Sexual problems

Many people with kidney failure experience sexual problems. Some accept an unsatisfactory sex life when help is available. Treatment is usually successful, provided both partners want to have a fulfilling sex life and are willing to accept help. Unless you admit there is a problem and ask for help, you will not solve it.

Emotional and psychological problems
Sexual problems involve two people. Both partners need to work hard to sort them out.

It is very common for people to experience changes in loving relationships after the diagnosis of kidney failure. It can be hard to maintain the same balance in a relationship that existed before the diagnosis, or to continue to share the same interests.

One partner often assumes the role of caregiver while the other assumes the role of the sick person. The healthy partner may not want to bother the patient for sex.

Unfounded fears can also cause problems. For example, some healthy partners worry about catching kidney failure through sex. Kidney failure, of course, cannot be spread by sexual contact.

The partner with kidney failure may struggle with diminished self-esteem. Someone who feels worthless, a burden, or unattractive, is unlikely to initiate sex. Later, when treatment has improved a patient's health, the desire to renew a sexual relationship can create new stresses.

It may take time and patience for both partners to resolve such problems.

Make sure you continue to communicate with your partner. If you cannot communicate, talk to your renal counselor, social worker or nurse. They may be able to help you, or will find a psychologist or counselor to whom you and your partner can talk.

Sexual Problems: Physical problems
Common sexual problems include:

  • lack of interest in sex
  • lack of arousal
  • difficulty in achieving orgasm

These problems often have physical causes, such as the following:

Tiredness
Tiredness may be caused by anemia, insufficient dialysis, or other medical problems.

A change in the dialysis prescription or anemia treatment often helps.

Hormonal disturbances
Hormones are chemicals that control many body functions. Some hormones are specifically designed to control sexual urges. The levels of these hormones can be higher or lower than normal in patients with kidney failure. With men, the testicles may produce less of the male sex hormone, testosterone.

Hormone injections can be given, but since hormone levels are rarely the only cause of sexual problems, injections alone are unlikely to be the solution.

Poor blood supply
Poor blood supply to the sex organs due to narrowing of blood vessels can result in a lack of arousal and inability to reach orgasm. In men one of the main reasons for impotence is the inability to achieve or to maintain an erection, which depends on the blood supply to the penis.

Nerve damage
Kidney failure can lead to nerve damage, which can affect the ability of some patients to become sexually aroused.

Medication
Some drugs, can contribute to sexual problems. If you tell your doctor you are experiencing problems, he or she will review the drugs you are taking to see whether alternative medication might be available.

"It is important to remember that women as well as men have problems becoming aroused. Unlike men however, women are able to engage in sexual relationships whether or not they are physically aroused. With the help of artificial lubrication, they should not find intercourse uncomfortable." - Juliet Auer, Dialysis Support Manager

Sexual Problems: Physical: Treating male impotence
Difficulty in getting or keeping an erection is a common problem among male kidney patients, usually resulting from one or more of the physical causes listed above. Your doctor will be able to discuss details of the treatments listed below and advise you on the advantages and disadvantages of each.

Vacuum device
This technique uses a mechanical device to create a vacuum around the penis, producing an erection. To maintain the erection, a tension ring (similar to an elastic band) is pushed onto the base of the penis. This stops the blood escaping from the penis too quickly. With the tension ring in place, the erection can be maintained for up to 30 minutes.

Penile injection therapy
A patient injects erection-producing medication into the base of his penis. The penis becomes erect almost immediately, and the erection lasts 1 to 2 hours.

Penile insertion (transurethral) therapy
With this technique the patient uses an applicator to insert a tiny pellet of medication into the end of the penis. Once the pellet is released, it causes an erection to develop over the next 10 to 30 minutes.

Penile implants
This is a surgical procedure involving the permanent insertion of a cylinder in the penis. A tube connects the cylinder to a pump in the scrotum. This procedure permanently alters the penis so that a natural erection will never again be possible.

Drug therapy
Drug therapy for impotence works by opening up the blood vessels to the penis. It may help patients who have trouble achieving erection due to lack of blood supply to the penis. It is not suitable for patients with heart problems.

May 1, 2006