By: Khomotso Fridah

Men’s Sexual Health and Epilepsy

Sexual health is a fundamental part of overall well-being, yet it is often overlooked in conversations about chronic health conditions. For men living with epilepsy, sexual health concerns can be complex, deeply personal, and difficult to talk about. Many men experience changes in sexual functioning, desire, or confidence, but these experiences are rarely discussed openly in clinical settings or broader public discourse. As a result, men may struggle in silence, unsure whether their concerns are common, treatable, or even related to epilepsy.

Addressing men’s sexual health within the context of epilepsy is essential for promoting holistic care. Understanding both the physical and psychological factors involved can help reduce stigma, encourage help-seeking, and improve quality of life for men living with epilepsy.

What Is Sexual Health?

Sexual health is not limited to sexual activity or physical performance. The World Health Organization (2025) defines sexual health as a state of physical, emotional, mental, and social well-being related to sexuality. This includes the ability to experience sexuality in a positive and respectful way, free from fear, discrimination, or coercion. Sexual health also involves access to accurate information, appropriate healthcare services, and supportive environments that allow individuals to express concerns without shame (WHO, 2025).

Sexual health care may include routine medical assessments, discussions about sexual functioning, hormonal health monitoring, mental health support, and education around relationships and intimacy. Importantly, sexual health is closely linked to overall health, meaning that changes in physical or psychological well-being often affect sexual functioning as well (WHO,2025).

For men, sexual health is often tied to identity, confidence, and relationship satisfaction. When sexual health concerns are not addressed, they can affect emotional well-being and interpersonal relationships, particularly for men living with chronic conditions such as epilepsy (McCabe et al., 2016; LaFrance & Kanner, 2008).

Men and Sexual Health Care

Men’s sexual health care involves supporting both physical and psychological functioning across the lifespan. Factors such as hormonal balance, cardiovascular health, neurological functioning, emotional regulation, and stress management all contribute to healthy sexual activity (McCabe et al., 2016; WHO, 2025). Open communication with healthcare providers and partners is also essential for identifying concerns early and accessing appropriate care (WHO, 2025).

Despite this, men are often less likely to seek help for sexual or emotional difficulties. Social expectations around masculinity may discourage men from discussing vulnerability, fear, or sexual concerns, particularly within healthcare settings (Addis & Mahalik, 2003; Courtenay, 2000). This reluctance can be especially pronounced in the context of chronic illness, where men may already experience a perceived loss of control or independence (Galdas et al., 2005).

For men with epilepsy, sexual health care should be integrated into routine epilepsy management. This includes creating space for conversations about sexual functioning, medication side effects, emotional well-being, and relationship concerns. When sexual health is treated as a normal part of healthcare, men are more likely to feel supported and empowered to seek help (Harden, 2006; Ouchida, 2023).

Challenges Men with Epilepsy Face

Sexual Dysfunction in Men with Epilepsy

Sexual dysfunction is more common among men with epilepsy than in the general population. Recent studies indicate that men with epilepsy experience higher rates of reduced libido, erectile dysfunction, and difficulties with sexual satisfaction (Abou Elmaaty et al., 2023; Balagandi et al., 2025). These challenges may arise from a combination of neurological, hormonal, medication-related, and psychological factors.

Seizure activity itself can disrupt brain regions involved in sexual desire and arousal. In addition, uncontrolled seizures have been associated with greater sexual dysfunction, suggesting that seizure frequency and severity may play a role in sexual health outcomes (Abou Elmaaty et al., 2023).

Hormonal Changes and Low Testosterone

Hormonal changes are an important consideration in men with epilepsy. Testosterone plays a key role in sexual desire, mood, energy levels, and overall well-being. Research suggests that epilepsy and some antiseizure medications may affect hormonal regulation, leading to altered testosterone levels or changes in hormone availability (Balagandi et al., 2025).

While not all men with epilepsy experience low testosterone, those who do may report reduced libido, fatigue, low mood, and decreased sexual satisfaction. These symptoms can significantly affect quality of life, particularly when they are not recognized or addressed within epilepsy care.

Medication Effects

Antiseizure medications are essential for managing epilepsy, but some medications have been associated with sexual side effects. Recent findings suggest that polytherapy, meaning the use of multiple antiseizure medications, may increase the risk of sexual dysfunction compared to monotherapy (Balagandi et al., 2025). Certain medications, such as valproate, have also been linked to higher rates of sexual difficulties in some men.

It is important to note that medication effects vary widely between individuals. However, when sexual side effects occur, they can be distressing and may negatively affect adherence to treatment if men feel unable to discuss these concerns with their healthcare providers.

Psychological and Emotional Challenges

Sexual health is closely connected to mental health. Men with epilepsy have higher rates of anxiety and depression compared to the general population, and these conditions are strongly associated with reduced sexual desire and erectile difficulties (Ejigu et al., 2019; Balagandi et al., 2025).

Fear of having a seizure during sexual activity is a common concern among men with epilepsy. This fear may lead to avoidance of intimacy, increased anxiety, and reduced confidence over time. Stigma surrounding epilepsy can further intensify these feelings, particularly when men worry about being judged, misunderstood, or rejected by partners.

When sexual health challenges are combined with emotional distress, the impact on self-esteem and relationships can be significant. Without appropriate support, these difficulties may persist or worsen.

Treatment Options and Support

Sexual health challenges in men with epilepsy are real and valid, and support options are available. The first step is open communication with a healthcare provider. Sexual concerns should be treated as legitimate medical issues and addressed within routine epilepsy care.

Medical and Hormonal Interventions

Healthcare providers may review antiseizure medication regimens to determine whether adjustments could reduce sexual side effects while maintaining seizure control. Hormonal evaluation may also be recommended when symptoms suggest possible testosterone imbalance. In some cases, referral to an endocrinologist or urologist may be appropriate.

Psychological and Relationship Support

Mental health support plays a crucial role in addressing sexual health concerns. Counselling or therapy can help men manage anxiety, depression, performance concerns, and relationship stress. Involving partners in discussions, when appropriate, may also help reduce fear and improve communication and intimacy.

Although epilepsy-specific sexual health interventions remain limited, broader sexual health treatments such as psychotherapy, lifestyle modifications, and evidence-based interventions for erectile dysfunction may be considered within an individualized care plan (Ouchida, 2023).

Conclusion

Men’s sexual health is an essential but often overlooked aspect of living with epilepsy. Challenges such as low libido, erectile dysfunction, hormonal changes, and emotional distress are common and deserve recognition and care. Addressing these concerns requires a holistic approach that considers both physical and psychological factors.

By encouraging open conversations, reducing stigma, and integrating sexual health into epilepsy care, healthcare providers and advocacy organizations can help ensure that men living with epilepsy feel supported, informed, and empowered. Sexual health is not separate from overall health. It is a vital part of living well.

Key Takeaways

• Sexual health includes physical, emotional, mental, and social well-being.
• Men with epilepsy experience higher rates of sexual dysfunction compared to the general population.
• Hormonal changes, medication effects, and mental health challenges all contribute to sexual health outcomes.
• Open communication with healthcare providers and partners is essential.
• Holistic, person-centred care can significantly improve quality of life.

References

Abou Elmaaty, A. A., El Sherifi, S. S., Elserafy, T. S., & Elshabrawy, H. A. (2023). Prevalence and forms of sexual dysfunctions in men with epilepsy. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 59, 129. https://doi.org/10.1186/s41983-023-00729-0

Addis, M. E., & Mahalik, J. R. (2003). Men, masculinity, and the contexts of help seeking. American Psychologist, 58(1), 5–14.
https://doi.org/10.1037/0003-066X.58.1.5

Balagandi, S. J., Al-Hakeim, H. K., & Maes, M. (2025). Sexual dysfunction in men with epilepsy: An observational case-control study. Epilepsy & Behavior, 167, 110388. https://doi.org/10.1016/j.yebeh.2025.110388

Courtenay, W. H. (2000). Constructions of masculinity and their influence on men’s well-being: A theory of gender and health. Social Science & Medicine, 50(10), 1385–1401.
https://doi.org/10.1016/S0277-9536(99)00390-1

Ejigu, A. K., Zewlde, K. H., Muluneh, N. Y., & Alemayehu, B. A. (2019). Sexual dysfunction and associated factors among patients with epilepsy. BMC Neurology, 19, 255. https://doi.org/10.1186/s12883-019-1432-1

Galdas, P. M., Cheater, F., & Marshall, P. (2005). Men and health help-seeking behaviour: Literature review. Journal of Advanced Nursing, 49(6), 616–623.
https://doi.org/10.1111/j.1365-2648.2004.03331.x

Harden, C. L. (2006). Sexual dysfunction in women and men with epilepsy. CNS Spectrums, 11(7), 497–503.
https://doi.org/10.1017/S109285290001476X

LaFrance, W. C., & Kanner, A. M. (2008).
Psychiatric comorbidities in epilepsy. International Review of Neurobiology, 83, 347–383.
https://doi.org/10.1016/S0074-7742(08)00017-5

McCabe, M. P., Sharlip, I. D., Lewis, R., Atalla, E., Balon, R., Fisher, A. D., Laumann, E., Lee, S. W. H., & Segraves, R. T. (2016). Risk factors for sexual dysfunction among men and women: A consensus statement from the Fourth International Consultation on Sexual Medicine. The Journal of Sexual Medicine, 13(2), 153–167. https://doi.org/10.1016/j.jsxm.2015.12.015

Ouchida, S. (2023). Sexual dysfunction in people with epilepsy: A scoping review. Epilepsy & Behavior, 139, 109028. https://doi.org/10.1016/j.yebeh.2022.109028

Harden, C. L. (2006). Sexual dysfunction in women and men with epilepsy. CNS Spectrums, 11(7), 497–503.https://doi.org/10.1017/S109285290001476X