Does epilepsy affect libido?
Yes. Several recent studies document that men with epilepsy (MWE) experience lowered libido. The following scientific data support this statement.
One study found that between 50 percent and 70 percent of all MWE report decreased sexual function and/or libido.
One survey showed that 57 percent of MWE recently experienced erectile failure, compared to 18 percent of men without epilepsy.
A recent study demonstrated that approximately 40 percent of MWE possess bioavailable testosterone levels below the normal control range. This is a significant finding because researchers now know that bioavailable testosterone levels, rather than total testosterone levels, affect libido.
How does epilepsy affect libido?
The following factors can affect libido in people with epilepsy:
Exposure to antiepileptic drugs (AEDs)
AEDs produce direct effects on the brain regions mediating sexuality and may also cause sexual dysfunction by secondary effects on reproductive hormones. Some AEDs have a greater impact on libido than others. Recent data show that, among men with localization-related epilepsy, those taking enzyme-inducing AEDs had less gonadal efficiency than those taking lamotrigine. Men taking enzyme-inducing AEDs also reached abnormally low testosterone levels at an earlier age.
Diminished libido and arousal tend to be most pronounced in MWE taking sedating AEDs such as barbituates.
In studies comparing the adverse effects of various AEDS on sexuality, researchers found the AEDs carbamazepine and phenytoin to have a much more negative effect on libido than lamotrigine.
Changes in the brain due to seizures
Sexual desire requires appropriate function of specific regions of the cerebral cortex, especially frontal and temporal lobes. People with complex partial seizures seem more prone to problems with sexual desire, particularly when seizures originate in the temporal lobe. Moreover, research suggests that damage to the temporal lobe, common in people with partial epilepsy, affects the ability to recognize subtle cues that are integral to establishing intimacy.
Sexual desire can be disturbed by psychological factors such as depression and anxiety. Although limited data exists on depression among people with epilepsy, statistics reveal that the suicide rate for people with epilepsy is 5 times greater than that of the general population, which strongly suggests that the rate of depression is also higher.
Fear that sexual activity will induce a seizure, particularly for those whose seizures are triggered by hyperventilation or physical exertion, may also have a negative impact on libido.
Are there ways to improve libido?
Researchers are experimenting with the use of testosterone in MWE to improve libido. Preliminary results are encouraging. Researchers note improved energy and sexual drive with the administration of testosterone, and decreasing frequency of seizures. Therefore, experts suggest that MWE experiencing decreased libido ask their doctor to order a test that will determine their level of bioavailable testosterone.
While the research on testosterone offers promise to MWE suffering from low libido, scientists caution that health care providers using testosterone to treat reduced libido in MWE should regularly monitor the following: behavioral changes (due to the possibility of developing anger or paranoia); blood count; liver function; lipid profile; and prostate-specific antigen (PSA) count, which is used to detect the presence of prostate cancer.
A recent survey indicates that very few MWE discuss sex with their physician, despite the prevalence of sexual problems among this population. By bringing these problems to the attention of a doctor, it’s possible that actions can be taken to combat them. For instance, a change in the type of AED may improve libido; so might the administration of testosterone.