The aim of the study was to evaluate the prevalence and the etiology of sexual dysfunctions (SD) in a group of epileptic outpatients. Sixty Italian men (30 patients and 30 controls), living in Sicily, were enrolled in the study. Our diagnostic investigation included physical and neurological examination, EEG, MRI and Hamilton Depression and Anxiety Scales administration. A "semi-structured" questionnaire and the short form of the Sex relation Evaluation Schedule Assessment Monitoring were administered to the whole sample to evaluate their sexual well-being. There was no correlation between SD and type of epilepsy, EEG abnormalities and different antiepileptic drugs, while a weak correlation was observed between seizure frequency and the main SD. Forty-seven percent of the patients were affected by mild to moderate depression and 73.3% were anxious. Moreover, those patients who had uncontrolled seizures presented alteration in their social and affective area. Our findings showed a low prevalence of SD in epileptic male outpatients, especially concerning hyposexuality, and an important role of the seizure frequency in the multifactorial aetiology of sexual impairment in epilepsy. However, larger and multicenter studies are needed to better define the effects of epilepsy per se and the individual treatments on sexual function.