— How Epilepsy Can Affect Sexual Health

By Serenity Mirabito RN, OCN

Attention to sexual health in people with epilepsy is often lacking. Sexual dysfunction, however, is a side effect of epilepsy and the medications that treat it.

Although not fully understood, epilepsy can also cause endocrine disorders that negatively impact the reproductive system, leading to infertility. People with epilepsy need to talk to their healthcare providers about ways to prevent sexual problems when diagnosed with the condition.

This article addresses the cause of sexual problems in people with epilepsy and how to treat them.

What Is the Connection Between Sexual Problems and Epilepsy?

Sexual problems like decreased libido or inability to orgasm are more likely to occur in people with epilepsy compared to those who don’t have the disease. Because the brain is responsible for both epilepsy and sexual behavior, there is a connection between the two, which includes:

• Brain excitability: Sexual dysfunction in people with epilepsy sometimes depends on the part of the brain from which the seizure originates. People with right-sided temporal lobe epilepsy have the highest rates of sexual dysfunction. People with partial epilepsy suffer from sexual dysfunction more than those with idiopathic generalized epilepsy.
• Sex hormones: Abnormal secretion of sex hormones is common in people with epilepsy. Low testosterone and estradiol levels are associated with epilepsy and sexual dysfunction.
• Endocrine disorders: People with epilepsy have fluctuating hormone levels that are either complicated by endocrine disorders or cause them. The hormonal instability and endocrine diseases further worsen sexual problems in men and women, including the ability to conceive.
• Psychological effects: People with epilepsy often complain of poor self-esteem and stigma around their illness. A limited ability to work, drive, or attend school can lead to depression and anxiety. The added fear of having a seizure during sex can also inhibit the desire for intimacy.

Do Drugs That Treat Epilepsy Cause Sexual Problems?

Not only do seizures, hormones, and psychological issues diminish sexual function, but the medications that treat epilepsy also impact sexual health. Some anti-epileptic drugs (AEDs) cause elevated liver enzymes that lead to suppressed sex hormones. Other AEDs have a depressive effect on the brain that can leave people feeling sedated and uninterested in sex.

AEDs known for increasing liver enzymes and decreasing sex hormones include:

• Luminal (phenobarbital)
• Tegretol (carbamazepine)
• Dilantin (phenytoin)
• Topamax (topiramate)

Speak to your healthcare provider about how anti-epileptic drugs could affect your sexual health.

How Are Sexual Problems Due to Antiepileptic Drugs Treated?

Some AEDs effectively treat seizures and have minimal sexual side effects. Changing medications may be an option depending on the type and severity of the seizure disorder. AEDs that have a decreased implication for sexual dysfunction are:

• Lamictal XR (lamotrigine)
• Keppra (levetiracetam)
• Trileptal (oxcarbazepine)
• Lyrica (pregabalin)

If switching AEDs doesn’t work, you may be able to take medications that help treat sexual dysfunctions. These include:

• Aphrodyne (yohimbine)
• Bloxiverz (neostigmine)
• Periactin (cyproheptadine)
• Tolvon (mianserin)
• Gocovri (amantadine)
• Dexedrine Spansule (dextroamphetamine)

Reducing the dose of the AED, building up a tolerance to the medication, and taking the drug after sex may improve sexual ability. It may take various approaches to find the best solution for improved sexual health, but keeping an open dialogue with your healthcare provider is essential.

Symptoms and Gender Differences

Sexual problems in people with epilepsy can affect up to 60% of men and 50% of women. Although men and women with epilepsy may experience decreased libido, other sexual problems manifest differently in each gender.

Men

In addition to decreased testosterone levels and the side effects of AEDs, performance anxiety can cause the following sexual problems in men with epilepsy:

• Erectile dysfunction
• Premature ejaculation
• Inability to ejaculate
• Decreased desire for sex
• Depression

Women

Endocrine disorders, low levels of female hormones, menstrual irregularities, and psychiatric conditions have been linked to sexual and reproductive dysfunctions in women with epilepsy.

Epileptic women often experience the following sexual problems:

• Decreased libido
• Inability to orgasm
• Painful sex
• Vaginal dryness
• Less sexual arousal
• Depression and anxiety

In addition, endocrine disorders that affect fertility in women with epilepsy are:

• Polycystic ovary syndrome (PCOS)
• Hypothalamic amenorrhea (when your hypothalamus causes your period to stop)
• Hyperandrogenemia (high levels of androgen)
• Galactorrhea (nipple discharge not associated with pregnancy or breastfeeding)
• Hirsutism (excess body hair)
• Menstrual abnormalities

How Are Sexual Problems With Epilepsy Treated?

Treating sexual problems associated with epilepsy begins by telling your healthcare provider. Various methods can help improve sexual dysfunction in people with epilepsy. Some options that may help include:

• Hormone replacement therapy: Replacing testosterone and estradiol may improve sexual health.
• Medications: Drugs are available to help increase sexual desire and treat conditions like premature ejaculation.
• Improving mental health: Treating underlying depression and anxiety can help with intimacy.
• Lubrication: Vaginal pain and dryness during sex can be relieved with water-based lubrication.
• Erection management: Prevent or reduce penile flaccidity by placing an elastic band at the base of the penis, using vacuum devices, or using an intracavernosal injection of vasodilators.
• Brain surgery: Research found anterior temporal lobectomy resulted in being seizure-free in 60% of patients. Those patients also reported significant improvement in sexual function.

Summary

People with epilepsy often experience sexual problems. Hormonal abnormalities, endocrine disorders, fear, and side effects of treatment may lead to sexual dysfunctions. Depression, loneliness, and anxiety can occur if sexual health is not seriously addressed. There are various methods available for improving sexual impairments in people with epilepsy. Talk to your healthcare provider about ways to prevent sexual problems if you have been diagnosed with epilepsy.

A Word From Verywell

Sexual health plays a valuable role in the quality of life; many people feel unsatisfied and disconnected when it’s poor. If you’ve been diagnosed with epilepsy and are struggling with libido, the ability to orgasm, infertility, or depression, you are not alone. Speaking to your healthcare provider about these symptoms so they can help you feel better is essential.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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