From the Director's Chair: Sex and Kidney Disease

By Paul Kellerman, MD

Now that I've got your attention, I felt it appropriate to talk about a topic that is very important to most people. Sex is not only a fact of life, but a very important part of most people's lives. Age is not necessarily a limiting factor, as many people are sexually active their entire lives. Close personal relationships with intimacy, even without active sex, provide important emotional support for all people, particularly in the face of illness.

Illness can significantly affect people's sex lives. People with kidney disease undergo changes in their sex hormones, which normally contribute to having a good sex life. Testosterone levels drop, estrogen levels drop, overall energy levels decrease and there is often depression in adjusting to a life on dialysis. More than 50% of men have symptoms of decreased sexual desire, impotence and decreased sperm counts. Women have decreased desire, decreased ovulation and fertility and much higher rates of miscarriage. Women on dialysis rarely carry babies to term but women who are transplanted can often have children if they so desire.

The causes of decreased sexual function include uremia (the illness from kidney dysfunction), anemia (low red blood cell counts), certain medications, and other medical conditions that interfere with sexual function, such as diabetes, hardening of the arteries, and depression. Once on dialysis, some patients may do better sexually than prior to starting dialysis , mostly due to dialysis clearing the uremia, but a majority of dialysis patients still have sexual problems.

The treatment of sexual dysfunction in men and women is initially the same: making sure patients receive adequate dialysis, correcting the anemia, removing medications that interfere with sexual function, if possible, and treating depression if present. There are also specific treatments available as well. Women may require female hormones such as estrogen or progesterone to undergo normal menstrual cycles and men may require testosterone if their levels are low.

Prior to 1998, for men, there were medications that helped with erections, either introduced into the urethra, or with injections. With the introduction of Viagra nine years ago and similar medications in recent years (such as Cialis and Levitra) that dilate blood vessels and cause erections, these pills are now the primary method of helping men with impotence. These pills must never be used if you are taking nitrates for heart disease (either by patch or pill), for the combination of these medications can drop your blood pressure dangerously low. Also, if you have active heart disease, for example angina, it can be harmful to use these medications.

There is very little data on use of these medications in women, but there are some indications that these agents may increase sexual desire and satisfaction in women too.

If you are concerned with any sexual problems, please talk initially with whomever you are most comfortable with – your nurse, social worker or doctor. We help patients deal with this problem all the time. Then, your doctor can discuss your treatment options and individualize the treatment for you.

"Every heart sings a song, incomplete, until another heart whispers back. Those who wish to sing always find a song. At the touch of a lover, everyone becomes a poet." – Plato