Sexuality and Chronic Kidney Disease

By DaVita social workers Denea Hart and Rachel Thomas

Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician.

Let’s talk about sexuality

You may have been spending most of your time and energy focusing on how chronic kidney disease (CKD) and dialysis have affected your daily activities such as work, household chores, diet and finances. You also may have been dealing with treatment difficulties, medication management and physical limitations. Concerns about body image and changes in your levels of sexual interest and activity may fall at the bottom of your list of priorities; however, sex and sexuality are an important part of your overall well-being.

Actually, we are talking about much more than just the physical act of sex. Even those who are not sexually active may have difficulties related to self-esteem, body image, emotional affection, gender identity, family roles and communication, just to name a few. It is important to know you’re not alone. Listed below are several sexuality issues, factors and barriers faced by patients with kidney disease.

Common sexuality issues associated with chronic kidney disease:

Men

• Decreased interest in sexual activities
• Difficulty achieving or maintaining an erection
• Difficulty achieving ejaculation
• Fear of rejection
• Feelings of inadequacy
• Concerns about body image

Women

• Decreased interest in sexual activity
• Difficulty in achieving sexual arousal
• Difficulty in achieving orgasm
• Sexual pain
• Feelings of inadequacy
• Difficulty with pregnancy and high risk of miscarriage
• Concerns about body image

Causes or contributing factors to sexual issues with chronic kidney disease:

• Sleep disorders
• Hypertension (high blood pressure)
• Change of role or identity within family
• Depression
• Body image
• Physical discomfort
• Anxiety
• Uremia (extra wastes in the blood)
• Medications
• Anemia (low blood count)
• Leg cramps
• Other medical issues

Barriers to sexual activities for people with chronic kidney disease

Most sexual issues fall under two categories: physical or emotional.

Physical

• Pain
• Fatigue
• Hormone imbalance

Emotional

• Grief
• Fear of rejection or failed performance
• Depression
• Anxiety
• Body image concerns
• Guilt
• Changes in family role

The good news: you can get help to work out sexual issues. Don’t be afraid or embarrassed to ask your social worker for help. Therapy can focus on improving communication with loved ones and increasing their awareness of how the person with kidney disease feels because of the physical and emotional changes from CKD. Sharing individual sexual needs and difficulties with a partner can create understanding and in some ways more intimacy. Stress reduction and coping skills are also important in resuming not only a healthy sex life but also your overall welfare. You also may want to talk to your doctor, as your medication or a medical condition could be a factor. You doctor may be able to make changes that will help you.

Good to know

Here is some helpful information about how to retain your sexuality after being diagnosed with CKD. Your social worker can assist you with questions or issues you might have or refer you to available resources in your community. Once again, it’s important to remember, you are not alone.

• There are no limits with regard to sexual activities you may engage in as a patient with renal disease, as long as activity does not place pressure or tension on the access site, causing damage.

• If you are sexually active, practicing safe sex and/or using birth control are needed, even if you think you may be physically unable to have children.

• Activities such as touching, hugging and kissing provide feelings of warmth and closeness even if intercourse is not involved.  Professional sex therapists can recommend alternative methods as well.

• Keeping an open mind and having a positive attitude about yourself and your sexuality may lower the chances of having sexual problems.

• There are both medical and emotional causes for sexual dysfunction. The reason for your dysfunction can be determined through a thorough physical exam in addition to an assessment of your emotional welfare and coping skills.

• Relaxation techniques, physical exercise, writing in a journal and talking to your social worker or a therapist can help you to feel better about your body image and/or sexual dysfunction.

• Resuming previous activities, such as dining out or traveling, as a couple or single adult, can be helpful.

• Provide tokens of affection or simple acts of kindness to show you care.

• Communicate with your partner or others about how you feel.

Treatments

Medication treatments may be appropriate for some people who struggle with sexual performance. Therapies may include hormone replacement, antidepressants, performance-enhancing drugs or simply making a change in a medication you are already taking. Any medicines used to treat sexual dysfunction issues should always be prescribed by a physician who is familiar with your medical history.

Sensitive subject

Some people find it difficult to talk about sex. Many religions and cultures teach that sex is only permitted in marriage, and even then it is seldom discussed. Sexuality is an important part of a person’s total well-being. Even though you may be embarrassed to talk about your sexual feelings or performance, professionals such as doctors and social workers are trained to help you with any issues you may have regarding sex. You may be hesitant to talk to a healthcare professional about such personal issues, but know that they are there to help you live life to the fullest.