Sexual Dysfunction in

Epileptic Men
ITP 2900-001
Jennifer Gravestock

Sexual dysfunction in epileptic men is very prevalent. The following is an overview of

sexual dysfunction in said population, reviewing factors such as effects of antiepileptic drugs
(AEDs) on sexual functionality. An overview and definition of epilepsy, overview of sexual
dysfunction as it relates to the general population, overview of sexual dysfunction in epileptic
men, and options for the typical male to support his sexual functionality will follow.
Epilepsy is a central nervous system disorder which causes the nervous activity in ones
brain to be disturbed, which results in convulsions and involuntary movements (Mayo Clinic
Staff, 2013). One in twenty-six people in the United States have epilepsy, which ends up being
approximately 2.2 million people with epilepsy in the United States. About 90,000, or 30% of
people have epileptic seizures which cannot be controlled by medication. Studies show that
veterans returning from war with traumatic brain injury are increasingly developing epilepsy as a
result of their injury. Epilepsy is the second most common neurological disorder and it affects
about 1-1.5% of the population. It is extremely important to control seizures, as they can cause
neural loss in both brain areas which are affected by the seizures and surrounding areas (About
Epilepsy).
The causes of sexual dysfunction in general can be quite extensive, ranging from drug
use (both legal and illegal), medical reasons such as vascular, endocrine, and systemic illness,
urogenital reasons, neurological reasons such as spinal cord injury or disease and neuropathy,
and psychogenic reasons such as psychosis, depression, bipolar illness, religious and social
taboos, low self-esteem, and dysfunctional relationships. The etiology of sexual dysfunction in
epileptic individuals is not understood thoroughly. Physicians suspect that sexual dysfunction is
multifactorial, including causation from the disorder itself and its perspective treatment.

Psychosocial and physiological causes for sexual dysfunctions are suspected to come into play as
well.
For men, the sexual ramifications of having epilepsy often times results in erectile
dysfunction (ED), lack of virility, and lack of sexual arousal (Montouris, Morris III, 2005). The
etiology of ED, which is defined as the inability to achieve or maintain an erection sufficient for
sexual performance, was once thought to have a primarily psychological basis, but it is now
understood that the causation of ED is often times physiological. Interestingly enough, the roots
of ED are most often psychogenic in men under forty, while ED in men over forty is often times
caused by physiological factors. Young men with epilepsy are at an increased risk of developing
ED. It is estimated that medications such as AEDs, antidepressants, NSAIDs, and neuroleptics
actually cause ED. A study by Nikoobakht et al found 42.5% of men with epilepsy have ED and
a study by Keller, Chen, and Lin found that young men with epilepsy are 1.8-3 times more
likely to have ED than those without epilepsy (cited in Ludwig, Philips, 2013).
Bauer et al state that epilepsy, especially temporal-lobe epilepsy, adversely affects mens
testicular endocrine functioning and that the AED carbamazepine may increase adverse effects of
epilepsy on serum levels of reproductive hormones. They go on to say that sex hormone levels
are altered by the effects of ictal and interictal epilepsy on the hypothalamic-pituitary axis and
sex-hormone production and metabolism are affected by AEDs (2004). Carbamazepine is one
of the most commonly prescribed AEDs to both adults and children, with approximately 34% of
adults on the drug (Malerba et al, 2010). The use of carbamazepine is associated with a
decreased proportion of free, bioactive testosterone, which may result in sexual dysfunction in
some men with epilepsy after long term carbamazepine treatment. Interestingly, 18% of men
taking carbamazepine reported decreased libido, impaired potency, or both (Rattya et al, 2001).

The bottom line is that some commonly used AEDs have a marked effect on sexual
dysfunction in males. While it is common that epileptic men experience diminished libido, the
use of many first-line AEDs to treat epileptic seizures causes androgen deficiency and could be
the causation for sexual dysfunction. AEDs such as phenytoin, carbamazepine, and barbiturates
actually induce hepatic enzymes to synthesize more sex hormone binding globulin, which
reduces the unbound and bound biologically forms of testosterone (Herzog et al, 2005). These
AEDs cause the liver to work more rapidly than normal and process hormones in the same rapid
fashion. It is thought that because of this rapidity of hepatic function, vital hormones for sexual
function cannot be appropriately utilized by the body.
It is difficult to determine whether sexual dysfunction is resultant of the epilepsy itself, or
if it is caused by the AEDs used to treat the disorder. Androgen deficiency is more common in
men with epilepsy. Androgen levels in epileptic men typically have early and accelerated
reductions compared with men without epilepsy. Sexual dysfunction, hyposexuality, reduced
potency and infertility are as high as 70% in men with epilepsy (Frye, 2006).
What can the average male do to prevent ED and sexual dysfunction? Weight loss has
been associated with improvement of erectile functioning in men thirty-five to fifty-five years of
age and exercise has been associated with improved erectile functioning. Any smoking or
recreational drug use should be discontinued to support sexual functionality, as both are associate
with ED. Speaking with ones physician to find another solution to a medication that may be
associated with causing ED may be beneficial as well (Ludwig, Philips, 2013). It is important,
however, that one communicate with their physician before making any decisions regarding their
AEDs on their own. With ones physician it is possible that sexual function can be restored.

References
About epilepsy. Retrieved from Epilepsy Foundation website:
http://www.epilepsyfoundation.org/aboutepilepsy/
Bauer, J., Blumenthal, S., Reuber, M., & Stoffel-Wagner, B. (2004). Epilepsy syndrome, focus
location, and treatment choice affect testicular function in men with
epilepsy. Neurolog, 62, 243-246. Retrieved from http://0go.galegroup.com.skyline.ucdenver.edu/ps/start.do?
p=AONE&u=auraria_main&authCount=1
Frye, C. (2006). Role of androgens in epilepsy. Expert Review of Neurotherapeutics, 6(7), 1061.
doi:10.1586/14737175.6.7.1061
Herzog, A. et al (2005). Differential effects of antiepileptic drugs on sexual function and
hormones in men with epilepsy. Neurology, 65 (7), 1016-1020.
doi:10.1212/01.wnl.0000178988.78039.40
Ludwig, W., & Philips, M. (2013). Organic causes of erectile dysfunction in men under
40. Urologia Internationals, 92. doi:10.1159/000354931
Malerba, A. et al (2010). Patterns of prescription of antiepileptic drugs in patients with refractory
epilepsy at tertiary referral centres in Italy. Epilepsy Research, 91 (2-3), 273-282.
doi:10.1016/j.eplepsyres.2010.08.002
Mayo Clinic Staff (2013, May 31). Epilepsy. Retrieved from Mayo Clinic website:
http://www.mayoclinic.org/diseases-conditions/epilepsy/basics/definition/con-20033721

Montouris, G., & Moris III, G. (2005). Reproductive and sexual dysfunction in men with
epilepsy. Epilepsy and Behavior, 7. Retrieved from http://0go.galegroup.com.skyline.ucdenver.edu/ps/start.do?
p=AONE&u=auraria_main&authCount=1
Rattya, J. et al (2001). Reproductive effects of valproate, carbamazepine, and oxcarbazepine in
men with epilepsy. .Neurology, 56, 31-36. doi:10.1212/WNL.56.1.31