Abstracts

It is frequently asserted that men with epilepsy are hyposexual. The reasons for this observation are variously cited as dysfunction in hippocampal-hypothalamic complex leading to endocrinological changes at testicular level, and the effects of anti-epileptic drugs(AEDs) on testosterone levels . The profound psychosocial effects of epilepsy on sexual interest have not been so frequently studied. Forty-five men aged between the ages of 18 and 60 were recruited form a district general epilepsy clinic(Leigh Infirmary). All took one AED only, and had not had any change in AED therapy in the previous 6 months. None of the men took anti-depressant medication. All lived independently in the community, did not suffer any progressive neurological condition nor from any endocrine dysfunction. Forty-five men in good health between the ages of 18 and 60 were recruited from the spouses of women with epilepsy attending the clinic, from friends of the men involved in the study, and from hospital personnel. There were no significant differences in age between patient and control groups. Men in the control group were more likely to be in regular employment.
Each man completed a battery of validated questionnaires. The Hospital Anxiety and Depression Scale(HADS), the WHOQOL-BREF(UK) . In addition they completed 2 validated sexual function questionnaires ;the Sexual Desire Inventory to explore their wish for sexual intimacy and activity and the Sexual Confidence/Competance Scale to examine confidence in performing sexual activities. Men with epilepsy had significantly higher anxiety scores than controls(P[lt]0.01), but did not differ on the depression subscale of HADS. There were no significant differences in overall quality of life scores between the groups, but the men with epilepsy rated their health and social relationships as being less satisfactory than the controls(P[lt]0.05). There were no significant differences between the groups in their desire for sexual intimacy, but men with epilepsy had significantly lower sexual confidence scores (p [lt]0.05) indicating that they were less confident than control men of their ability to initiate sexual activity with a partner or achieve orgasm. Sexual function demands a complex interplay of both endocrinological/neurological systems as well as social and cognitive factors. Previous studies of men have tended to concentrate on endocrinological causes of hyposexuality in men with epilepsy and in particular to consider diminished libido purely in terms of these men[apos]s testosterone levels.This approach ignores the fact that recent work strongly suggests there is not a simple relationship between testosterone levels and sexual interest/activity in men and fails to take into account the profound effects on self confidence and social funtion that epilepsy causes.