Full text
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| Author(s): |
Sílvia de Vincentiis
Total Authors: 1
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| Document type: | Master's Dissertation |
| Press: | São Paulo. |
| Institution: | Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD) |
| Defense date: | 2008-03-14 |
| Examining board members: |
Kette Dualibi Ramos Valente;
Clarice Gorenstein;
Rosa Maria Figueiredo Valerio
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| Advisor: | Kette Dualibi Ramos Valente |
| Abstract | |
It is known that in women with epilepsy, the epileptic syndrome, seizure frequency and antiepileptic drugs may act on sexual function, sexual behavior and reproductive function. Several factors have been associated with these changes such as: duration and severity of the epilepsy, kind of antiepileptic drug and locality of the epileptogenic lesion. Based on knowledge acquired with studies in women, it is assumed that female adolescents suffer similar influences. This study aimed to evaluate several aspects related to sexual function, to sexual behavior, to sexual education and to gonadal function in female adolescents with epilepsy. We prospectively studied 35 females, with ages between 10 and 20 years, with active partial and generalized epilepsies and epileptic syndromes classified according to ILAE criteria (1989). Criteria of exclusion were: patients that had not yet had their menarche, those in use of hormonal contraceptives or intrauterine devices, either at the moment of the evaluation or in the last three months; patients with previous gynecological surgery or endocrine disorders; patients with associated chronic disease or moderate to severe mental deficiency that might hinder completion of the study protocol. Information on sexual function and education were obtained with a standard questionnaire. Our study protocol for gonadal function included analysis of the following criteria: regular menstrual cycles, dysmenorrhea, hormonal levels (FSH, LH, stradiol, progesterone, prolactin, testosterone, T3, free T4, TSH), pelvic ultrasound study, and recent or ongoing pregnancy. Gonadal function was considered normal when at least one of the above parameters was found to be adequate. No significant differences were observed between age at first sexual intercourse (p=0.54), sexual activity (p=0.23), libido (p=1,00) and orgasm (p=0.23) among patients with epilepsy, when compared to controls. Sexually active adolescents reported the use of contraceptives, although only 20.1% with orientation done by a health professional. Age of menarche was similar in both groups, but the use of valproate close to menarche and frequent seizures were factors that anticipated this event. Moreover, adolescents with epilepsy presented irregular menstrual cycles more frequently than controls. Menstrual irregularity was correlated to the presence of tonic-clonic generalized seizures (p=0.02), regardless the epilepsy type or syndrome, and with longer disease duration (p=0.06), despite of seizure frequency. Higher rates of pregnancy were observed in adolescents with epilepsy compared to controls (p<.0001). Abortion rates were similar in both groups. In this study, adolescents with epilepsy presented sexual function and behavior similar to their peers without chronic diseases. Although the gonadal function of these patients was spared, menstrual disorders were significant, suggesting that these adolescents may be in an ongoing process with anovulatory cycles and reproductive dysfunction in later adulthood. Therefore, aspects related to sexual behavior and function, contraception and gonadal function in adolescents with epilepsy require special attention by health professionals. (AU) | |