Abstracts

Although epileptic dysfunction, antiepileptic drug therapy, and the stigma of having epilepsy/seizures can be expected to affect sexual function, this issue is largely taboo in the treatment and counselling of patients with epilepsy. Sexual function, behavior and attitudes were assessed via self report measures in 118 patients with epilepsy (m/w: 54/64) as compared to 128 healthy control subjects (m/w: 55/73). The questionnaire comprised 6 parts evaluating: 1. frequency of sexual behavior, 2. beliefs in sexuality and epilepsy, 2. a need hierarchy, 3. attitude towards sex, 4. general sexual functioning, 5. sexual functioning during the last 4 weeks, 6. a symptom check list. Questionnaires were consecutively given to unselected inpatients. Completion was voluntary, which may have led to a response bias. Independent epilepsy variables were, localization and lateralization, seizure type and frequency, antiepileptic drug (AED) regimen, and onset and duration of epilepsy. With the exception of a poorer education, patients did not differ from controls in demographic variables. Patients had fewer partners and were less sexually active. Fifty six percent of patients claimed to be impaired in sexuality by epilepsy, 32% suggested an influence of AED, 43% expressed fears that sex may trigger seizures, and 65% to 70% were afraid that epilepsy or AED will damage the unborn child. As compared to controls, men and women with epilepsy more often rated sex as being holy, immaculate or controlled and both sexes ranked sexuality less significant than controls. Both sexes scored poorer on sexual drive, arousal, frequencies of sexual activities, and success in terms of orgasm and/or ejaculation. Multiple regression analysis indicated that in both sexes need, appetence, arousal, and sexual function were primarily determined by attitudes and fears. Generalized tonic clonic seizures, antiepileptic polytherapy, and a greater seizure frequency appeared to have an effect in some respect. Epilepsy and its treatment appear to have some impact on sexual behavior and function, but sexuality in epilepsy appears primarily determined by psychological variables like attitudes and fears. Thus it is time to remove the taboo from sexuality and to clear up prejudice. Counselling, successful seizure control and AED monotherapy, may improve the situation significantly.