Persons with well-controlled or infrequent seizures should have no serious problems dating or developing and maintaining a stable, intimate relationship. For persons with uncontrolled seizures, dating and romantic relationships can be more difficult. Nevertheless, many people with frequent seizures have adjusted well to their condition and are successful in pursuing an active romantic life. All persons with epilepsy sooner or later face some important questions: Do I tell this person that I have epilepsy? When should I tell him or her? How much should I tell?
There is no reason to rush the disclosure of epilepsy. Unless the seizures are so frequent that one might occur on the first date, it is best to wait until the ice is broken and trust and openness have developed in the relationship. These positive developments may happen on the first date or the tenth date, or they may never happen. If the two persons are obviously incompatible, there is no reason to discuss the disorder. If the relationship is developing slowly but is promising, it is reasonable to discuss the epilepsy earlier rather than later. It is best to tell the other person face to face, not over the telephone or by letter.
The way in which the disorder is presented is often how the other person will see it. The person with epilepsy should be honest in telling the truth about the disorder and how he or she has been affected by it. The other person should be allowed to react to what he or she has heard. The person with epilepsy has had time to adjust to the disorder, but the friend needs time to ask questions and to think about it.
Epilepsy should not be made the focus of the conversation. The two people should discuss it and then move on to other subjects. Like everyone else, a person with epilepsy is defined by many traits and attributes; epilepsy should not be allowed to be the defining feature.
Anyone who dates and gets involved in romantic relationships is likely to experience rejection at some time or another. Some prospective partners may say no to the first date or the second date, and others may break up the relationship after an extended period of dating. Rejection is, unfortunately, part of dating and relationships for everyone; it is not unique to persons with epilepsy. People are rejected for a variety of physical characteristics, personality traits, social beliefs, and other reasons. Numerous observations and feelings about other people merge in the subconscious parts of our minds, and we end up attracted to some people and not to others. Epilepsy may contribute to the reasons for rejection by some people, but it may be "attractive" to others who have a need to nurture or care for someone. However, a healthy and long-term relationship is more likely to develop when the other person is attracted to the individual's personal qualities and is able to put epilepsy in its rightful place as a medical problem.
Persons with epilepsy can enjoy all the sexual feelings and pleasures others enjoy. Epilepsy is not generally associated with restrictions on sexual activities. Most persons with epilepsy have normal sex lives. There is no convincing evidence that seizures are more likely to occur during sexual activities. Rarely, seizures may be more likely to occur during or shortly after physical exertion and intense emotional experiences. In this case, some modifications may be needed for the enjoyment of an active sex life.
Sexual dysfunction, a common problem in the general population, refers to an inability to experience sexual feelings and arousal or to perform sexual activities. For example, the failure of a man to achieve an erection (impotence) or the inability of a man or woman to achieve an orgasm (anorgasmia) are forms of sexual dysfunction. In the general population of people without epilepsy, many women do not routinely achieve orgasm, and intermittent impotence is a problem for young men and even more of a problem for older men. Impotence is more common among men with epilepsy than for men in the general population. Antiepileptic drugs, mainly the barbiturates (phenobarbital and primidone), can cause or aggravate the impotence. The epilepsy itself, and not antiepileptic drugs, may contribute to sexual dysfunction, especially if the seizures are poorly controlled. If depression is present, its treatment may lead to resumption of normal sexual functioning. Viagra (sildenafil) appears to be safe for epilepsy patients and does not interact with antiepileptic drugs.
Studies suggest that some persons with epilepsy have a reduced libido, or a lower level of interest in sexual activity, compared with people in the general population. Only a minority of persons with epilepsy have such a problem, and they are not usually concerned about it. More often, a spouse feels that the partner's interest in sex is less than he or she would expect. Women with epilepsy are more likely than other women to experience painful intercourse and sexual dissatisfaction. If sexual dysfunction is a problem, a person should not hesitate to discuss it with the doctor, and referral to a gynecologist, urologist, or other specialist may be helpful.
Adolescent girls and women with epilepsy should be aware that antiepileptic drugs can cause birth defects. They also need to be educated about the different types of birth control and the effects of antiepileptic drugs on birth control pills. Adolescent girls with epilepsy have a higher frequency of unplanned pregnancy than females their age in the general population. In one study, approximately 30% of females with epilepsy who were age 24 years or younger experienced unplanned pregnancy, a higher rate than in the general population. However, the reasons for the increased rate of pregnancy in these women is uncertain.
Men with epilepsy who are potential fathers also need to know about family planning, but they should be reassured that in general they are just about as likely as other men to father healthy babies. The rate of epilepsy among children whose fathers have epilepsy but whose mothers do not is only slightly higher than the rate in the general population. Some studies show a slight increase in birth defects among babies whose fathers took antiepileptic drugs, but others show no increase at all.
Most men and women with epilepsy have normal sex lives, are fertile, and are able to have perfectly healthy children. Nevertheless, epilepsy, its treatment, and associated disorders may affect fertility and reproduction. Men with epilepsy may have slightly reduced fertility. Hormonal changes associated with the seizures may contribute to the problem. In addition, sperm production may be reduced in men who take antiepileptic drugs. Women with epilepsy also have somewhat higher rates of infertility than women in the general population. Antiepileptic drugs and irregular menstrual cycles probably contribute to this infertility.
The polycystic ovary syndrome in women is characterized by high levels of testosterone in the blood, increased hair growth on the body (hirsutism), multiple ovarian cysts, irregular menstruation, and lack of ovulation. Many of the affected women are obese. This syndrome is more common among women with epilepsy. Some evidence suggests that it occurs more often in women who take valproic acid. Infertile couples in which one member, or both, have epilepsy should consult with an infertility specialist. Common causes of infertility, such as endometriosis (abnormal location of the lining of the womb) in women or a varicocele (abnormal collection of veins in the scrotal sac) in men, should be investigated and treated. Infertility should never be dismissed as simply a problem of the epilepsy or the antiepileptic drugs used to treat it.
Topic Editor: Steven C. Schachter, M.D.
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