Answer. Any disease that can injure arteries, smooth muscles and fibrous tissues, especially diabetes, kidney disease, alcoholism, multiple sclerosis, atherosclerosis and vascular disease may result in impotence. For example, between 35 and 50 percent of diabetic men are impotent. Emotional stress, anxiety, guilt, depression, low self-esteem and fear of sexual failure are thought to be responsible for more than 80 percent of impotence. The largest cause of kidney disease in the U.S. is diabetes, and 85 percent of those with kidney failure have high blood pressure. There is no surprise that men with kidney failure have other things than sex to think about. 

Dealing with Impotence

First, make sure that the diagnosis is correct. Expecting sexual function at the age of 60 to equal what was remembered at age 21 may create worries that should not be there. Your doctor will start by taking a history to determine sexual activity to find out whether the problem might be erection, ejaculation, orgasm or missing sexual desire. Should you have an active medical illness, such as an access infection or peritonitis, interest in sex is turned off. An absence of male sex hormones (testosterone) is a rare but important cause of impotence. Checking for prostate problems by history (difficulty urinating, dribbling, constant full bladder), including a screening prostatic specific antigen (PSA) test is part of the workup. Next, a review of your medications might find a specific drug that could be switched. Lab tests are helpful, especially checking on whether severe anemia, often present in kidney patients, is causing fatigue and disinterest in sex. With permission, the man's sexual partner may be interviewed to find another point of view of what goes wrong during sexual intercourse.

Treating Impotence

Correcting impotence is a step-by-step matter going from minor changes to sometimes big time intervention. Stopping suspect drugs is the first thing to do. Then, offering support and encouragement including behavior modifications such as stopping smoking or heavy drinking is the next step. In the past, drugs were directly injected into the penis with a very fine needle, resulting in an erection that may last for up to one hour. Training for this therapy takes place in the doctor's office, and often the man's partner is given the training as well. Sterile technique is important. Another approach that is not used too often is a vacuum pump operated by hand or by battery. At a cost of about $500, Medicare will pay for the device when presented with a physician's justification. It requires instruction to learn how to lubricate the penis which is then inserted into a plastic tube. Air is pumped out, and a rubber ring around the base of the penis keeps it firm during sex. Viagra® has become the buzzword for treatment of impotence, gaining remarkable worldwide popularity. Limited evidence suggests that Viagra® (sildenafil citrate) may be effective for men on dialysis, or after a kidney transplant. In fact, unless the man has active heart disease or takes nitroglycerin, Viagra® is worth a try. An erection occurs within five to ten minutes. Medicare does not pay for this relatively expensive drug. When all fails, urologists have several "devices" to put into the penis by surgery with an air bulb in the scrotum that pumps up the penis just before intercourse. Keep in mind that Viagra® (50 mg) requires sexual stimulation such as touching or kissing. For most men, Viagra® works the first or second time but may not work until the third or fourth time. After taking Viagra®, an erection may start as fast as 30 minutes lasting for up to four hours. Before calling Viagra® a failure, ask your doctor about increasing your dose to 100 mg or decreasing your dose to 25 mg. 

Good luck and try to be open about getting help. For many, a return to normal is really possible.

Answer provided by Eli Friedman, MD, Chief of the Division of Renal Disease for State University of New York, Health Science Center at Brooklyn. Dr. Friedman serves as the Chairperson of the AAKP Medical Advisory Board. 

The American Association of Kidney Patients presents Ask the Doctor, an opportunity for readers to submit kidney related health questions to healthcare professionals who specialize in an area of concern. The answers are not to be construed as a diagnosis and therefore, alterations in current healthcare should not occur until the patient’s physician is consulted.

This article originally appeared in the June/July 2003 issue of Kidney Beginnings: The Magazine, Vol. 2, No. 2.

Back