmarketing surveillance of gender-specific adverse effects, as with all adverse effects, depends on voluntary reporting. Only a small percentage of significant adverse events are believed to be captured by the present system. Consumers, ethicists, and some physician groups are now arguing that women should be included in all aspects of the development of drugs they will ultimately use-even pregnant and lactating women. Some of the issues of concern for women with epilepsy regarding epilepsy treatment, reproductive function and general health will be reviewed, followed by a discussion of the drug development process and how it does, and could better, address the concerns of women. Key Words: Epilepsy-Women-Anticonvulsant drugs-HormonesDrug therapy-Drug toxicity-Reproduction-Clinical drug evaluation-Clinical trials-Fertility-Teratogens. EFFECT OF HORMONES ON SEIZURES AND ON AED EFFICACYSteroid hormones are active in the central nervous system (CNS) and may alter the seizure threshold to a clinically significant extent (1). The ovarian sex steroid hormones, estrogen and progesterone, appear to act in an opposing fashion to modulate excitability of neurons of the cerebral cortex ( 2 ) . Estrogen has a seizure activating effect in experimental models of epilepsy such as the electroshock seizure threshold and after creation of a new seizure focus. Progesterone has an inhibitory effect in these same models. In human females, estrogen appears to activate interictal epileptiform activity whereas progesterone and its reduced metabolites reduce epileptiform activity.Both estrogen and progesterone exert their opposing effects, at least in part, at the GABA-A receptor complex (3). A recognition site for these neuroactive steroids has been identified on the GABA-A receptor complex (43). When k strogen occupies the receptor site, chloride conductance through the receptor is reduced, whereas progesterone has the opposite effect. Estrogen and progesterone also alter RNA encoding the synthesis of the GABA-A receptor complex and of GABA itselfprobably thr...

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Self‐Reported Sexual Function and Sexual Arousability in Women with Epilepsy

Cited by 87 publications

References 29 publications

The Effects of Epilepsy and Its Treatment on Sexual and Reproductive Function

The Effects of Epilepsy and Its Treatment on Sexual and Reproductive Function

A sexualidade nas adolescentes com epilepsia

Maximizing the Health of Women with Epilepsy: Science and Ethics in New Drug Development

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