Reproductive Matters

Sexual problems are common for men and women who suffer from kidney disease. Not only are emotional problems likely to occur as a result of the stress of the disease, but there are also a number of medical problems that can affect sexual function and fertility, both in men and women.

Emotional problems are common. Patients may find themselves going through a grieving process due to loss of kidney function, which may affect their independence, their job, and their role in the family. Some patients experience a change in body image. Dialysis can lead to lowered self-esteem, coupled with anger and depression, which can affect sexual function. The balance in the relationship may have changed – one seeing themselves as the carer and the other in a sick role. Couples need to communicate to one another their feelings and fears. Counselling can facilitate the exploration of these feelings.

Contraception is important for people with kidney disease. Do not assume that because you have kidney disease, you cannot conceive a child. Most methods of contraception are suitable. Barrier methods such as condoms and diaphragms can be used. The coil can sometimes cause infection and heavy periods. The contraceptive pill has a tendency to raise blood pressure, sometimes one of the combined forms of oestrogen and progesterone are prescribed. The morning after pill may be used in the usual manner.

Fertility levels vary during different stages of kidney disease. Women of childbearing age do not often get pregnant while on kidney replacement therapy as the treatment only replaces a small percentage of kidney function, which, in turn, can interfere with egg production.

For female patients whose menstrual cycle remains, however irregular, it is possible to conceive. Although pregnancy is uncommon, some women have given birth. Due to risks to the mother and the high rate of miscarriage, patients are normally advised to take precautions against pregnancy. Some women decide to delay pregnancy for one or two years after they have had a kidney transplant.

“For female
patients whose
menstrual cycle
remains,
however irregular,
it is possible to
conceive.”

Men with kidney disease may have a reduced sperm count and may experience difficulties in fathering a child. After successful transplantation, sperm numbers generally rise. Men with kidney disease can have a variety of sexual problems. These include loss of libido and ejaculatory problems. However, the most worrying and most common is impotence. Impotence often has physical causes and is usually a combination of factors.

“Men with kidney
disease may have a
reduced sperm count
and may experience
difficulties in
fathering a
child.”

• Poor blood supply occurs as part of the natural ageing process and is common in older men. It is particularly common in men with diabetes and kidney disease.
• The testicles may produce less of the male hormone, testosterone.
• Some drug treatments can contribute to impotency, the biggest culprits being ‘betablockers’ such as atenolol, propranolol, metoprolol and bisoprolol.
• Tiredness can affect sexual performance. This can be caused by anaemia, under-dialysis or other medical problems e.g., heart problems.
• Psychological or relationship issues.

Treatment for impotence is commenced by checking out general health. Anaemia, if present, is corrected, treatment time may need to be extended or drug treatment may be changed. Viagra is commonly prescribed. Trials show that about 8 out of 10 men benefit with improvement in erectile performance. Patients with angina or heart problems should not take Viagra. It is advisable to consult your unit doctor to ensure that it is a safe option in your case.

There are many other interventions which are performed by specialist doctors e.g., urologists. A referral is sent from the unit doctor. Counselling is recommended for emotional problems relating to impotence. Many men, who have had difficulty fathering a child while undergoing kidney replacement therapy, have been successful in doing so following transplantation.

Communication is the most important factor in any relationship. Wherever there is a problem share your feelings and fears with your partner. Nursing and medical staff recognise that patients can have difficulties in sexual relationships and will gladly talk to you and your partner. Professional guidance can help – all that may be needed is a little reassurance.