Investigation On Related Factors Of Sexual Dysfunction In Han Women With Epilepsy And Study On Its Correlation With Estrogen Receptor Gene Polymorphism

Part Ⅰ Investigation on incidence and related factors of sexual dysfunction in Han women with epilepsyObjective Women with epilepsy(WWE)are believed to be at risk of sexual dysfunction,and face many sexual challenges due to multiplefactors.This study aimed to assess the factors associated with sexual dysfunction in Chinese HanWYVE.Methods Continuous collection of 112 cases of Han married WWE from January 2015 to December 2017at the Institutional Ethics Comnittee of the Affiliated Hospital of Yangzhou University,and 120 matched non-epileptic healthy Han married women as a control group.112 WWE were classified as focal(FE)or comprehensive(GE)epilepsy and were treated with antiepileptic drugs(AEDs)for 1 year or more.Data collection was performed with a form inquiring about the participants5 demographic parameters,including age,educational level,employment,family monthly income,history of infertility and irregular menses.Investigate the details of epilepsy diseases in WWE:age of onset,duration of illness,seizure frequency,medication adherence.All participants were submitted to relevant scales and questionnaires(FSFI,SAS,and SDS).In addition,WWE were evaluated by the MMAS-8 and NHS3 scales.Sexual function and related factors were compared between the two groups.Results A high rate(70.5%)of sexual dysfunction was detected in WWE,for 24.2%in controls.Sexual dysfunction affected all dimensions:desire(85.7%),arousal(56.3%),lubrication(47.3%),orgasm(66.1%),satisfaction(58.9%)and pain(41.1%).Elevated rates of anxiety(40.2%)and depression(33%),and poor medication adherence(31.3%)were also found in WWE.Binary logistic regression found that poor economic status(OR=13.904,95%CI:2.025-95.472,P=0.007 and OR=6.350,95%CI:1.323-30.477,P=0.021),anxiety(OR=1.222,95%CI:1.055-1.415,P=0.007)and poor medication adherence(OR=0.297,95%CI:0.124-0.707,P=0.006)were associated with sexual dysfunction.Conclusions The associated factors of sexual dysfunction in Chinese Han WWE are multifactorial.WWE have higher levels of anxiety,poor family economic status and poor medication adherence.Medical professionals should not only better control seizures,but also evaluate and improve patients’ sexual function,so as to improve the quality of life of WWE.Part Ⅱ Study on association between estrogen receptor gene polymorphism and sexual dysfunction and sex hormones in Han women with epilepsyObjective To investigate the association between estrogen receptor a(ERa)gene and β(ERβ)gene polymorphisms and sexual dysfunction and sex hormones in Han women with epilepsy in Yangzhou.Methods 112 women with epilepsy(WWE)and 120 healthy controls were tested for sex hormones by chemiluminescence.The ERa gene(PvuⅡ and XbaⅠ)and the ERp gene(Rsal and Alul)polymorphisms were analyzed by polymerase chain reaction-restriction fragment length polymorphisms(PCR-RFLP).The differences of sex hormones,ER genotype and allele frequencies between the two groups were compared.The association between ERa and ERβ gene polymorphisms,sex hormones and sexual function in two groups were analyzed.Results(1)The levels of prolactin(PRL)and the ratio of estrogen(E2)to progesterone(P)(E2/P)in the WWE group were significantly higher than those in the control group(t=2.072,P=0.039;t=4.405,P<0.001=.(2)There were significant differences in the frequencies of ERa gene PvuⅡ TT,TC and CC in two groups(X2=12.142,P=0.002).The frequency of C allele in WWE group was significantly higher than that in control group(57.1%vs 42.1%;X2=10.512,P=0.001).There were significant differences in the frequencies of ERp gene AluI GG,GA and AA in two groups(X2=1 1.249,P=0.004).The frequency of A allele in WWE group was significantly higher than that in the control group(30.8%vs 17.5%;X2=11.267,P=0.001).(3)There was significant difference in E2 level between ERa gene PvuⅡ TT,TC and CC in WWE group(F=3.367,P=0.038);There was a significant difference in testosterone level between ERa Xbal gene AA,AG and GG in WWE group(F=5.960,P=0.003).(4)There were significant differences in the FSFI total score and dimensions of sexual arousal,lubrication and satisfaction between ERa gene PvuⅡ TT,TC and CC in WWE group(F=4.362,P=0.015;F＝3.570,P=0.031;F=5.774,P=0.004;F=3.678,P=0.028);There were significant differences in dimensions of sexual desire and lubrication between ERp gene Alul GG,GA and AA in WWE group(F=6.850,P=0.002;F=7.568,P=0.001).(5)There were significant differences in testosterone level and PvuⅡ T alleles between the SD subgroups and the Non-SD subgroup in WWE group(X2=3.172,P=0.002;X2=5.223 P=0.022);There was significant difference in the frequency of ERp gene Alul GG、GA and AA in SD subgroups and the Non-SD subgroup(X2=21.579,P<0.001=.(6)Binary logistic regression found that ERa gene PvuⅡ CC genotype was independently associated with sexual dysfunction in WWE(ORF=6.074,95%Cl:1.257-29.352,P=0.025);Testosterone level was an independent protective factor for sexual function(OR=0.412,95%Cl:0.201-0.842,P＝0.015).Conclusions The ERa gene PvuⅡ polymorphism may be independently related to the sexual dysfunction in Han women with epilepsy in Yangzhou,and the PvuⅡ CC genotype may be the risk genotype of sexual dysfiunetion.PvuⅡ C allele may increase the risk of sexual function.PvuⅡ T allele may be associated with higher sexual desire,arousal,lubrication and satisfaction.ERp gene Alul A allele may be associated with lower sexual desire and higher lubrication.Higher testosterone level may be protective factor for sexual function.However,the conclusions of this study have yet to be confirmed by large-scale,multi-regional,multi-ethnic epidemiology and further laboratory studies.