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.
