Sexual dysfunctions and blood hormonal profile in men with focal epilepsy

PURPOSE: To evaluate the incidence of sexual dysfunction in men with focal epilepsy and to establish their hormonal profiles. METHODS: We prospectively analyzed sexual functions and hormone blood levels in 40 male patients (age ranged from 18 to 44 years, with an average age of 27.6+/-5.6 years) with refractory focal epilepsy. We used the Czech version of the structured questionnaire entitled International Inventory of Erectile Function (IIEF) to assess the patients' sexual functions. The subscales of this questionnaire separately evaluate erectile function (IIEF I), orgasmic function (IIEF II), sexual desire (IIEF III), intercourse satisfaction (IIEF IV), and overall satisfaction with sex life (IIEF V). In all of the patients, the following blood tests were performed: quantitative assessment of blood levels of prolactin (PRL), total testosterone (total-T), free androgen index (FAI), sexual hormone-binding globulin (SHBG), estradiol (E2), dehydroepiandrosterone sulfate (DHEAS), progesterone (PRG), follicle-stimulating hormone (FSH), and luteinizing hormone (LH). All these quantitative laboratory data were correlated with other clinical variables and with the results of the IIEF. chi2 and Wilcoxon tests were used for the statistical analysis. A p-value<0.05 was considered to be statistically significant. RESULTS: At least one of the types of sexual dysfunction, as defined by IIEF (IIEF I, II, and III), was found in 22 (55%) of the 40 patients (55%). Erectile dysfunction (IIEF I) was found in six (15%) of 40 patients, orgasmic dysfunction (IIEF II) in six (15%) of 40 patients, and loss of sexual desire (IIEF III) in 16 (40%) of 40 patients. According to other subscales of IIEF, 22 (55%) of 40 patients were not satisfied with sexual intercourse (IIEF IV), and 20 (50%) of 40 patients were not satisfied with their sex livee (IIEF V). None of the subscales of IIEF was significantly correlated with the age of the patients or with the duration of epilepsy. In patients with at least one of the sexual dysfunctions (IIEF I, II, and III), we found a statistically significant increase of FSH and SHBG, and a decrease of DHEAS and FAI in comparison with those in the patients with normal sexual functions. In patients with erectile dysfunction, we found the same changes and a significant increase of E2. In patients with orgasmic dysfunction, we found a statistically significant decrease of DHEAS. In patients with dysfunction of sexual desire, we noticed a significant increase of SHBG and a decrease of DHEAS and FAI. All patients with orgasmic dysfunction were being treated with carbamazepine (CBZ) in monotherapy or combination therapy. In patients with at least one type of sexual dysfunction (IIEF I, II, and III), we found a higher proportion of valproate treatment in monotherapy or combination therapy in comparison with CBZ. CONCLUSIONS: Our study showed a relatively high incidence of sexual dysfunction and dissatisfaction with sexual intercourse and sex life, as defined by the IIEF I-V questionnaire, in men with refractory focal epilepsy. The most frequent dysfunction in these patients is the impairment of sexual desire. However, our study indicates some specific hormonal changes related to various types of sexual dysfunction that are not related to antiepileptic drug treatment.