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Chronic Kidney Disease and Sexuality

Chronic Kidney Disease (CKD) is a condition in which the kidneys are damaged and cannot filter blood as well as they should. Because of this, excess fluid and waste from blood remain in the body and may cause other health problems, such as heart disease and stroke. CKD has varying levels of seriousness. When the kidneys stop working, dialysis or a kidney transplant would be needed for survival. Kidney failure treated with dialysis or kidney transplant is called end-stage renal disease (ESRD). A staggering 75 million people suffer from CKD in Europe whilst the worldwide frequency has been estimated to be 700-800 million people, with a projection that CKD will become the 5th cause of death globally in 2040.

Sexual dysfunction (SD) is a major and common problem in both men and women suffering from CKD. Erectile dysfunction is present in 70% of male patients, as well as reduced libido and difficulty in reaching an orgasm. Female patients suffer from impaired vaginal lubrication, loss of arousal and desire, dysmenorrhea, and difficulty in reaching an orgasm. Kidney transplantation is known to cause an improvement in sexual complaints; however, the prevalence of SD after kidney transplantation still remains quite high in both men and women and this may be due to the fact that patients need to undergo immunosuppressive therapy that may cause impotence in men and loss of sexual interest in both men and women. The aetiology of SD in patients with CKD is caused by multiple underlying conditions including the uremic milieu, anaemia, cardiovascular disease, CKD mineral and bone disorders, sex hormone disturbances, autonomic neuropathy, hyperparathyroidism, and hyperprolactinemia. Psychosocial (like depression and body image concerns) and relationship factors also play an important role in the aetiology of sexual dysfunctions. Despite the high prevalence of sexual dysfunctions, attention to and knowledge of SD from renal care providers is limited. Renal care providers are often uncertain to which extent complaints of SD affect the patients. The majority of providers are hardly aware of the physiological and emotional problems patients have to endure. Whether this is due to a lack of awareness of the high prevalence and impact of SD or barriers to discussing sexual issues with the patient remains uncertain. 

The nephrologist can play an important role in the detection and counselling of SD due to their leading involvement during the whole process of disease. 

What are the main reported barriers to not talking about sexual health concerns?

1. Patients do not express SD spontaneously

This point of view may cause an ongoing circle of avoidance. Patients as well are worried that the doctor might dismiss sexual health concerns rapidly. The hesitation on both sides may be the reason talking about SD remains a problem among patients and nephrologists. Screening may be a solution to break through this ongoing circle of avoidance and detect SD in an early stage.

2. Time management

Time management also affects the frequency of discussion, as “insufficient time” and “not finding a good moment to discuss” are major reasons for retaining nephrologists from discussing SD. To manage sexual health problems, adequate training is a requirement.

3. Insufficient training and knowledge

The lack of education about SD is a widespread problem throughout all medical departments. There is no standardized training for medical students regarding sexual health and often students receive varied and sometimes even inadequate training. Implementation of a sexual education program into residence training will contribute toward diminishing barriers regarding the discussing and counselling of SD. Taking additional training through workshops may be an idea. Referral after a first screening may also be beneficial. A sexologist may be required also for the management of a couple and relationship issues.

Implementation of sexual education into residence training and raising awareness among nephrologists on the importance of SD could improve care and quality of life for patients with CKD.

REFERENCES

Chronic Kidney Disease Basics | Chronic Kidney Disease Initiative | CDC. (n.d.). Centers for Disease Control and Prevention. Retrieved September 24, 2022, from https://www.cdc.gov/kidneydisease/basics.html 

EKHA. Improving prevention, treatment & care of chronic kidney disease in the aftermant of Covid-19. Retrieved September 24, 2022, from https://ekha.eu/wp-content/uploads/EKHA_call-to-action-to-tackle-CKD-at-EU-level.pdf

Van Ek G. F., Krouwel E.M., Nicolai M.P., Bouwsma H., Ringers J., Putter H., Pelger R.C.M., Elzevier H.W., (2015). Discussing Sexual Dysfunction with Chronic Kidney Disease Patients: Practice Patterns in the Office of the Nephrologist. The Journal of Sexual Medicine, Volume 12, Issue 12,, Pages 2350-2363, ISSN 1743-6095, https://doi.org/10.1111/jsm.13062.

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