Comprehensive Epilepsy Center
Women's Health - Sexual Functioning 

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Sexuality is a vital part of human behavior. Most people have their own ideas about what constitutes sex, who is sexually attractive, etc. These ideas may change throughout life and are influenced by culture, religion and society, among other things. When a person is dissatisfied with their sexual life, this can adversely affect both their physical and emotional well-being. Conversely, physical and psychological problems often have an impact on sexual behavior and functioning.

Although we experience sexual feelings with many parts of our bodies, none of this is possible unless they brain and nervous system are functioning properly. Since epilepsy is a brain disorder, it is not surprising that many people with epilepsy also experience sexual dysfunction. Some symptoms of sexual dysfunction in women are:

• Abnormal or irregular menstrual cycles
• Pain during sexual intercourse (dyspareunia)
• Vaginal muscle spasms during sexual intercourse (vaginismus)
• Inability to achieve orgasm
• Substantially decreased or increased interest in sex

Some symptoms of sexual dysfunction in men are:

• Lack of morning erections
• Inability to maintain or get an erection
• Inability to achieve orgasm
• Sperm or semen abnormalities
• Substantially decreased or increased interest in sex

Anyone who experiences sexual dysfunction deserves a thorough evaluation. This usually includes laboratory testing of medication and hormone levels, a complete physical examination, screening for mood disorders, and a visit with a reproductive health specialist (a gynecologist for women and a urologist for men). Dysfunction of potency (impaired physical responses to sexual stimuli) are treated differently than dysfunctions of libido (Sexually directed thought and feelings). Some people may have both types of dysfunction.

There are many factors that can contribute to sexual dysfunction, and sometimes a problem is due to one or more factors.

• Low self-esteem
• Hormone disturbances
• Relationship problems
• History of sexual abuse or trauma
• Prescription or other medications
• Lack of sexual experience
• Physical illness or condition
• Fear
• Psychological problems (depression, anxiety, etc.)
• Lack of sexual education

Sexual dysfunction in people with epilepsy is usually due to one of two things:

1. Hormonal disturbances
   For instance, most seizure medications are broken down by the liver. However, sex steroid hormones, such as estrogen and testosterone, are also broken down in the liver, so seizure medications may increase liver metabolism. This results in abnormal hormone levels. Hormones may also be altered by seizure activity in areas of the brain that control hormone production or release. Finally, certain medications such as Tegretol, Dilantin, and Phenobarbitol increase the amount of a chemical called sex hormone binding globulin, which leads to decreased levels of hormones in the blood.
2. Brain disturbances
   Many areas of the brain are responsible for sexual behavior and responses. Seizure activity or abnormalities in brain structures (such as the limbic area) may lead to sexual dysfunction. Some studies have shown that people with complex partial seizures, especially if the seizure activity starts in the temporal lobe, seem to be at a higher risk of having sexual dysfunction. Other studies have shown that sexual functioning greatly improves in people who have had epilepsy surgery and become seizure-free.

Most sexual dysfunction is very treatable. If you think you are having a problem of this nature, it is important to tell your doctor. But remember, the most important sex organ is the brain!