Many Americans feel awkward and embarrassed when speaking to their doctors about sexual health. As a result, many important conversations don’t take place. This is unfortunate, since sexual health can have a significant impact on your quality of life. Chronic kidney disease (CKD), and especially kidney failure, is one of many medical conditions that can negatively impact your sexual health. 

In a recent webinar hosted by the American Kidney Fund, Dr. Toby Gottheiner, MD, a nephrologist and Medical Advisor of Medical Clinical Affairs at Satellite Healthcare, along with Emily Watson, MSW, LCSW, a renal social worker and Director of Social Work at Satellite Healthcare, discuss:

• Normal sexual function
• Types and risk factors of sexual dysfunction in men and women 
• Physical and psychological risk factors for sexual dysfunction in CKD
• Treatment options for sexual dysfunction in CKD

Normal Sexual Function

While there is much variation among individuals, normal sexual function consists of five basic stages:

• Desires, or sexual urge in response to physical or situational stimulus
• Arousal, or physical response to desire
• Plateau, or intensification of physical response
• Orgasm, as illustrated by ejaculation in males, and constriction of vaginal wall in females
• Resolution, or decreased arousal

Types and Risk Factors of Sexual Dysfunction in Men and Women 

Sexual dysfunction may occur in the desire, arousal, or orgasm stage. This may manifest as:

• Lack of or reduced desire 
• Lack of physical response to desire, as with erectile dysfunction (ED)
• Inability to achieve orgasm for females, and delayed or premature ejaculation in males

Another class of sexual dysfunction is pain during sex. Both males and females can experience this.

While some risk factors for sexual dysfunction are shared by men and women, others can differ. Shared risk factors include:

• Age
• Bitterness toward a partner
• Medical conditions such as diabetes, hypertension, and heart disease
• Medications, especially blood pressure drugs and antidepressants
• Anxiety and depression
• History of sexual trauma

Men may also experience sexual dysfunction due to neurological issues, obesity, and smoking. Women may experience sexual dysfunction as a result of childbirth and menopause.

Physical and Psychological Risk Factors for Sexual Dysfunction in CKD

Sexual dysfunction of some type is common in people living with CKD, affecting up to 70% of men and up to 84% of women, and these percentages are thought to be low due to underreporting. There are multiple physical and psychological risk factors: 

Physical Factors

Physical risk factors include hormonal changes affecting the pituitary gland, testicles, and testosterone in men, and the pituitary gland, ovaries, and estrogen in women. Vascular disease can also play a part, interfering with blood flow, blood supply to nerves, ovary and penis function, and fertility. Dialysis can also cause extreme fatigue, which, in turn, affects libido and the sexual cycle. 

Psychological Factors

Psychological factors can include anxiety and depression related to:

• Loss of overall quality of life
• Financial stress
• Fear of what the future may bring
• Body image changes
• Loss of independence or increased dependence on others
• Waiting for a transplant
• Tension in interpersonal relationships

Treatment Options for Sexual Dysfunction in CKD

Treatment approaches for both men and women have included:

• Hormone and medication therapy
• Treating anemia (insufficient red blood cells)
• Treating depression and anxiety with medications and/or talk therapy
• Zinc supplements
• Optimizing dialysis

Additional treatment for men can include:

• Prolactin suppression 
• Erectile dysfunction medications
• Devices and procedures (penile injections, implants, etc.)

Supplemental treatment for women may include:

• Use of progestins to initiate menstruation 
• Lubricants 
• Birth control for those who are child-bearing age

If you are experiencing symptoms of sexual dysfunction, speak with your doctor so that you can explore your treatment options and restore your sexual health.

*American Kidney Fund. (2019, July 18). Sexual Health, Sexuality, and Kidney Disease [Webinar]. https://www.kidneyfund.org/training/webinars/sexual-health-sexuality-and-kidney-disease.html