| RE:
ERECTILE DYSFUNCTION IN PATIENTS WITH CHRONIC RENAL FAILURE
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LEONARDO E. MESSINA,
JOAQUIM A. CLARO, ARCHIMEDES NARDOZZA, ENRICO ANDRADE, VALDEMAR ORTIZ,
MIGUEL SROUGI
Section of
Urology, Paulista School of Medicine, Federal University of Sao Paulo,
UNIFESP, Sao Paulo, SP, Brazil
Int
Braz J Urol, 33: 673-678, 2007
To the Editor:
Although
it is a major factor affecting quality of life in end stage renal disease
(ESRD), sexual dysfunction receives very limited attention in follow up
of dialysis patients (1). Successful dialysis improves most symptoms of
ESRD, yet many patients continue to experience many forms of sexual dysfunction
during the dialysis treatment (2). Sexuality was the fifth most important
life stressor cited by 135 dialysis patients in a study of quality-of-life
issues (3). More than half of patients suffering from ESRD and receiving
dialysis treatment describe sexual dysfunction, most commonly a loss of
interest in sexual activity (1,4). Despite the importance of these issues,
only 25 % of patients discuss sexual function with their physicians (3).
Moreover, it has been noted that lack of knowledge about sexuality, conservative
attitudes toward sexuality, and anxiety when discussing sexual concerns
are widespread among health care providers (5).
Sexual dysfunction addresses alterations
related to drive, arousal, penile erection/vaginal lubrication, ability
to reach orgasm and satisfaction with orgasm (6); all are affected by
ESRD. A questionnaire given to dialysis patients revealed that 65 % were
dissatisfied with sex since starting dialysis, 40% have stopped having
sex, 27 % have no desire for sex, and 23 % reported they could not achieve
orgasm (2). There is no known single cause for these changes, but there
are several physical and psychological factors that are thought to contribute
to them. Stress, depression and anxiety due to kidney disease and treatment
may affect patients’ sexual desire and ability to enjoy sex (4).
Other factors that may influence a patient’s interest in sex include
medications, diet, anemia, lack of sleep, inadequate dialysis, uremia
and changes in hormone balance (1,3,7).
Complaints of reduction in libido, impotence
and marked reduction in the frequency of sexual relations have been reported
in more than 50% of male ESRD patients (7). Proposed factors that may
cause sexual dysfunction in male dialysis patients are uremia, decreased
penile blood supply, hormonal disturbances, low hematocrit level, drugs
such as beta-blockers, fatigue, psychological problems such as depression
and anxiety, and difficulties with partner (1,2,8).
In comparison to males, sexual dysfunction
is more common in healthy females as well as females on dialysis (1).
A study comparing sexual function before and after renal insufficiency
found that the percentage of females who completely abstained from sexual
intercourse increased from 9 to 40%. Among the females on dialysis who
continued to have sexual activities, the anorgasmic percentage increased
from 9 to 31% (8,9). In another study, 100% of the women on hemodialysis,
67% of those on peritoneal dialysis, and 31% of those with kidney transplants
reported a lack of desire for sexual activity and lack of sexual fantasy
(10). Numerous hypotheses have been put forward as to the origin of the
sexual dysfunction in female dialysis patients including: uremia, hyperprolactinemia,
gonadal dysfunction, depression, changes in appearance, hyperparathyroidism
and zinc-deficiency (7-10). Moreover, the capacity of hemodialysis in
reversing sexual dysfunctions do not appear to be significant at 6-months
(11) and 18 month follow ups (12).
The study conducted by Messina et al. adds
further understanding of erectile dysfunction that reaches up to 60 %
in their patients undergoing hemodialysis.
Since improving the quality of life is a
major goal in medicine, we should pay more attention to the sexual functioning
of our patients that might help increasing our patient’s enjoyment
and satisfaction with life with minimal or no additional costs.
REFERENCES
1. Diemont WL, Vruggink PA, Meuleman EJ, Doesburg WH,
Lemmens WA, Berden JH: Sexual dysfunction after renal replacement therapy.
Am J Kidney Dis. 2000; 35: 845-51.
2. Calaluce M: Better education and care of sexual health of ESRD patients
may positively affect quality of life. PD Today. 1998, 4: 17.
3. Milde FK, Hart LK, Fearing MO: Sexuality and fertility concerns of
dialysis patients. ANNA J. 1996; 23: 307-15.
4. Camsari T, Cavdar C, Yemez B: Psychosexual function in CAPD and hemodialysis
patients. Perit Dial Int. 1999; 19: 585-8.
5. Ulrich BT: Sexual knowledge of nephrology personnel. ANNA J. 1987;
14: 179-183.
6. McGahuey CA, Delgado LP, Geleberg AJ: Assessment of sexual dysfunction
using the Arizona Sexual Experience Scale (ASEX) and implications for
the treatment of depression. Psychiatric Annals. 1999; 29: 39-45.
7. Palmer BF: Sexual dysfunction in uremia. J Am Soc Nephrol. 1999; 10:
1381-8.
8. Binik YM, Mah K: Sexuality and end-stage renal disease: research and
clinical recommendations. Adv Ren Replace Ther. 1994; 1: 198-209.
9. Rozemann D, Gurewicz S, Blickstein I: Sexual function in women on dialysis.
Dial Transpl. 1990; 19: 640-4.
10. Toorians AW, Giltay EJ, Donker AJM, Gooren LJ: Sexual functioning
in chronic renal failure. Semi Dial. 1997; 10: 176-181.
11. Soykan A, Boztaþ H, Kutlay S, Ýnce E, Nergizoðlu
G, Dileköz AY, et al.: Do sexual dysfunctions get better during dialysis?
Results of a six-month prospective follow-up study from Turkey. Int J
Impot Res. 2005; 17: 359-63.
12. Procci WR, Martin DJ: Effect of maintenance hemodialysis on male sexual
performance. J Nerv Ment Dis. 1985; 173: 366-72.
Dr.
Atilla Soykan
Division of Consultation Liaison Psychiatry
School of Medicine, Ankara University
Ankara, Turkey
E-mail: asoykan@pol.net
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