Did you know?

Many men and women while on dialysis experience problems in sexual and reproductive function which can have a major impact on their quality of life. These problems can affect the social and the marital life of individuals with end-stage kidney disease. Sexual function concerns (e.g., fertility, libido and impotence) are also common after transplantation.

Sexual function reductions can be caused by many things, directly or indirectly related to end-stage kidney disease, e.g.: diabetes and/or hypertension, anemia, hormonal disturbances, side effects of medication, advanced age, prolonged duration of hemodialysis and psychosocial factors.

You will probably find improvement in these problems after transplantation, you will feel better and have more energy. This will help to make your sexual life more enjoyable. In fact, for most people, sexual and reproductive function should return to normal. Many men and women see improvement in their sexual function after transplant, some even seeing their sexual and reproductive health fully return to normal. This can be for a variety of reasons, including improved general health, energy level, etc. However, other individuals still experience sexual and reproductive health concerns after transplant.

Effects of Chronic disease

MEN

  • A significant proportion of men with advanced chronic kidney disease experience sexual health concerns, including erectile dysfunction, decreased desire, and a decline in the frequency of intercourse. The proportion of erectile dysfunction in end stage kidney disease patients on hemodialysis is as high as 84%, which is higher than in the general population. However, sexual and reproductive health generally improves in men after kidney transplantation.

WOMEN

  • Issues with menstruation, fertility, and sexual function are common in women with chronic kidney disease and end stage kidney disease. Around 60% to 70% of women on dialysis experience sexual dysfunction. But usually, libido and sexual function in women with end-stage kidney disease improve after transplantation.
  • Women who become pregnant after transplantation are at higher risk to experience maternal complications like high blood pressure- induced by pregnancy (preeclampsia). Premature birth and low birth weight are also common complications in infants of moms who have a transplanted kidney.
  • Research evidence shows that kidney transplant recipients experience better sexual function than patients on dialysis.
  • The frequency of unintended pregnancy among transplant recipients is high as 93% and the frequency of contraceptive use is only 48% to 72%.

How am I doing?

The integration of a new organ into the body may cause an adjustment in body image, and consequently mental health issues which may have a negative influence on intimacy and sexual behaviours. It is normal to have these feelings related to your body image and sexual behaviors. Talk with your healthcare provider if you are having these issues. Referral to a psychologist can be an alternative.

Some medications may impact your sexual function. For example, some medications used to treat high blood pressure can affect your desire and sexual function. Medications used to treat anxiety and depression also may negatively influence sexual function. Additionally, anti-rejection drugs can also cause certain side effects such as weight gain, acne, bruising, and increased body hair for both men and women. These side effects can lead to feelings of unattractiveness or disinterest toward sex. Talk to your healthcare provider if you are experiencing fertility or sexuality issues, as there may be treatment options for you, including adjusting your current medications that can decrease these side effects.

After transplantation, many hormonal imbalances improve rapidly in both men and women, improving sexual health by increasing libido, energy and fertility, and by decreasing impotence. For this reason, in the case of women, contraception should be discussed and planned before transplantation. Women should not become pregnant for at least one year after transplant, even with stable kidney function. Some medications that women take after transplant can cause problems to a developing baby. In some cases, pregnancy may not be recommended at all because there may be a high risk to your life, the baby, or possible loss of the transplant.

What can I do?

You need to remember that the definition of sexual satisfaction is complex and personal. Also, it depends on both the individual’s own sexual well-being and the relationship between partners.

Remember sexuality refers not only to sexual intercourse. It can include many things, like touching, hugging, or kissing. So, involve your partner; try to familiarize yourself with your partner’s body again, openly talk about your concerns, discuss feelings about self-image, and be patient.

Professional sex therapists can be helpful in understanding and managing a recipient’s sexuality and sexual health. Emotions can also affect sexual functioning, including stress, marriage problems, or depression.

After transplantation you can have the false perception that you are unlikely to acquire infections, and the likely improvement in libido and sexual functioning after transplantation may lead you to engage in high-risk behaviors, such as having sex without protection.

The potential for acquiring a sexually transmitted infection is concerning given your immunocompromised status, and complex drug treatment which might have unfavorable interactions with sexually transmitted infections treatments. For this reason, if you are not in a committed, single-partner relationship, you should follow safer sex practices, including the use of a barrier such as condoms to prevent sexually transmitted infections during oral, vaginal and anal sex.

Men and Women transplant recipients: depending on the time since your transplantation, you must consult and discuss with your transplant team before trying to have a child. Men recipient’s sperm may be affected by the anti-rejection drugs. For women recipients, the anti-rejection drugs increase the risk of pregnancy complications, also the risk of rejection increases if pregnant.

How can I do it?

If you have concerns regarding your sexual health, talk to your healthcare professional. Don’t be afraid to ask questions and seek answers. Many of these the concerns you have may be able to be addressed through treatment.

Having a positive body image generates benefits in the areas of both mental and physical health. For this reason, it is important to have the support of a team of health professional who can help you resolve any body image concerns you may be having.

For women: Talk with your healthcare provider if you have a transplant and are considering pregnancy. Changes in your medications by the doctor may be needed so that it is safe for you to become pregnant. Birth control is very important at this time until you and your healthcare provider have agreed that it is safe for you to become pregnant.

Testimonial

My nephrologists never mentioned that kidney disease is directly linked to sexual dysfunction. To witness, I have two boys, one of which was conceived and born while I was on dialysis. To my knowledge, there is no direct impediment to enjoying intimacy and sexual relations while on dialysis and even less after kidney transplant. Intimacy and sexual function problems stem from other physiological mechanisms, but mostly from psychosocial impacts of kidney disease.

Having lived with kidney disease for 20 years, having been on dialysis for 8 years and now being 12 years after transplant, it is my conviction that much depends on how you have accepted your kidney illness and the nature of your body image. But, physiology does put up some barriers.

In my case, my testosterone levels were low, and this was caused by the kidney disease. This meant that my sexual drive was on neutral. I lost interest in sexuality; it simply never came up as something I could do. The non-existent sexual drive meant that I stopped trying to get “bendy” with my wife. A good-night hug in bed before going to sleep and a peck on the cheek in the morning was all I needed. After a year of this, my wife started feeling rejected and we became estranged. It is interesting to note that at this time, I would sometimes get erections, but never when my wife was around. My health providers explained that testosterone levels vary during the day, they were not surprised. Unfortunately, my estrangement with my wife led ultimately to divorce.

After my transplant, my hormone levels were back to normal and I was able to achieve fulfilling intimate relations with my girlfriend. It was difficult at first because I hadn’t had sexual relations for a long time so there was a bit of a learning curve to get through. I had to learn to relax, feel comfortable in the presence of my partner and, crucially, not focus on getting an erection and the anticipated sexual performance. After years without sexual intercourse and the hardship its absence had caused, I had lost the ability to feel comfortable in intimate encounters with a woman.

Thanks to much dialogue with my new partner, it was possible for me to rebuild my positive body image and recover the capacity to feel comfortable in intimate settings. We used Viagra on a few occasions, only at the beginning. But as soon as we had lived through mutually satisfying sexual encounters, I had regained my confidence and the blue pill stayed in the package.

Living with kidney disease, and all that it entails, has the potential to change a person. I would say that now my sexual life is much more fulfilling in multiple ways. My experiences have allowed me to grow as a person and gain much confidence in myself, as a father, but as well as a lover. The sexual disfunction that I felt at the beginning was short lived. Thanks to my partner’s patient and loving help, I learned to enjoy sex in new ways, which were just as pleasurable for her, and helped us get closer and intimate. So, I learned that I needed to feel confident in myself as a person and to trust my partner for my sex drive to come back, perhaps even stronger than before.

This testimonial was written by Nicolas Fernandez (kidney transplant recipient; PhD; Associate professor Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal).

More Information

This section was written by Dr Daniela Massierer (BSc(PT), MSc, PhD; Postdoctoral fellow at Centre for Health Outcomes Research (CORE)-RI-MUHC). And reviewed by Jack Lennon (Executive Director/Improving Renal Outcomes Collaborative and kidney transplant recipient); AND by our research team.

References

1. Nikoobakht M, Behtash N, Ramezani-Binabaj M, et.al. Comparison of sexual function changes in recipients of kidney transplant in females receiving kidney from the living donor and deceased donor. Urologia. 2020;87(4):203-208.

2. Kurtulus FO, Salman MY, Fazlioglu A, et. al. Effects of Renal Transplantation on Female Sexual Dysfunction: Comparative Study With Hemodialysis and a Control Group. Transplant Proc. 2017;49(9):2099-2104.

3. Mota RL, Fonseca R, Santos JC, et al. Sexual Dysfunction and Satisfaction in Kidney Transplant Patients. J Sex Med. 2019;16(7):1018-1028.

4. Shah S, Venkate san RL, Gupta A, et al. Pregnancy outcomes in women with kidney transplant: Metaanalysis and systematic review. BMC Nephrol. 2019;20(1):24.