The relationship between epilepsy and sexual dysfunction: a review of the literature
Atif et al. SpringerPlus
The relationship between epilepsy and sexual dysfunction: a review of the literature
Muhammad Atif 0
Muhammad Rehan Sarwar 0
Shane Scahill 1
0 Department of Pharmacy, The Islamia University of Bahawalpur , Bahawalpur, Punjab , Pakistan
1 School of Management, Massey University , Auckland , New Zealand
Background and objectives: Regardless of the disease states that people suffer from, maintaining sexual function is an important indicator of quality of life. The objective of this review was to figure out the relationship between epilepsy, antiepileptic drugs (AEDs) and sexual dysfunction. Results: In various epidemiological and clinical studies, epilepsy has been correlated with a reduction in sexual function. This sexual dysfunction is not always detected in epileptic patients until systematic efforts are put in place, as part of the assessment and treatment process. Therefore, precise evaluations of the incidence of treatment related sexual dysfunction in epileptic patients is still lacking. Conclusions: This literature review concluded that sexual function is influenced by the pathophysiology of epilepsy, as well as through the use of AEDs. To maximize quality of care in patients with epilepsy and those patients with other disease states who receive AEDs, it is important to address the status of the patient's sexual function as part of the initial routine assessment and with any treatment related follow-up. Minimizing the effects of AED related sexual dysfunction can be achieved by raising awareness among patients, providing education and training for physicians regarding sexual dysfunction and obtaining a baseline sexual history from the patient so are important recommendations. In addition, systematic studies are needed to explore the risk and mechanism of such treatment related side effects on sexual function.
Epilepsy; Sexual dysfunction; Antiepileptic drugs; Epidemiology; Relationship
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Background
Historically discussion around sexual practices and
associated dysfunction was taboo. However, in the modern
era, awareness of issues associated with sexual
dysfunction has been more commonly aired. Western civilization
has become more open-minded about discussing sexual
dysfunction, and in particular about erectile dysfunction
(ED) in men, often associated with chronic disease. With
this opening up of society there has been encouragement
for people to think about their sexual performance and
to seek advice from health consultants (Laumann et al.
1999; Kaufman et al. 2015).
The very first orally available drug for male ED was
sildenafil (Viagra) which not only treated the problem
but also through marketing campaigns, increased
awareness among people. These days ED is considered amongst
the general public to be a “medical condition” that can
be managed. In terms of etiology both physical (ED in
men due to circulatory disorders) and psychological
factors (inadequate interpersonal associations, psychiatric
illness) are responsible for sexual dysfunction. Another
cause of sexual dysfunction is the use of drugs such as
anti-hypertensive (Fogari et al. 1998), anti-psychotics
(Baldwin and Birtwistle 1997), anti-depressants
(Baldwin et al. 1997; Goldstein and Goodnick 1998) and
antiepileptic drugs (AEDs) (Hamed et al. 2015; Kirmani et al.
2014; Lombardi et al. 2015; Meryn 2015; Svalheim et al.
2015; Urso et al. 2014; Kaufman et al. 2015; Sivaraaman
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and Mintzer 2011; Kaufman and Struck 2011b). The link
between sexual dysfunction and drug induced as opposed
to disease induced effects is complicated, and the case of
epilepsy and AEDs has received less attention than one
might expect. Sexual dysfunction may impact on
compliance and is reported to be dose dependent with various
AEDs (Kaufman and Struck 2011a). For example, case
reports of gabapentin-induced sexual dysfunction
suggest that the minimum total daily dose required for
sexual dysfunction is 900 mg (Dalal and Zhou 2008; GRANT
and OH 2002).
The human sexual response and sexual
dysfunction
Natural sexual response of a human can be divided into
four stages and disturbance can occur in any one these
stages;
1. Desire typically this consists of fantasies about, and the desire to have, sexual activity.
2. Excitement the individual sense of sexual enjoyment,
associated with physiological alterations, including
penile tumescence and erection in men, and
pelvic vasocongestion, inflamed external genitalia, and
lubrication and extension of the vaginal canal in
women.
3. Orgasm height of sexual enjoyment, by the discharge (...truncated)