Seattle Institute for Sex Therapy, Education, and Research

(206) 522-8588

Sexuality and the Renal Patient

Sexuality is a difficult topic for most people to discuss, even those without disabilities. The body is private, and sexual practices are not mentioned even among friends. Many people feel inadequate: they fear they are not attractive enough, tall enough, physically endowed enough - in other words - they have problems with their body image and their self-esteem in relation to how lovable and worthwhile they are.

The way people feel about their bodies influences how they feel about their sexuality and whether they feel lovable and capable and worthwhile. Factors such as body image, illness/disease, personal relationships, and psychological states such as depression and anxiety affect sexuality.

When a person becomes disabled in any way, all the fears and uncertainties about sexuality common to American culture become magnified. A person with renal disease also has real physiological problems in many areas of functioning which impact sexuality.

The physical and emotional effects of renal disease on sexuality are very complex for both the person with kidney disease and their partner. The source and development of any particular area of sexual dysfunction is often unclear for the renal patient, each person reacts individually, and it may never be possible to pinpoint the exact cause of a dysfunction.

Renal patients who have questions about their sexuality may need a complete assessment which involves them, their partner, their doctor and nurse, a sex therapist and a rehabilitation person or other healthcare provider. Not all doctors specialize in both urology and sexuality. Names of doctors with these specialties are available through Seattle Institute.

Kidney disease alters the general metabolic state of the individual, so it may affect testosterone secretion or lead to testicular atrophy in males, women may cease ovulation and menstruation. Premature hardening of the arteries in the pelvis may retard orgasmic function. Chronic uremia is associated with listlessness and lethargy and may also affect the pelvic autonomic nervous system which controls sexual arousal. Anemia and electrolyte imbalance may contribute to weakness and impaired neuromuscular function, debility and depression.

The psychosocial impact of this disability is far-reaching. Fear of dying, fear of frequent hospitalizations, anger at having the illness, anger at loss of control and independence, depression from loss of income and loss of the ability to earn as much as previously, changes in social and personal roles, changes in recreation, major adjustments in all areas of life, resentment over being dependent on a machine or medication, resentment of the necessity of becoming so knowledgeable about one's illness and so responsible for one's own healthcare, being forced to think about every bite of food and every sip of liquid - the sheer number and complexity have the potential to overwhelm even the most stable of personalities. The spouse and/or other family members may feel resentment and then subsequent guilt over the need to focus the entire family on the renal patient's health needs. Any physical or emotional preoccupation from whatever cause can interfere with both male and female sexual desire, arousal and orgasm and so the renal patient and spouse may be impacted in many, many ways.

Even though healthcare professionals may deal with handicapped clients regularly, they still may not feel completely comfortable discussing sexuality with a person who is physically impaired. Many professionals report receiving little instruction on sexuality in their training. Their discomfort may be interpreted as disapproval by the client, who may also be uncomfortable with the subject even though they want the information. It can be useful to have printed material on sexual functioning for specific disabilities available to assists client in asking the questions and knowing where to begin looking for the answers.

It is important to encourage renal patients to persevere in getting the answers they need. Intimacy and pleasure are essential for health for human beings. Kidney disease limits many of the usual pleasures of life such as eating and drinking, the pleasure of participation in strenuous sports, and the simple pleasure of feeling good most of the time. Encourage clients to avoid limiting themselves more by not looking for the pleasures still available.

The degree and intensity of sexual dysfunction varies depending on the individual and on the stage of renal failure. In uremic states without treatment there is often loss of desire. In dialysis stage there is often some increase in sex drive though often lower sexual functioning than in the pre-disease state, with erection and orgasm problems and often less desire for sexual contact.

After kidney transplant there is often an increase in sexual functioning, especially in males, with an increase in intercourse, sexual desire and overall satisfaction. There may not be as much increase in frequency or sexual interest in women.

A healthcare provider may need to assure clients that it is acceptable to talk and to ask questions about sex, that it is acceptable to express feelings such as loss, depression, anger, anxiety, and that it is acceptable to talk about how this will affect their relationships.

There are some important things to remember to remind the client. Sexual satisfaction does not equal an erection, or lubrication, or an orgasm. Libbey Livingston, a Seattle sexuality counselor, describes sex as being like going to a Baskin and Robbins ice cream store, there are many choices, many of which any given individual might like.

The following suggestions can be copied and used as a handout for ideas and reference sources:

ALTERNATIVES TO SEXUAL INTERCOURSE FOR RENAL PATIENTS AND THEIR PARTNERS

Schedule times for increased structured nurturing of each other. If you don't feel any sexual desire, just cuddle, hug, hold each other. Do massage (light stroking with fingers or feathers feels wonderful). Snuggle into pillows together, create a soft, comfortable environment to spend time together. If there is no lubrication, use one of the many supplementary lubricants available. If there is no erection, use the non-erect penis; don't limit yourself, you have fingers, mouth and hands, lips, other erotic areas. Try sexual aids such as vibrators. Penile implants are available. If there is no orgasm, don't let it limit you, enjoy the simmer and the sensation and the closeness and the intimacy.

Ask yourself these questions from Dr. Carrera's book, Sex: The Facts, the Acts and Your Feelings:

• what has changed about your body and your sensations?
• what is (about) the same?
• what can you still do and feel?
• what is pleasurable? what is unpleasant?
• when is lovemaking a problem?
• does your disability interfere with pleasuring yourself? what are the alternatives?
• does your disability interfere with pleasuring your partner? what are the alternatives?
• are you willing to explore new activities and new areas of sensation to replace familiar ones affected by your disability?
• what can you do to learn to communicate your feelings, needs and concerns to your partner?

Both partners should be sensitive to each other's energy level. A well male partner may miss the sexual attention his partner used to provide. He could now stimulate himself to orgasm while his partner lies in a comfortable position beside him stroking his body with a feather. A well female partner should ask what her ill partner wants and needs. She can stimulate herself to orgasm while her partner lies beside her stroking her, cuddling her and/or stimulating himself at the same time. Realize that intercourse is not essential to sexual satisfaction.

Don't blindly agree with the tyrannical myth of the need for intercourse to achieve satisfaction. Explore and find out what's true for the two of you.

The partner with renal disease: find a way to make yourself comfortable in bed; position yourself with pillows so you can reach your partner's body easily and with little expenditure of energy. The well partner should also be comfortable and in a position to easily stroke and pleasure their partner. Begin with light caressing. Learn about yourself and each other. Feel free to use sexual aids like feathers, fur, supplemental lubrication and vibrators to achieve needed stimulation and pleasure with low expenditure of energy.

Be creative. Enjoy yourself and your partner.

Copyright © 1999 by Sharma Oliver, R.N.

[Back to Top of Page]