Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

The sexual and reproductive health in men with generalized epilepsy: a multidisciplinary evaluation

International Journal of Impotence Research volume 18, pages 287–295 (2006)Cite this article

Abstract

This study was specifically aimed to evaluate the sexual and reproductive health in a group of men with generalized epilepsy. In total, 44 men with generalized epilepsy were included in this study, their ages between 18 and 48 years (29.2±9.9) and duration of illness between 2 and 35 years (11.2±7.4); 34 patients were treated with conventional antiepileptic drugs (AEDs). Sexological and psychological interviews together with serum total testosterone, E2, FSH, LH and prolactin were determined. Hyposexuality was diagnosed in 61.4%. Erectile dysfunction (ED) and premature ejaculation represented 70.4 and 66.7%, respectively. Variables such as hyposexuality, seizure duration and its poor control on AEDs were significantly associated with depressive symptoms. Compared to the normal control group, all patients reported elevated E2 levels (P<0.001), 10 had FSH (n=4) and LH (n=6) levels exceeding that of the normal range for controls and two had hyperprolactinemia. Although the patients’ mean value of total testosterone remained within the normal range, but it was significantly lower in hyposexual men compared to nonhyposexual (P<0.002), only two epileptic patients had markedly reduced level of total testosterone beyond normal control levels. This study strongly supports that: (1) The risk of hyposexuality and reproductive disturbances is high in epileptic patients with GTC convulsions despite the AEDs utilized. The risk for SD is further increased by poor seizure control and the frequently accompanied depressive manifestations. (2) It is possible that elevated E2 could increase the risk of SD by reducing active testosterone through negative feedback and the reduction of active testosterone could increase seizure intractability to antiepileptic medications.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

Abbreviations

AEDs:

Antiepileptic drugs

E2:

estradiol

FSH:

follicle stimulating hormone

LH:

Leutinizing hormone

VPA:

valproic acid

GTC:

Generalized tonic clonic

References

  1. Kluver H, Bucy PC . Preliminary analysis of the functions of the temporal lobes in monkeys. Arch Neurol Psychiatry 1939; 42: 979–1000.

    Article  Google Scholar 

  2. Velasco ME, Taleisnik S . Effects of interruption of amygdaloid and hippocampal afferents to the medial hypothalamus on gonadotrophin release. J Endocrinol 1971; 51: 41–55.

    Article  CAS  Google Scholar 

  3. Hierons R, Saunders M . Impotence in patients with temporal lobe epilepsy. Lancet 1966; 2: 761–763.

    Article  CAS  Google Scholar 

  4. Pitchard PB . Hyposexuality: a complication of complex partial epilepsy. Trans Am Neurol Assoc 1980; 105: 193–195.

    Google Scholar 

  5. Toone BK, Wheeter M, Nanjee M, Fenwick P, Grant R . Sex hormones, sexual activity and plasma anticonvulsant levels in male epileptics. J Neurol Neurosurg Psychiatry 1983; 44: 824–826.

    Article  Google Scholar 

  6. Morrel MJ, Sperling MR, Stecker M, Dichter MA . Sexual dysfunction in partial epilepsy. Neurology 1994; 44: 243–247.

    Article  Google Scholar 

  7. Isojarvi JI, Repro M, Pakarinen AJ, Ylipalosaari PJ, Myllyla VV . Carbamazepine, phenytoin, sex hormones and sexual function in men with epilepsy. Epilepsia 1995; 36: 366–370.

    Article  CAS  Google Scholar 

  8. Duncan S, Blacklaw J, Beastall GH, Brodie MJ . Antiepileptic drug therapy and sexual function in men with epilepsy. Epilepsia 1999; 40: 197–204.

    Article  CAS  Google Scholar 

  9. Silveria DC, Souza EA, Carvalho JF, Guerreiro CA . Interictal hyposexuality in malw patients with epilepsy. Arq Neuropsiquiatr 2001; 59 (1): 23–28.

    Article  Google Scholar 

  10. Herzog AG . A hypothesis to integrate partial seizures of temporal lobe origin and reproductive endocrine disorders. Epilepsy Res 1989; 3 (2): 151–159.

    Article  CAS  Google Scholar 

  11. Herzog AG . Reproductive endocrine considerations and hormonal therapy for men with epilepsy. Epilepsia 1991; 32 (S6): S24–S37.

    Google Scholar 

  12. Morrell MJ . Sexual dysfunction in epilepsy. Epilepsia 1991; 32 (S6): S38–S45.

    Article  Google Scholar 

  13. Baired AD, Wilson SJ, Baldin PF, Saling MM, Reutens DC . Sexual outcome after epilepsy surgery. Epilepsy Behav 2003; 4 (3): 268–278.

    Article  Google Scholar 

  14. Lambert MV . Seizures, hormones and sexuality. Seizure 2001; 10 (5): 319–340.

    Article  CAS  Google Scholar 

  15. Longo LPS, Saldana LEG . Hormones and their influence in epilepsy. Acta Neurol Latinoan 1966; 12: 29–47.

    Google Scholar 

  16. Werboff J, Hedlund L, Havlena J . Audiogenic seizures in adult male castrated rats treated with various hormones. Endocrinology 1963; 3: 389–397.

    CAS  Google Scholar 

  17. Souza EAP, Keiralla DMB, Silveira DC, Guerreiro CAM . Seizural dysfunction in epilepsy: identifying psychological variables. Arq Neuropsiquiatr 2000; 58: 214–220.

    Article  CAS  Google Scholar 

  18. Silva HCA, Carvalho MJ, Jorge CL, Cunha Neto MB, Goes PM, Yacubian EMT . Alteraç es Sexuais na epilepsia: Resultados de uma avaliaç o multidisciplinar. Neuropsiquiatr 1999; 57: 798–807.

    Article  CAS  Google Scholar 

  19. Proposal for revised classification of epilepsies and epileptic syndromes: from the commission on classification and Terminology of the International League Against Epilepsy. Epilepsia 1989; 30: 389–399.

  20. Semi-Structural Interview for Diagnosis of Non-organic Sexual dysfunction based on diagnostic criteria of research of ICD 10 1992. WHO: Geneva.

  21. Murphy J . Diagnostic schedules and rating scales in adult psychiatry. In: Tsuang MT, Tohen M, Zahner GEP (eds). Textbook in Psychiatric Epidemiology. Wiley: New York, 1995.

    Google Scholar 

  22. Pritchard PB . Hyposexuality: a complication of complex partial epilepsy. Trans Am Neurol Assoc 1980; 10: 193–195.

    Google Scholar 

  23. Goma A, Abdel-Regal S, Abdellah M, Hamed S . Monitoring antiepileptic drug therapy in Upper Egypt: a retrospective 6-years experience in Carbamazepine. J Egypt Soc Pharmacol Exp Ther 2004; 25 (2): 319–335.

    Google Scholar 

  24. Baird AD, Wilson SJ, Bladin PF, Daling MM, Reutens DC . The amygdala and sexual drive: insights from temporal lobe epilepsy surgery. Ann Neurol 2004; 55 (1): 87–96.

    Article  Google Scholar 

  25. Walker AE . Man and his temporal lobes. Sur Neurol 1973; 1: 69–70.

    CAS  Google Scholar 

  26. Herzog AG, Seibel MM, Schomer DL, Vaitukaitis JL, Geschwind N . Reproduction endocrine disorders in men with partial seizures of temporal lobe origin. Arch Neurol 1986; 43 (4): 347–350.

    Article  CAS  Google Scholar 

  27. Schacter SC . Neuroendocrine aspects of epilepsy. Neurol Clin 1994; 12: 31–39.

    Article  Google Scholar 

  28. Guldner GT, Morrell MJ . Nocturnal penile tumescence and rigidity evaluation in men with epilepsy. Epilepsia 1996; 37 (12): 1211–1214.

    Article  CAS  Google Scholar 

  29. Kanner AM, Rivas Nieto JC . Depressive disorders in epilepsy. Neurology 1999; 53 (S2): S26–S32.

    CAS  PubMed  Google Scholar 

  30. Smith DF, Baker GA, Dewey M, Jacoby A, Chadwick DW . Seizure frequency, patient-perceived seizure severity and the psychosocial consequencies of intractable epilepsy. Epilepsy Res 1991; 9: 231–241.

    Article  CAS  Google Scholar 

  31. Boneff AN . Topical treatment with chronic prostatitis and premature ejeculation. Int Urol Nephrol 1971; 4: 1183–1185.

    Google Scholar 

  32. Masters WH, Johnson VE . Human Sexual Inadequacy. Little, Brown and Co.: Boston, 1970.

    Google Scholar 

  33. Baker DE, Smith DF, Dewey M, Jacoby A, Chadwick DW . The initial development of health related quality of life model as an outcome measure in epilepsy. Epilepsy Res 1993; 16: 65–81.

    Article  CAS  Google Scholar 

  34. Demerdash A, Shaslan M, Midani A, Kamel F, Fahri M . Sexual behavior of a sample of females of epilepsy. Epilepsia 1991; 32: 82–85.

    Article  CAS  Google Scholar 

  35. Christianson AS, Silfevenius H, Saisa J, Nilson M . Life satisfaction and sexuality in patients operated for epilepsy. Acta Neurol Scand 1995; 92: 1–6.

    Article  CAS  Google Scholar 

  36. Jobe PC, Dailey JW, Wernicke JF . A noradrenergic and serotoninergic hypothesis of the linkage between epilepsy and affective disorders. Crit Rev Neurobiol 1999; 13: 317–356.

    Article  CAS  Google Scholar 

  37. Davidson JM, Camargo CA, Smith ER . Effects of androgen on sexual behavior in hypgonadal men. J Clin Endocrinol Metabol 1979; 48: 955–958.

    Article  CAS  Google Scholar 

  38. Davidson JM, Kwan M, Greeleaf WJ . Hormonal replacement and sexuality in men. Clin Endocrinol Metabol 1982; 11: 599–623.

    Article  CAS  Google Scholar 

  39. Cogen PH, Antunes JL, Correll JW . Reproductive function in temporal lobe epilepsy: the effect of temporal lobectomy. Surg Neurol 1979; 12: 243–246.

    CAS  PubMed  Google Scholar 

  40. Dana-Haeri J, Oxley J, Richens A . Reduction of free testosterone by antiepileptic drugs. Br Med J 1982; 284: 85–86.

    Article  CAS  Google Scholar 

  41. Herzog AG, Klein P, Jacobs AR . Testosterone versus testosterone and testolactone in treating reproductive and sexual dysfunction in men with epilepsy and hypogonadism. Neurology 1998; 50 (3): 782–784.

    Article  CAS  Google Scholar 

  42. Petra P . The plasma sex steroids binding protein (SBP or SHBG). A critical review of recent developments on the structure, molecular biology and function. J Steroid Biochem Mol Biol 1991; 40: 735–773.

    Article  CAS  Google Scholar 

  43. Leonard MP, Nickel CJ, Morales A . Hyperprolactinemia and impotence: why, when and how to investigate. J Urol 1989; 942: 992–994.

    Article  Google Scholar 

  44. Carter JN, Tyson JE, Tolis G, Van Vliet S, Faiman C, Friesen HG . Prolactin-screening tumors and hypogonadism in 22 men. N Engl J 1978; 299: 847–852.

    Article  CAS  Google Scholar 

  45. Cramer JA, Jones EE . Reproductive function in epilepsy. Epilepsia 1991; 32 (6): S19–S26.

    Article  Google Scholar 

  46. Manni P, Pardridge WN, Cefalu W, Nisula BC, Bardin CW, Santner SJ et al. Bioavailability of albumin bound testosterone. J Clin Endocrinol Metabol 1985; 61: 705–710.

    Article  CAS  Google Scholar 

  47. Murialdo G, Galimberti CA, Fonzi S, Manni R, Costelli P, Parodi C et al. Sex hormones and pituitary function in male epileptic patients with altered or normal sexuality. Epilepsia 1995; 36: 360–365.

    Article  CAS  Google Scholar 

  48. Barragry JM, Makin HL, Trafford DJH, Scott DF . Effects of anticonvulsants on plasma testosterone and sex hormone binding globulin levels. J Neurol Neurosug Psychiatry 1978; 41: 913–914.

    Article  CAS  Google Scholar 

  49. Victor A, Lundberg PO, Johanson ED . Induction of sex hormone binding globulin by phenytoin. Br Med J 1977; 2: 934–935.

    Article  CAS  Google Scholar 

  50. Connell JM, Rappeport WG, Beastall GH, Brodie MJ . Changes in circulating androgens during short term carbamazepine therapy. Br J Clin Pharmacol 1984; 17: 347–351.

    Article  CAS  Google Scholar 

  51. Miralles-Garcia JM, Garcia-Diez LC . Specific aspects of erectile dysfunction in endocrinology. Int J Impot Res 2004; 16 (2): S10–S12.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Assiut University Hospital, Assiut, Egypt

    S Hamed

  2. Department of Psychiatry, Assiut University Hospital, Assiut, Egypt

    K Mohamed

  3. Department of Urology, Assiut University Hospital, Assiut, Egypt

    A El-taher

  4. Department of Physiology, Assiut University Hospital, Assiut, Egypt

    E Hamed

  5. Department of Clinical Pathology, Assiut University Hospital, Assiut, Egypt

    H Omar

Authors
  1. S Hamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K Mohamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A El-taher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E Hamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H Omar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S Hamed.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hamed, S., Mohamed, K., El-taher, A. et al. The sexual and reproductive health in men with generalized epilepsy: a multidisciplinary evaluation. Int J Impot Res 18, 287–295 (2006). https://doi.org/10.1038/sj.ijir.3901406

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijir.3901406

Keywords

This article is cited by

Search

Advanced search

Quick links