Abstracts

RATIONALE: 30 to 40% of women with epilepsy (WWE) experience sexual dysfunction. The physiological basis for this is not known. Reproductive endocrine disturbances may be one mechanism for sexual dysfunction in WWE. METHODS: WWE between 18 and 40 years of age taking a single anti-epileptic drug (AED) for ? 3 months completed validated sexual function questionaires. Fasting sera was obtained between 7:30 and 8 a.m. on menstrual cycle day 2, 3, or 4 and analyzed for estrone, estradiol, testosterone, free testosterone, dehydroepiandrosterone sulfate (DHEA-S), prolactin, sex hormone-binding globulin (SHBG), and thyroid stimulating hormone (TSH). RESULTS: Hormonal and sexual functioning data was available for 40 WWE. 28 had localization related epilepsy and 12 had primary generalized epilepsy. 46% had arousal insufficiency (vaginismus, dypareunia, and/or insufficient lubrication). WWE who experienced arousal insufficiency had significantly lower DHEA-S (p<0.05) and significantly higher SHBG (p<0.05) than WWE who did not experience arousal insufficiency. Free testosterone was also lower in the WWE who had arousal insufficiency but this difference was not significant (p=0.06). There were no differences in other hormones between the two groups. CONCLUSIONS: WWE who experience sexual arousal dysfunction had lower gonadal androgens and significantly lower adrenal androgens and higher steroid hormone binding than WWE who did not experience sexual dysfunction. Androgens support sexual behavior in all women. Therefore, it appears that AED induced reduction in androgens because of enhanced metabolism and binding may be one mechanism for sexual dysfunction in this population.