12 Jan

The most common sexual side-effect of epilepsy is simply lack of interest. In men, the sex hormone, testosterone, is produced in the testes. If the levels of testosterone are low, sex drive and sexual interest are lowered too, and it may be more difficult to get an erection. Some anticonvulsant drugs have a direct effect on the testes and reduce the amount of testosterone they produce. Other drugs have an indirect effect on testosterone levels by altering liver function. When the liver has to work harder, one result is an increase in the blood level of a protein which ‘binds’ to testosterone, so there is less free ‘working’ testosterone circulating in the blood. In this case the testes are working quite normally, but they cannot increase their production of sex hormone enough to compensate for this extra binding.
People who lack sexual interest will have sex less often than many other people, but this is not to say they have a problem. There are plenty of people in the general population who have sex seldom or even never, and who are perfectly happy with things as they are. It can become a problem if you are worried that you are missing out on a side of life that you would like to experience. If you have a partner it may cause difficulties if they are more interested in sex than you are. Lack of interest may lead to other problems too: a man may have difficulty getting an erection, for example, or a woman finds she seldom feels sexually aroused or reaches orgasm.
If your lack of interest in sex worries you, it may be worth asking your doctor if you can have tests to check your level of testosterone. Some doctors, though not all, recommend testosterone replacement therapy to men who are worried about a lack of sexual interest and whose testosterone level is low. It is not a treatment much used at the moment, but it is worth asking your doctor about it if you have this problem.
Although lack of interest in sex is nearly always a result of anticonvulsant drugs, there is some suggestion that a few men who have very frequent seizures during adolescence have a low sexual drive and reduced sexual interest when they become adults, even though they have normal levels of sex hormones.
Perhaps the main sexual anxiety of those people with epilepsy who have a sexual partner is that they will have a seizure during intercourse. There is the fear of looking unattractive, putting their partner off or possibly even ruining the relationship. It is an understandable fear and yet it is also an unrealistic one. You are in fact no more likely to have a seizure during sex than at any other time of the day or night. The odds against it happening are high, so there is really no need for you to feel apprehensive about it. You certainly should not let the idea of it happening put you off sex or make you reluctant to have intercourse. It is also very rare indeed for sexual activity to be a specific trigger for seizures; I have never come across anyone who has experienced this condition, and only a very few such cases have ever been reported.
A few women always find it hard to ‘let go’ during sex; they fear the loss of control which sex involves, and this often prevents them reaching orgasm. It is possible that for some women this anxiety lies at the heart of their fear of seizures during sex; it is part of a general reluctance to ‘let go’ during sex rather than a specific fear of seizure. If you think these feelings may be playing a part in your fears, psychosexual counselling from a qualified therapist might help you resolve them.

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