Loss of sex drive and other sexual problems
Whilst the sexual difficulties of male dialysis patients are often neglected, those of female patients are almost completely ignored. As yet, there has been very little research carried out into the sexual difficulties of female dialysis patients. The largest study was a survey of 99 Italian female haemodialysis patients. Compared to women who did not have kidney failure, the dialysis patients had sex less often and were less able to have an orgasm. Also, most patients noticed a loss of sex drive.
If a young woman is not having periods, research has shown that, with hormone replacement therapy, sex drive is often improved. This is in addition to the other benefits of hormone replacement therapy.
Some women with kidney failure are deficient in testosterone. Although this is normally thought of as a male hormone, it is required, in small amounts, to play a part in female libido (sex drive).
Sex life frequently returns to normal after a successful kidney transplant.
Specific sexual problems for women
Inhibited desire, not wanting sex, may be due to many factors. Women may still want to be intimate with their partners but not want penetration. If the physical problems associated with kidney failure (such as anaemia and hormonal problems) have been dealt with, then sex therapy may be an effective treatment, encouraging the couple to talk through problems and learn new techniques in lovemaking.
Lack of ability to orgasm
Many women can have pleasurable sex without orgasm, but lack of orgasm is a problem for many women. It is a myth that female orgasm is associated with penile penetration and thrusting. Most women need clitoral stimulation.
Anaemia and hormonal disturbance can affect the ability to have an orgasm, and these should be treated. However, some women may require additional clitoral stimulation. This can be achieved using manual stimulation or a vibrator. If these do not work, a vacuum device called Eros (www.eros-therapy.com), which stimulates clitoral blood flow, may suit some women, though it is advised that it is used after advice from a doctor or psychosexual therapist.
Trials are under way to investigate the value of creams containing a drug called alprostadil, which may increase genital and clitoral blood flow. This drug is also used to give impotent men erections.
Pain on intercourse (also called dyspareunia)
Pain during penetration is a common problem for women. It may be due to a lack of lubrication, or an infection such as thrush. An allergy to condoms or contraceptive creams may also be responsible.
A doctor or therapist may need to be consulted. If a women gets into a cycle where sex is always associated with pain, it may be damaging for the woman and her relationship with a partner.
This is an involuntary spasm, or tightening, of the muscles around the vagina, which may make penetration painful or impossible. Many different factors can cause vaginismus, such as painful intercourse, anxiety and previous traumatic experiences such as sexual abuse or complicated childbirth.
It is important to recognise that vaginismus may occur in women who are otherwise sexually responsive and affectionate with their partner.
A doctor or sex therapist should be able to help someone with vaginismus.
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.