Reproductive issues and kidney disease
Sexual dysfunction and infertility are common in men and women suffering from chronic kidney disease. These may result in anxiety, loss of self-esteem, marital discord, and depression, contributing to impaired life quality.
Sexual function in men and women is controlled by various neurologic, psychological and hormonal mechanisms, which are all affected in chronic kidney disease. Medications prescribed for various comorbidities may also contribute.
Men with kidney ailments have hormonal alterations in which the prolactin levels are elevated, and various gonadal hormones from the hypothalamus and the pituitary gland are produced at lower levels. About two-thirds of men on dialysis have low testosterone levels and have abnormal sperm production and motility. Poor erectile function and lack of sexual desire may cause further issues. In women, lack of pulsatile Luteinizing Hormone (LH) release often contributes to anovulation. Loss of lubrication in women contributes to sexual dysfunction. Diabetes itself can cause loss of sexual function, and diabetes is the leading cause of chronic kidney disease worldwide.
For those with chronic kidney disease and on hemodialysis, various medications for improving erectile function and sustaining erection can be tried. Women with poor lubrication can use artificial lubricants. Sometimes, hormonal medications may be employed for both women and men in conjunction with the gynaecologist and the urologists to improve sexual function. Regular dialysis up to three times per week will decrease the toxin load, and this is essential for maintaining hormonal balances and general sexual we l l being. Psychiatric counselling to relieve stress and counselling may help tremendously to achieve better sexual function.
Favourable effects have been reported in male fertility after renal transplantation. However, the increase in fertility also depends upon the care after transplantation and close follow up and monitoring of the various parameters by the treating nephrologist. The reduction of the toxin load and the normalisation of the kidney function after renal transplant itself will play a tremendous role in restoring sexual function. An increase in the sexual drive and overall better sexual performance is well known to be restored after transplantation. Further, the age of developing End-stage renal disease also plays a crucial role in determining the recovery of fertility post-transplantation.
The recovery of fertility also depends upon the preservation of vas deferens and testicular blood supply during the surgery, which is done on priority for the patient. Patients who had low levels of sperm before the transplant have an improvement in sperm motility and count in up to 12 months after the procedure.
Many men have fathered children successfully after transplantation. Many women, who lost reproductive function due to chronic kidney disease and are on dialysis will recover reproductive function, have normal menstrual cycles, and bear children after renal transplantation. However, sexual dysfunction due to severe and irreversible damage due to factors like advanced age, longstanding diabetes, various coexisting medical factors and prolonged dialysis may not be completely reversible. A renal transplant hence is an effective option for patients with chronic kidney disease regarding sexual function and childbearing. It has been established that after transplantation, the medications given to men will have minimal effect on procreation, the effects of medicines are more pronounced in women, but they do not usually come in the way of normal childbearing.