Renal failure and sexual health

  • Patients with Chronic Kidney Disease often show signs of sexual health disorders. 

  • What are the main problems in the sexual health of CKD patients?
  • For men, mainly it is erectile dysfunction (studies report that up to 80% of patients undergoing hemodialysis may experience erectile dysfunction), decreased sexual desire, fear of rejection, difficulty in sexual arousal, reduced libido as well as infertility. Women often have decreased sexual desire, poor opinion of their body, fear of rejection, pain during intercourse, often decreased libido, difficulty in sexual stimulation, and difficulty in reaching orgasm. For women at the end-stage kidney disease, the most common problems are menstrual disorder and infertility. Obviously, the sexual health problems of a patient with CKD are not only related to his physical health.
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  • What are the factors contributing to these problems?
  • It is the renal insufficiency (uremia) itself, anemia, coexisting conditions (e.g. diabetes mellitus, hyperlipidemia, etc.), cardiovascular problems and the medication that the patients take.
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  • How can we distinguish sexual dysfunction derived from physical or psychological factors?
  • It is difficult to pinpoint the main factor responsible for sexual dysfunction. It is important for the patient to confide his problem in his nephrologist. A comprehensive medical and psychological assessment must be made, and sexual history must be taken. Initially, medication that may affect the patient’s sexual health should be assessed and be replaced. An estimation of the penile perfusion and the nerve function as well as of the sex hormones that can affect the sexual behavior of patients should be evaluated. If no pathological cause is revealed, it is likely that sexual dysfunction is due to psychological causes. One cannot overlook the fact that these patients often have a significant psychological burden due to the chronicity of their illness. This psychological burden can play a central role both in the appearance of erection problems as well as the reduction in the patient's sexual desire.
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  • Is there a therapy for sexual dysfunction derived from pathological causes?
  • Yes. Initially, all modifiable factors that potentially affect patients' sexual lives must be examined, medication should be evaluated, anemia should be corrected, as well as testosterone, estrogen and prolactin levels. In the event of hormonal disturbances, the correct hormonal environment can be restored. In the case of vascular and other erectile dysfunction, either oral medication (sildenafil, tadalafil, vardenafil), local therapies (intraperitoneal injections) or revascularization treatments are available. Women with vaginal atrophy and dryness can benefit from local estrogen treatment or vaginal lubricants. Hormone replacement therapy can restore regular menstruation. The benefits of this treatment, however, must be weighed against the cardiovascular risk associated with hormone replacement therapy.
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  • Is there a treatment for sexual dysfunction derived from psychological factors?
  • The feeling of anxiety or depression is normal when the patient experiences a serious illness such as kidney failure. Relaxation exercises can help control these fears. Regular physical activity improves the physical condition and body appearance. If sexual problems persist, counseling can help. Appropriate medication can always help along with the guidelines provided by a physician.
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  • After transplantation, is there any differentiation of the problems of sexual health?
  • After kidney transplant, the hormonal environment is restored and many of the sexual health problems of the patients are resolved.
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  • Should a dialysis patient avoid sexual intercourse?
  • No. There is no contraindication to Chronic Kidney Disease for Sexual Contact.
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  • Extra tips
  • - Take care of your appearance. When you look good, you feel beautiful.
  • - Don’t think of sexual intercourse as the only sexual act, since it can cause you extra anxiety.
  • - Work with your partner to find pleasant ways to enjoy your sexual intercourse.
  • - It is useful to know that sexual anxiety is common to other patients too, and that there is help.
  • - Don’t ignore the problem and maintain a positive attitude.
  • Many of the problems associated with sexual health are not purely medical but closely related to emotional stress. You should have a positive attitude and talk about your problem with your nephrologist so that the proper treatment of the problem is made. Every problem has a solution.
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  • Mesogeios Dialysis Centers Group Scientific Team  
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  • Bibliography 
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