SEXUAL DYSFUNCTION IN DIALYSIS PATIENTS   Sexual dysfunction is commonly observed in patients with chronic kidney diseases . Almost 5...

SEXUAL DYSFUNCTION IN DIALYSIS PATIENTS

 

Sexual dysfunction is commonly observed in patients with chronic kidney diseases. Almost 50% of these patients may experience sexual dysfunction symptoms that may appear as👉:

1]    Erectile dysfunction.

2]    Diminished libido (sex drive or desire of sexual activity).

3]    Absent or diminished rate of intercourse frequency.

Of note, can be improved by adequate dialysis. However, complete normalization of this complication is rarely achieved by maintaining on regular dialysis.

Chronic diseases of the human kidney can be complicated by many physiological alterations and hormonal abnormalities, for example (1) impairment of the process of spermatogenesis, (2) diminished testosterone concentration levels, and, (3) Elevated luteinizing hormone (LH), follicle stimulating hormone (FSH) as well as prolactin serum levels. In addition, breast enlargement in male patients (called gynecomastia) can be observed in 30% of males on regular hemodialysis.

Impotence (erectile dysfunction) is usually the main complaint of a male patient with chronic kidney disease. A full detailed history with physical examination is needed to declare cause of the patient’s complaint. However, if there is no obvious cause can be elucidated, an underlying psychological background like persistent stress or depressive illness can be considered.

Management

Several attitudes can be considered for management of sexual dysfunction in patients with chronic kidney disease👉:

1]    Augmentation of the given dialysis dose.

2]    Withdrawal of the suspicious medications that impair sexual potency e.g. Beta blockers.

3]    Management of the anemia related to chronic kidney disease.

4]    Hormonal balance:

i.        With low testosterone and high prolactin, “bromocriptine” should be tried.

ii.        With normal prolactin and low testosterone, testosterone could be tried.

5]    If no response to i and ii, use of vacuum tumescence devices may be effective (see below).

6]    A specific agent, Sildenafil , can be dedicated for clinical cases with psychological, vascular, or neurological background as a first line agent. 

Considering the vasodilator effect of Sildenafil, the use of this agent may be associated with hypotension during dialysis, so, its use is better restricted to dialysis-off days to avoid this complication. Furthermore, the combination of nitrates, whatever its form, to Sildenafil is a serious combination with hazardous effects and usually not advised.

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Moreover, replacement of the deficient hormones like testosterone hormone and control of the hyperprolactinemia to the normal levels may be additional maneuvers for improving sexual dysfunction. Adding Zinc supplements may also have its role in antagonizing gonadal failure and increasing libido desire. Finally, intravenous injection of certain prostaglandins (alprostadil, PGE1) and the use of vacuum tumescence devices may be effective in selected cases, in addition to the administration of urethral suppository of PGE1 and surgical placement of a penile prothesis may be also beneficial.

However, A successful kidney transplant has its beneficial impact on the patient general health that is reflected on the patient’s reproductive system. This recovery can be observed as normalized serum testosterone with associated rise in the sperm count. Of course, kidney transplant has been approved as the best therapy for the end stage kidney failure, appetite will be better metal power, muscular performance, mental and social integrity, disappearance of anemia and patient’s mood and intelligence. All these parameters could participate in all body functions improvement.