Disturbances in sexual function are a common feature of chronic renal failure [1-4]. Over 50 percent of uremic men complain of symptoms that include erectile dysfunction, decreased libido, and marked declines in the frequency of intercourse [1,3]. These problems may improve but rarely normalize with the institution of maintenance dialysis, commonly resulting in a decreased quality of life [2,3,5]. By comparison, a well-functioning renal transplant is much more likely to restore sexual activity; however, some features of reproductive function may remain impaired, particularly reduced libido and erectile dysfunction .
Sexual dysfunction in uremia is primarily organic in nature, as demonstrated by abnormal nocturnal penile tumescence . (See "Overview of male sexual dysfunction".) It is presumed that the uremic milieu plays an important role in the genesis of this problem. Other organic (and not necessarily uremic) factors that may contribute to erectile dysfunction include peripheral neuropathy, autonomic dysfunction, peripheral vascular disease, and pharmacologic therapy.
Psychologic and physical stresses that may contribute to disturbances in sexual function are also commonly present in patients with chronic renal failure [2,6-8]. One study surveyed a randomly selected group of 68 patients treated with chronic peritoneal dialysis about their actual and desired level of sexual function . The following results were obtained:
- 63 percent reported never having intercourse.
- 19 percent had intercourse less than or equal to two times per month.
- 18 percent had intercourse more than two times per month.
There was no difference among the three groups with respect to age, the amount of dialysis received, or the serum albumin concentration. Standard psychologic questionnaires indicated that the patients who never had intercourse were more depressed and anxious, and assessed their overall quality of life at a level that was significantly lower than that of the other two groups. Similar observations have been made in patients on maintenance hemodialysis.