Answer. In some cases, the issue of sexual function in kidney disease patients poses a most-difficult problem. Physicians, including kidney specialists and transplant surgeons, have to address this patient problem from time-to-time. Depending on the patient, changes in sexual function can have many different causes, and several of these may be common to many kidney disease patients. Please be assured that treatment for sexual dysfunction for both men and women is more successful today than ever before and patients should not feel shy discussing this issue with caregivers.

The first common reason a sexual arousal problem may occur is chronic kidney disease (CKD) itself. As kidney failure progresses, women of childbearing age may experience significant changes in the menstrual cycle or stop menstruating all together, and men may become impotent. These changes show us all how important normal kidney function is for a healthy and happy life. In addition, many causes of kidney failure, such as diabetes and hypertension, may cause problems related to sexual function. Therefore, it is most important to address CKD early and to aggressively treat it as well as its root causes. Optimum treatment will often allow the patient to regain some or all lost sexual function.

A second cause of sexual dysfunction may be related to medications prescribed to treat CKD or its related problems. Certainly, patients should not ignore treatment advice for serious disease. However, drug therapy may be accompanied by changes in sexual function of one sort or another. Therefore, it is wise to review all medications with a physician and pharmacist. Patients who take numerous medications may want to ask their pharmacist to perform a computer search to determine if combining prescribed medications would have adverse effects on sexual or other normal body functions.

A third area to consider when looking at changes in sexual function related to CKD is medical problems, such as anemia, often associated with progressive kidney disease, as well as psychological features of progressive chronic illness, such as anxiety, depression and insomnia. Sometimes, these “secondary” physiologic and psychologic changes may have as much of an affect on a patient as the disease itself. Certainly, kidney specialists have known for decades that anemia in renal failure can cause fatigue, add to the general ill feeling affecting the patient and may even worsen feelings of loss, which many patients experience with progressive kidney failure. Altered sleep patterns, restless leg syndrome and anxiety associated with facing a chronic health problem may further compound the difficult circumstances of early kidney failure. Patients should be aware that medical and surgical care associated with dialysis and kidney transplantation may address many of these issues and may allow a new beginning on the road to much improved health.

Normal sexual function indicates the general good health of an individual. One of the goals for treating CKD, as well as other chronic illnesses, should be to restore health to the patient as long as possible. When such restoration is complete, normal physiologic and psychologic well-being is more assured. Therefore, treatment plans for patients with early symptoms of sexual dysfunction should take into account not just diagnosis and treatment of the disease, but optimal care regarding causative factors and concurrent illnesses. When such an approach is taken and the patient and partner are educated to these matters, oftentimes difficulties with sexual arousal can be reversed and normal function restored.

Answer provided by Thomas Peters, MD, a transplant surgeon at the Jacksonville Transplant Center at Shands Jacksonville Medical Center in Jacksonville, Fla. Dr. Peters also serves on the AAKP Board of Directors and AAKP Medical Advisory Board.

This article originally appeared in the December 2004 issue of Kidney Beginnings: The Magazine, Vol. 3, No. 4.

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