Sexual dysfunction in uremic men
- Biff F Palmer, MD
Biff F Palmer, MD
- Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- William L Henrich, MD, MACP
William L Henrich, MD, MACP
- University of Texas Health Science Center at San Antonio
- Peter J Snyder, MD
Peter J Snyder, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Male Reproductive Endocrinology
- Professor of Medicine
- University of Pennsylvania School of Medicine
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:
●Sixty-three percent reported never having intercourse.
●Nineteen percent had intercourse less than or equal to two times per month.
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- HYPOTHALAMIC-PITUITARY-TESTICULAR FUNCTION
- Phosphodiesterase inhibitors
- Psychotherapy and/or psychoactive medications
- Dopamine agonists
- Vacuum tumescence device
- Renal transplantation
- SUMMARY AND RECOMMENDATIONS