Sexual dysfunction is frequently reported by patients with epilepsy. Despite its fundamental role in human life, there has been surprisingly little research into the neurological control of human sexual behaviour. Multiple causes may lead to sexual dysfunction. The basis for hyposexuality has been attributed to both epilepsy and antiepileptic drug (AED) use, making it difficult to distinguish between the illness-specific and pharmacological impacts on sexual functioning. Low levels of androgens are associated with sexual arousal insufficiency and sexual dysfunction. When examining sexual dysfunction in men and women with epilepsy, the Arizona Sexual Experience Scale (ASEX) may be helpful in evaluating sexual function. Laboratory tests for oestrogen, free and total testosterone, and serum SHBG (sexhormone binding globuline) may also be useful in evaluating sexual health. Sporadic case studies suggest that hypersexuality is a rare but dramatic outcome of unilateral temporal lobectomy. Sexual seizure manifestations are also rare clinical phenomena during or after complex partial seizures that have received attention in the recent literature.