Men with epilepsy have many concerns regarding quality of life. One of the core quality of life issues most men with epilepsy face is sexual function.
Antiepileptic drugs can reduce sexual interest and impair the quality of sexual experiences. In fact, in a recent study, researchers found that carbamazepine and phenytoin can decrease testosterone levels in men, which in turn can diminish libido (sexual drive) and may impair sexual function1. Other AEDs can also affect testosterone levels, although the newer AEDs may interfere with testosterone metabolism less than the older ones.
Decreased libido is not the only sexual problem facing men with epilepsy. Erectile dysfunction (or impotence) is more common in men with epilepsy than in the general population. How antiepileptic medications are related to impotence is unclear.
Unfortunately, depression is common in people with epilepsy. As such, many patients take what are called selective serotonin reuptake inhibitors (SSRI’s), a class of antidepressants. However, research has shown that between 30% and 60% of SSRI-treated patients experience sexual dysfunction2. Although these side effects may resolve within several weeks after starting the drug, when they persist, dose reduction, altering the timing of the daily dose, changing antidepressant medication, or a drug holiday may be helpful.
Epilepsy itself may be a cause of sexual dysfunction in men, especially if seizures are poorly controlled. Also, concomitant depression and fatigue (perhaps enhanced by antiepileptic medications) probably also contribute.
Men with epilepsy and erectile dysfunction should be referred to a urologist to ensure that the dysfunction is not the result of a primary urological disorder. Medical therapies for erectile dysfunction (sildefanil and vardenafil) appear safe for men with epilepsy and other neurological disorders. If no contraindications are present, patients should be allowed to use them.
1. Herzog AG, Drislane FW, Schomer DL, Pennell PB, Bromfield EB, Dworetzky BA, Farina EL, Frye CA. Differential effects of antiepileptic drugs on sexual function and hormones in men with epilepsy. Neurology. 2005 Oct 11; 65(7): 1016-20.