Loss of sex drive and impotence
Men with kidney failure have a variety of sexual problems. These include having sex less often, loss of interest in sex (sometimes called loss of libido), and being unable to ejaculate (come). However, the most common sexual problem – and usually the most worrying for the man – is difficulty in getting or keeping a hard penis (erection problems). This is usually called impotence. Erectile dysfunction (ED) is an alternative name.
What normally happens first in men with kidney failure is that they become less able to keep an erection for as long as usual, although they are still able to ejaculate. Eventually, many kidney patients lose the ability to get a hard penis at all. This can obviously lead to frustration, particularly if the sex drive is unchanged. The situation can be even more upsetting if the man’s partner interprets the problem as a loss of interest in them personally.
What causes impotence?
Impotence has many possible causes. In most men with kidney failure, sexual problems do not have just one cause, but are usually due to a combination of:
- Poor blood supply. In order to make the penis hard, extra blood enters the penis and is then prevented from leaving it. Many kidney patients have narrowed blood vessels all over their body, including those vessels that supply the penis. This reduces the blood supply to the penis, and makes it difficult to get an erection. It is not just kidney patients who have this problem. It also occurs as part of the natural ageing process and is commoner in older men, as well as in men with diabetes.
- Leaky blood vessels. To keep the penis hard, the extra blood that has entered the penis must stay inside it. In men with kidney failure, the extra blood sometimes leaks back out of the penis, and so the erection is lost.
- Hormonal disturbances. Hormones are chemical messengers that control many body functions. They are carried around the body in the blood. Some hormones are specifically designed to control sexual urges. The levels of these sex hormones can be either higher or lower than normal in people with kidney failure. In particular, the testicles may produce less of the male sex hormone, testosterone.
- Nerve damage. The nerves that supply the penis are also involved in getting an erection. When someone has kidney failure, nerve damage may prevent the nerves from working properly.
- Tablets. Most tablets do not cause impotence on their own. However, a few drugs can contribute to sexual problems. The biggest culprits are the blood pressure tablets called beta blockers, such as atenolol, propanolol, metoprolol and bisoprolol.
- Tiredness. Tiredness can affect sexual performance. Tiredness in kidney patient may be caused by anaemia, by not receiving enough dialysis, or by other medical problems, such as heart disease.
- Psychological problems. When a kidney patient starts dialysis there are many stresses to deal with. Not surprisingly, some patients feel quite depressed. If so, they may not feel like having sex.
- Relationship difficulties. The illness of one partner naturally causes stresses in a relationship. For instance, household jobs, such a decorating or washing-up, which used to be done by the patient may now sometimes have to be done by the partner. This can lead to arguments or resentment on either side of the relationship.
How is impotence investigated?
The first and most important step is for the subject to be raised. There is often a lot of unnecessary suffering due to either denial of the problem or fear of embarrassment. Some kidney doctors and nurses have no experience of treating sexual problems in people with kidney failure, or are embarrassed themselves. If this is the case, patients should ask to see an expert in sexual problems. Sadly, few kidney units have such an expert at present.
Once the problem of impotence has been recognised, the following should take place:
- A general health check. This will include an assessment of the distance a person can walk on level ground without having to stop, which is a useful guide to general health.
- Physical examination. This will include an examination of the genitals. The doctor will also feel for a pulse at various points in the legs. If the pulses are weak, this means that the blood vessels in the legs have narrowed, reducing the blood supply. Then there will usually also be narrowing of the blood vessels supplying the penis, reducing its blood supply.
Blood tests. In addition to the usual blood tests, there will be tests to measure the blood levels of various hormones. These include testosterone, and also luteinising hormone (LH), follicle stimulating hormone (FSH) and prolactin. LH and FSH are hormones that regulate the testicles. Prolactin’s usual role is to produce milk in females, but it is often present in larger than normal amounts in male dialysis patients with impotence.
- Review of medication. The doctor should review the various tablets that the patient is taking. Some types of tablets may contribute to a patient's sexual difficulties. Alternative medication is sometimes available.
- Investigation of psycho-sexual problems. The patient will be asked to consider whether psychological or relationship difficulties may be contributing to the physical problem of impotence.
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.