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Introduction and safe sex?

1. Are sexual problems common for people with kidney failure?

Sexual problems are common for men and women who have kidney disease. Not only are emotional problems likely to occur because of the stress of kidney disease, but also there are a number of medical conditions that can affect sexual function and ability to have children, in both men and women.

Emotional problems that can cause sexual difficulty

Many people in their lifetime suffer with some sort of emotional problems leading to sexual difficulties. The stability of a relationship prior to the onset of kidney failure can play a significant part in dealing with sexual difficulties of both men and women. Some common emotional problems are caused by people going through a grieving process due to loss of kidney function, independence, their job and place in the family. Change in body image, or not feeling a whole man or whole woman due to decreased sexual function. Dialysis can lead to lowered self esteem with anger and depression, also affecting sexual function.

Partners can feel powerless in a relationship because they do not know what to do to help the person with kidney failure, or if they receive a negative reaction when trying to help. The equal balance of the relationship may have changed, one seeing themselves as the carer and the other in a sick role. People need to talk about their fears and feelings. They also need to know that what they have said has been heard by the other person. Other hidden fears may also be present. For instance, some people may believe that kidney disease could be transferred during sex. This is not true.

Many kidney patients and their partners may want to have counselling, either by a psychologist or sexual counsellor. This can be very effective.

Investigating sexual problems

In the past, many health professionals working with kidney patients have tended to avoid getting involved with their patients’ sexual problems. Even now, despite the more general interest and openness about sexual matters, people with kidney disease may still find that they have to raise the subject first.

Another possible reason why some doctors and nurses have avoided the subject of sexual problems has been a mistaken belief that the available treatments were unlikely to work. This view needs to be updated.

As with other aspects of kidney failure, there isn’t usually just one straightforward problem that can be easily corrected. Often there are several issues to look at and patience is required. Nevertheless, treatment is usually successful, provided both partners are keen to have a sex life and are willing to accept help. It may be possible to adjust medication, increase dialysis, improve haemoglobin or treat erectile problems.

1. Contraception

Contraception is important for people with kidney disease, just as it is for everyone else. Don’t assume that just because you have kidney failure that you cannot have a child. The coil contraceptive and condoms are safe for people with kidney disease to use. The oral contraceptive pill can cause some complications more frequently in women with kidney disease than in the general population, so needs to be prescribed with care.

Barrier methods of contraception are effective, so long as they are used carefully. The male condom and female condom (Femidom) also act as a barrier to the spread of sexually transmitted diseases, for example herpes or AIDS. A diaphragm or spermicidal jelly can also be used. Disadvantages of these methods are that men may not like to use a condom. Women may find it difficult to position the Femidom or a diaphragm correctly into the vagina; or find the process distasteful, especially since spermicidal jelly must be used as well, to increase the effectiveness of the contraceptive.

Failure of a barrier method may occur when the device becomes dislodged during or after intercourse. Kidney patients are able to take the ‘morning after pill’, but this treatment can cause sickness and should not be used regularly.

The oral contraceptive pill (often just called ‘The Pill’) can be used in women with kidney diseases, but a low oestrogen type is generally preferred. High blood pressure is very common in women with kidney diseases, and this is also a common side effect of oral contraceptives. Therefore blood pressure should be monitored and sometimes it is necessary to increase the dose of blood pressure drugs.

Women can use an intrauterine coil. This is a small plastic and metal device which is inserted into the neck of the womb. Someone experienced is needed to insert and remove a coil, usually a doctor or nurse. Contraception is generally effective, though the coil may cause some bleeding or heavier periods, and there is a small risk of infection in the womb. There is a new type of coil available, which may suit some people, and may overcome some of the disadvantages of coils. It is marketed in the UK under the name ‘Mirena’, and combines some hormonal treatment with the coil effect. Unlike the old copper coil, Mirena reduces menstrual bleeding and in many cases periods stop completely. In some women on dialysis, this may be an advantage if the blood loss from periods has caused anaemia. Mirena is less likely to raise blood pressure than some oral contraceptive methods, but like any type of medication can have side effects. It needs to be inserted by a doctor and changed every five years.

A man can have a vasectomy or a woman can be sterilised. These procedures can be carried out in people with kidney failure in the same way as anyone else. Before contemplating sterilisation, it is important to realise that the success of reversal by surgery is limited, so if someone changes his or her mind about children, it may not be possible to regain normal fertility. Lastly, sterilisation does not protect against sexually transmitted diseases, so safe sex with barrier methods should be practised if having sex with multiple partners.

These various methods of contraception require consultation with a nurse or doctor in order to decide which would suit someone the best

1. Safe sex and sexually transmitted diseases
2. People with kidney disease can get sexually transmitted diseases, so safe sex is important.

Sexually transmitted diseases can occur in people with kidney failure just as they can in anyone else.

There may be symptoms, such as genital itching or a discharge from the penis or vagina. However, many sexually transmitted diseases may cause no symptoms, so do not take chances, play it safe!

Some conditions such as HIV/AIDS and viral hepatitis may cause particular problems in someone with kidney failure. In particular, it is currently not possible to have a kidney transplant if you are HIV positive (note that these conditions can be transmitted by means other than sex).

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The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.