Kidney Commute CE Study Guide: Sexuality and Kidney Disease

Continuing education series for professionals.

Sexual dysfunction is prevalent in patients with kidney disease,¹ but why and what treatments are available for this important but often neglected aspect of health? Read on to learn this and more.

What is sexual dysfunction? 

"Many people think sexuality only refers to sexual intercourse, but sexuality includes many things like touching, hugging, or kissing," said Doctor Kelly Beers, a nephrologist at Albany Medical College. "It includes how you feel about yourself, how well you communicate, and how willing you are to be close to someone."

The Diagnostic and Statistical Manual of Mental Disorders defines sexual dysfunction as:

• Assigned female at birth: Sexual interest or arousal disorder, orgasmic disorder, genital pelvic pain, or penetration disorder. 
• Assigned male at birth: Erectile disorder, hypoactive disorder, premature ejaculation, and delayed ejaculate. 

A combination of medical, psychological, and sexual history can help healthcare professionals diagnose sexual dysfunction.

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Why are CKD patients more likely to experience sexual dysfunction?

One study² of the general population found that sexual dysfunction impacts 43% of people assigned female at birth and 31% of people assigned male at birth. For those with kidney disease, this number goes up to 80%, or 8 in 10 patients, reporting sexual problems.¹

Why does this number increase so dramatically in kidney disease patients?

"There is disruption of the hypothalamic gonadal axis and various hormonal changes like reduction in estrogen and progesterone or an increase of prolactin and the luteinizing hormone. Blood pressure can also affect a person's ability to get or stay erect," said Doctor Silvia Shaw, a transplant nephrologist at the University of Cincinnati. "About 75% of people assigned female at birth with kidney disease have menstrual disorders. Menorrhagia, oligomenorrhea, amenorrhea, and earlier menopause are very common. Vaginal disorders (like atrophic vaginitis, vaginal dryness, and dyspareunia) and decreased libido can also occur. The luteinizing hormone surge can cause women with advanced kidney disease or on dialysis to experience infertility."

Medications used to manage kidney disease can also impact a person's ability to have or want sexual relations.

"Our kidney patients are on drugs like antihypertensives, pain medications like opioids, and tricyclic antidepressants that can cause sexual dysfunction. Beta-blockers including atenolol and hydralazine can cause sexual dysfunction in those assigned male at birth," said Dr. Shaw.

Finally, the patient's emotions, energy levels, and general well-being affect their sexual health.

"Dialysis and late-stage kidney disease can make people really tired, have uremia, and other unpleasant symptoms. Being sick can make you not want to have sex," said Marika Sterling, a nurse practitioner at Albany Medical College. "Adjusting to a chronic condition can also be hard, leading to depression or anxiety, which feed into sexual dysfunctions."

Keep learning: Read Sexuality, Contraception, and Pregnancy in Kidney Transplantation.

Normalizing sexual dysfunction conversations

To adequately address sexual dysfunction, practitioners need to normalize these conversations with their patients.

"We as doctors and practitioners might consider this more of a personal issue than patients do. We need to normalize it as part of everyday conversations," said Meredith Pensack, obstetrician-gynecologist at the University of Cincinnati. "For example, 'How are you? Are you tired? How are specific symptoms? How's your sex life?' If you make it normal and part of the conversation, the patient will respond because they won't think it's awkward for you."

Taking these conversations to the entire interprofessional kidney care team is also essential.

"I usually refer men to their primary doctor to discuss erectile dysfunction medications. The issue with that is a lot of medications people on dialysis and those with high blood pressure or heart failure use are contradicted by those medications," said Sterling. "I refer women to OBGYNs. Some hormone or estrogen replacement therapies have shown some improvement and Bupropion or Wellbutrin may have good effects on sexual dysfunction for men and women."

Whether medical interventions work or not, try to address the issue holistically and find creative solutions to help patients achieve their desired emotions or sensations.

"Address the holistic aspects of sexual dysfunction while recognizing it's probably due to hormonal imbalances and underlying issues like fatigue and depression," said Pensack. "I always emphasize that there is more than one way for patients to become intimate with partners and help them find other ways to have intimate fulfillment."

You can also share additional resources for patients to check out independently.

"Planned Parenthood is a great resource for men and women. They give excellent care to patients and offer sliding scale or discounted prices. One of the harsh realities is that kidney patients on Medicare tend to have very limited contraceptive options but Planned Parenthood can help," said Pensack. "There is also an app called Meet Rosy which is an excellent resource for all patients and their sexual health."

More resources to share with patients:

• Sexuality and Chronic Kidney Disease
• Sexuality and Kidney Transplant
• Pregnancy and Kidney Disease
• Pregnancy and Kidney Transplant
• Treating Impotence

Take the sexuality and kidney disease CE quiz.

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Sources

¹“Chronic Kidney Disease and Sexual Health.” Chronic Kidney Disease and Sexual Health, Centers for Disease Control and Prevention, 27 Feb. 2023, https://www.cdc.gov/kidneydisease/publications-resources/sexual-health.html. 
²Rosen RC. Prevalence and risk factors of sexual dysfunction in men and women. Curr Psychiatry Rep. 2000 Jun;2(3):189-95. doi: 10.1007/s11920-996-0006-2. PMID: 11122954.