Early sexual debut in Norwegian youth with epilepsy: A population-based study Morten I. Lossius a, ⁎, Kristin Å. Alfstad a , Betty Van Roy b , Petter Mowinckel c , Jocelyne Clench-Aas d , Leif Gjerstad e,f , Karl O. Nakken a a The National Center for Epilepsy, Division for Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway b Division of Mental Health, Akershus University Hospital, Lørenskog, Norway c Department of Pediatrics, Oslo University Hospital, Oslo, Norway d Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway e Department of Neurology, Division for Surgery and Clinical Neuroscience, Oslo University Hospital, Rikshospitalet, Norway f Faculty of Medicine, University of Oslo, Oslo, Norway abstract article info Article history: Received 13 October 2015 Revised 2 December 2015 Accepted 9 December 2015 Available online xxxx Objectives: In comparison with controls, youth with epilepsy (YWE) have greater psychosocial problems. Howev- er, information about their sexual behavior is sparse. We have performed a large, population-based questionnaire study to examine differences in sexual behavior between YWE and controls. Methods: A randomly chosen cohort of youth (13–19 years) from Akershus county, Norway (n = 19,995) was asked to complete a questionnaire anonymously with questions on epilepsy and sexual activity. Results: The response rate was 85%. Two hundred forty-seven participants reported having or having had epilepsy, i.e., a lifetime epilepsy prevalence of 1.2%. Compared with controls, a higher proportion of YWE reported having had sexual intercourse (43.6% vs. 35.3%, p = 0.009). The mean age at sexual debut was significantly lower in YWE than in controls (14.0 years vs. 15.0 years, p b 0.001), and this was particularly marked among boys. A higher proportion of YWE reported not having used contraceptives at their last sexual intercourse compared with controls (31.6% vs. 22.3%, p = 0.03). Ten percent of YWE, compared with 2% of the controls, reported that they had been forced into their first sexual intercourse. Conclusion: In YWE, some aspects of sexual behavior differ from those of their peers, with earlier sexual debut and less frequent use of contraceptives. More attention should be directed toward this subject, aiming at avoiding unwanted pregnancies and potential emotional traumas in this already vulnerable patient group. © 2015 Elsevier Inc. All rights reserved. Keywords: Youth Epilepsy Sexual behavior Psychosocial Population-based 1. Introduction The teenage years can be a challenging period, and an unpredictable and possibly stigmatizing disease like epilepsy may make this period even more troublesome. Besides struggling to find their own identity, many have their first sexual experiences during these years. In people with epilepsy, sexual functions may be negatively affected by the underlying etiology, the seizures, the treatment, and psychoso- cial factors [1–5]. Sexuality in youth with epilepsy (YWE) has received surprisingly little attention in the literature to date [6]. As these youths have more psychosocial problems than their healthy peers [7–9], it might be assumed that this also applies to sexual difficulties. We have previously shown that YWE struggle with peer relation- ships, using data from the same cohort [7]. Contributing to peer problems is probably also a lower level of social skills and social adjust- ment found in YWE [10,11]. Poor self-esteem due to a feeling of being stigmatized is likely to be particularly difficult during the years of iden- tity formation and may well influence romantic and sexual desires [12]. In a questionnaire study of US high school students, only 31% of youths stated that they would date a person with epilepsy [13]. However, whether such peer problems, reduced social skills, and stigmatization really affect sexual behavior in YWE is not known. A Canadian population-based study of people with juvenile myoclonic ep- ilepsy (JME) reported many pregnancies outside a stable relationship [14]. Adverse social outcome is also found among those with other epilepsy syndromes, e.g., living alone and never in a long-term romantic relationship [15]. In these studies, a wide range of psychosocial and psychiatric problems was found. An increased prevalence of psychiatric comorbidity in the population with epilepsy is well established [16]. It is tempting to assume that such problems may also affect sexual functions and behavior [17,18]. Thus, it might be reasonable to believe that teenagers with epilepsy generally have a later sexual debut than their peers who do not have epilepsy. In a large population-based study in Norway, we investigated various aspects of sexual activity in YWE and their peers, including Epilepsy & Behavior 56 (2016) 1–4 ⁎ Corresponding author. E-mail address: mortenl@ous-hf.no (M.I. Lossius). http://dx.doi.org/10.1016/j.yebeh.2015.12.014 1525-5050/© 2015 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh