Sexuality and Chronic Kidney
Disease
Many people think that sexuality refers
only to the act of sexual intercourse. Sexuality includes many
factors, such as how people feel about themselves, how they
communicate with others and how willing they are to build a
relationship. In addition, sexuality involves a wide range of
pleasurable sexual activities that may or may not include
intercourse, such as touching, hugging and kissing. Being a
sexual person is healthy. Lovemaking may provide a way of
feeling "normal" for people who are chronically ill.
How can kidney disease affect sex life?
Kidney disease can cause physical and
emotional changes that may affect your sex life. The chemical
changes that occur in your body with kidney disease affect
hormones, circulation, nerve function and energy level. These
changes usually lower sexual interest and/or sexual ability.
Physical changes may cause people with kidney disease to feel
less attractive sexually. Many of the medicines used to treat
high blood pressure may affect sexual functioning.
Use of steroids may cause weight gain,
acne, and unwanted hair growth or loss. Surgical scars can cause
patients to feel unattractive. Medical changes and changes in
self-image may affect sexual interest and functioning.
Is sexual intercourse safe for kidney
patients?
Patients and their partners may worry that
sexual activity could cause the patient's death or harm the
dialysis access or transplanted kidney. No limitations need to
be placed on kidney patients sexually. If sexual activity does
not place pressure or tension on the access site, it will not
cause damage. After receiving a transplant, it is important to
wait until the scar has begun to heal. Once the doctor says it
is all right to resume sexual activity, there is no reason to
worry about damaging the transplanted kidney. Fear can cause
people to avoid sexual activity needlessly.
For some couples, sexual intercourse is
not possible. Some may feel that sex is not as important as it
once was. Activities such as touching, hugging, and kissing
provide feelings of warmth and closeness even if intercourse is
not involved. Professional sex therapists can recommend
alternative methods.
Will a child's sexual development be
affected by kidney failure?
This depends on the child's age when
kidney failure occurs. Young children with kidney disease are
usually smaller than other children their age. They are also
slower to develop sexually. Children who are on dialysis
probably will have slower growth and sexual development than
children who have kidney transplants. If a teenager has kidney
disease, sexual development may slow down or even stop. For
example, teenage girls may not have periods. Changes due to
kidney failure and treatment may make the teenager feel
different from his or her friends. Parents should express their
concerns about growth and sexual development to the doctor.
Parents of a child or teenager who is ill must fight the impulse
to protect their child from the pain of growing up. Self-worth,
independence, and sexual identity are important for teenagers.
Parents need to talk openly with their children about physical,
emotional, and sexual issues. Support groups for children and
teenagers with kidney disease can be helpful. Contact a renal
social worker or the National Kidney Foundation to find out if
support groups are available near you.
Can you get AIDS from a transplant and
risk giving AIDS to your sex partners?
Kidneys for transplantation and blood
transfusions are now routinely tested for the AIDS virus. The
risk of getting AIDS from a transplant or transfusion in the
last few years is very small. Therefore, the risk of giving AIDS
to a sex partner is small as a result of a transplant. Most
health departments and health clinics can do a simple
confidential blood test for HIV. Until the results of this test
are known, use of a condom lowers the risk of passing the AIDS
virus to a sex partner. Practicing safe sex is important for
everyone.
Can a kidney transplant from someone of
the opposite sex affect me sexually?
No. The sex of the kidney donor has no
physical effect on the recipient's ability to function sexually
or on sexual preference (heterosexual, homosexual, or bisexual).
Do transplant patients have fewer sexual
problems than dialysis patients?
Generally, transplant patients have fewer
sexual problems than dialysis patients because they may have
fewer physical problems that affect their sex life like fatigue
or anaemia. But, having a transplant does not make them less
prone to sexual concerns. The level of interest in and ability
to have sex varies with things like the quality of the
relationship, age, stress level, and physical conditions.
Will sexual problems get worse the longer
dialysis continues?
This depends on the person. Having kidney
failure, like any other chronic diseases, means that the body is
in a weaker overall state of health. However, as the body
adjusts to the treatment, the kidney patient should feel better
physically and emotionally, and interest in sex may return to
its earlier level. It is important to be patient and allow time
to get used to the kidney disease and treatment. Being flexible
and having a positive attitude about yourself and about sex may
lower the chances of having severe sexual problems.
Can you tell whether sexual problems are
due to physical or emotional causes?
Yes. This requires a complete medical,
psychological and sexual history of the patient and his/her
partner. Medicines should be reviewed for sexual side effects
and changed if possible. Blood tests should include hormone
levels and blood sugar levels to check for diabetes. Men can be
checked to see if nerve and blood supply to the penis are good
and if they can have an erection. If no physical problem is
found, an emotional cause must be considered.
What can be done if the problem is
physical?
Several options are available for men
whose penis will not get or stay hard (erection). Penile implant
surgery places inflatable or semi-rigid rods into the penis. In
some cases, surgery can improve blood flow to the penis. If the
man does not want surgery, male hormones may be given. Oral and
injectable medications can cause an erection. External suction
devices can make the penis hard enough for intercourse, but they
require time and hand strength. Doctors with special training in
impotence can give information on all options as well as their
advantages, disadvantages, and side effects.
Women patients usually have less vaginal
wetness and may have pain during sexual activity. Lower hormone
levels can cause vaginal dryness. Use of a water-soluble vaginal
lubricant can lower or stop pain associated with intercourse. Do
not use petroleum jelly because it can increase the risk of
infection. Some women may be unable to have a climax or may need
more time to get "turned on" because of loss of energy, hormone
changes, or medications for high blood pressure. A change in
blood pressure medicine or extra hormones may be needed. Your
doctor can provide information on options.
What can be done if the problem is
psychological?
Feeling worried, anxious and depressed is
normal when faced with a serious loss such as kidney failure.
These emotions can cause loss of energy and lower interest in
many activities including sex. If a sexual problem does occur,
embarrassment and guilt often follow. Fear that the problem will
happen again may cause the person to shy away from sexual
situations. Relaxation exercises can help to control these
fears. Regular physical exercise and activity help keep the mind
busy and can improve physical condition and body image. If
sexual problems continue, sex therapy can help. Even if the
problem is psychological, some of the treatment options
mentioned for physical problems may be helpful.
Can sex therapy help?
Sex therapy deals with the sexual problems
of couples and individuals. The first step in sex therapy may be
sexual education for the individual or couple. The therapist may
assign activities to be done at home. These include
communication exercises, stress reduction activities, and
practicing ways of improving skills in giving and receiving
enjoyable touches. Sex therapy can help with problems such as
low sexual interest, trouble in reaching climax or reaching
climax too soon, pain during sexual activity, and erection
difficulties. Therapy also can help a person work through the
effects of chronic illness on sexual functioning.
A sex therapist can be a psychiatrist,
psychologist, physician, or social worker. Look for someone who
is licensed and who has advanced training and experience in
sexuality and sexual problems. Charges vary and may be covered
partly by insurance.
What can kidney patients do to help
themselves?
Take an active role in learning about
kidney disease and treatment. Follow the prescribed diet and
fluid limits. Take all medications properly and tell the doctor
of any side effects. Ask for an exercise program to help muscle
tone, strength, and endurance. Your doctor and dietician can
suggest a weight gain or loss program, if needed. Lead a healthy
lifestyle. Be aware of other things that could affect your
sexual functioning, such as drinking too much alcohol and
smoking.
See also in this A-Z guide:
- Treating Impotence: A Sexual Problem in
Men
- Coping Effectively: A Guide for
Patients and their Families
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