By Donna F. Brassil, RN, MA, CURN and Jean H. Lewis, BSN, RN, CNP

Chronic illnesses, such as chronic kidney disease (CKD), produce a wide spectrum of stressors affecting every body system including sexual functioning. Although there are no limitations or restrictions regarding sexual activity, sexual function is impaired in many individuals with chronic renal failure or those on dialysis. Some men experience erectile dysfunction (ED) or have a diminished interest in sexual activities. Sexual function may improve after a kidney transplant, although it rarely returns to the pre-illness state.

Erectile Dysfunction or impotence, as it is commonly called, is a treatable medical condition. ED is the inability to obtain or maintain an erection satisfactory for sexual relations. It differs from other sexual problems such as premature ejaculation or lack of sexual desire. It affects how a man feels about himself and his relationship with his partner. ED is a problem with solutions.

ED is thought to affect between 20-30 million men in the United States. Due to the personal nature of the problem, many men choose to suffer in silence making it difficult to calculate an accurate number of men suffering from ED. Since 1998, when the first oral medication for ED became available, more men are seeking help for this problem.

ED is generally caused by such problems as diabetes, hypertension, renal disease, vascular disease, spinal cord injury and multiple sclerosis. Pelvic surgery, such as removal of the prostate, can damage arteries and nerves near the penis causing ED. Medications including some for high blood pressure, depression and anxiety can also affect erections. Smoking and heavy alcohol use will create problems with erections over time as well.

There are many options available for treating ED and it is estimated that 95 percent of all patients with ED can be successfully treated regardless of the cause of their ED. A urology nurse can provide patients with education materials on ED to help them become more knowledgeable on the subject. Most healthcare providers will suggest proceeding from the least invasive treatment options to the more invasive treatments if necessary.

Before starting any treatment, a medical, surgical, psychosocial, medication and sexual history will be taken to better understand each person’s situation. A physical exam can give clues to problems. Several blood tests can help diagnose ED. A lipid profile including cholesterol (HDL and LDL) and triglycerides, blood sugar and testosterone levels, are but a few of the tests that may be checked by a healthcare provider.

• Hormone replacement therapy by injection, patch or gel if indicated by abnormal hormone levels.

• Vacuum device therapy is a non-invasive method to help achieve or maintain erections by the means of vacuum pressure and constriction bands.

No one treatment is for everyone. Men may have to experiment to find the treatment that works best for them and their partner. Everyone’s situation is different. Some men may use a combination of therapies.

Sexuality and the Female Kidney Patient

Women who have kidney disease may also face the challenge of impaired sexual functioning. However, the good news is that clinical trials are currently taking place and new medications for desire and arousal problems are now being studied. In addition, women today are becoming more aware of their sexual needs and human sexuality overall is becoming more openly discussed within our society.

Women experiencing sexual difficulties from kidney or other chronic disease, should be aware of certain considerations. First, there are treatment options and it is crucial to speak to a healthcare professional about concerns and symptoms. Second, it is important to keep in mind that sexual problems are commonplace in populations of women with chronic illness as well as in healthy women. Third, female sexual dysfunction (FSD) is a complex issue in that it encompasses physiological as well as psychological components. These components are active and underlying factors in the different types of FSD. To better treat women with sexual disorders, FSD has been broken down into four classifications:

1) Hypoactive Sexual Desire Disorder (HSDD) - No interest in having sex or a decrease in desire for sexual activity.

2) Female Sexual Arousal Disorder (FSAD) - During sexual excitement, there is little or no vaginal lubrication and it is difficult to achieve orgasm.

3) Orgasmic Disorder - Inability to have an orgasm following sufficient sexual stimulation.

4) Sexual Pain Disorder - Vaginal pain during or after intercourse. It is not unusual to have more than one of these disorders since they are so closely related. In a

1999 National Health and Social Life Survey of 1,749 women, 43 percent reported sexual dysfunction. Of these, 22 percent reported a decrease in sexual desire, 14 percent reported difficulty with arousal and seven percent experienced pain during intercourse. This report also indicated that sexual dysfunction is more common among females with poor physical and emotional health.

FSD may be caused by physical, emotional or psychological problems. The physical causes include hormonal changes, surgery, anemia, fatigue, certain medicines and chronic illness such as kidney disease, diabetes, high blood pressure, spinal cord injuries or cancer. Emotional causes include stress, low self-esteem, anger about disease, fear and poor body image. Psychological causes include depression and sexual abuse. Females who require dialysis or transplant surgery report a higher incidence of desire and orgasmic disorders. Chronic diseases that persist for a lifetime can have a major impact on a woman’s self-image and her ability to feel sexual.

Women experiencing a decreased desire for sexual activity, if their body does not react to sexual activity compared to other times in their life, or they are having vaginal pain during sex, are not alone. There are treatments available for each of these problems; however, it is important that women are diagnosed correctly since each type of FSD has different treatments. An evaluation will include a thorough physical examination including a gynecological examination, medical history, surgical history, psychosocial evaluation and sexual history. Hormone and laboratory tests are essential too.

Treatments for FSD may include:

• Changing medications.

• Individual or couples counseling.

• Hormone replacement therapy.

• Vaginal lubricants.

• Masturbation, kegel exercises.

• Changes in the routine or environment.

• Changes in love-making technique.

• Massage, warm baths.

• Vibrating aids, fantasy.

• Eroticize daily life (snuggle, touch).

• EROS-CVD (Clitoral Vacuum Device) which is a small device designed to increase arousal and vaginal lubrication by placing a suction cup over the clitoris.

For both men and women having problems with sex, it is important to know there are doctors and other professionals with the skills, knowledge and understanding to help. It is important for the patient to discuss their concerns with a professional. With the advances in care for ED, FSD and kidney disease, it is in the power of the kidney patients to be proactive about their care and seek better sexual health.

 Donna F. Brassil, RN, MA, CURN is the Director of Clinical Trials for the Urology Department at the New York University Medical Center.

Jean H. Lewis, BSN, RN, CNP is an adult nurse practitioner in the urology clinic at the Minneapolis, Minn. Veterans Affairs (VA) Hospital. She is the Coordinator of the Erectile Dysfunction Clinic.

This article originally appeared in the December 2006 issue of Kidney Beginnings: The Magazine.