Renal - Sexual advice and Chronic kidney disease

For some kidney patients, being diagnosed with chronic kidney disease can cause sexual problems. Not all patients will experience problems, but for patients that do, there are a range of treatments and help available.

It is important to remember that many people in their lifetime suffer with some sort of emotional problems which can lead to sexual difficulties. Sexual difficulties can make people feel isolated; some people may feel self-conscious, or fearful of their sexual problems that they suffer for months without seeking any advice or support.

Some common causes of sexual difficulties that patients with chronic kidney disease may experience are:

• Physical because of chronic kidney disease and certain medications
• Psychological due to anxiety, depression, some patients compare chronic kidney disease to a grieving process due to loss of kidney function, which may affect their sex life
• Emotional for example unresolved grief, unhappiness due to other problems or relationship difficulties

Altered body image and changes in relationships

• Preparation for dialysis may mean the creation of an “access point” in the form of a dialysis catheter for peritoneal dialysis or a fistula. Changes to your body may cause concern for some patients. As health care professionals we recognise that body image is an important part of general wellbeing. Sometimes personal, both physical and emotional adjustments need to be made to cope with kidney disease. For some patients it can be helpful to talk to someone outside your immediate situation about any concerns you may have with your altered body image
• Discussing this with staff may help to relieve some of your fears or anxieties, please speak to a member of the chronic kidney disease team if you feel you would benefit from being referred to the renal psychologist for counselling regarding this. The chronic kidney disease team can also arrange for you to be referred for psychosexual therapy
• Psychosexual therapy has been around since the 1950’s psychosexual therapists have a background in medicine but in addition have undertaken specialist training in the causes and treatments of sexual dysfunction

Contraception

Contraception is important to people with chronic kidney disease, it should not be assumed that kidney failure will stop everyone having children, for a man or a woman. There are many different methods of contraception available, please discuss this with your GP or family planning clinic.

Loss of sex drive

Low sex drive may be described as a lack (or loss) of:

• Spontaneous sexual thoughts and/or
• The wish to initiate or respond to sexual activity

Of course, this is only a problem if it causes distress to the man and/or conflict in his relationship.

Common causes of low sex drive in a man can include:

• Health problems such as kidney failure
• Side effects of medications
• Psychological problems such as depression or anxiety

If you are experiencing any of the above concerns, please speak to a member of the chronic kidney disease team or your renal doctor.  If needed, a referral can be made to the renal psychologist for support or a referral can be made to the psychosexual therapy team if required.

Erectile dysfunction (impotence)

Men with chronic kidney disease may experience erectile dysfunction, which can also be known as impotence. Erectile dysfunction is the inability to get and maintain an erection that is sufficient for satisfactory sexual intercourse.

Most men will find they are unable to get or maintain an erection occasionally, perhaps because of tiredness or stress and this can be quite normal. Erectile dysfunction is only diagnosed when the problem is persistent and recurrent. It is very easy for a “one-off” incident to turn into a persistent problem, through fear that the difficulty will recur.

Any problems experienced or concerns regarding erectile dysfunction can be discussed with a member of the chronic kidney disease team or your kidney doctor, so that if required you can be referred to other specialists to resolve or improve the issue.

Menstruation (periods)

When a woman has chronic kidney disease their menstruation cycles may stop all together. This is because with chronic kidney disease toxins in the body can build up. Over time this can prevent egg production and menstruation. If you have any concerns about this subject, you can speak to a member of the Chronic Kidney Team for advice.

Vaginal dryness

Normally the walls of the vagina stay lubricated with a thin layer of clear fluid. The hormone oestrogen helps maintain that fluid and keeps the lining of the vagina healthy and thick. Patients with chronic kidney disease often have lower levels of oestrogen. Vaginal dryness can be uncomfortable; it can lead to itching, burning and painful intercourse. Any burning, itching or discomfort in the vaginal area should be reported to your GP. Your GP may organise a pelvic exam to rule out other possible causes for your discomfort. The most common treatment for vaginal dryness is topical oestrogen therapy, or a water-soluble vaginal lubricant which can be prescribed by your GP.

Pregnancy

Pregnancy is not normally advised in patients with chronic kidney disease stage 4 or 5, due to the pregnancy risks of both mother and baby and needs to be discussed with your renal consultant in advance. In most cases, it would be advisable to defer pregnancy until at least 1 year after a successful kidney transplant.

Contact Details

If you have any questions, please contact 0161 206 1882 or email renalckd@nca.nhs.uk