Sexual dysfunction in End-Stage Renal Disease (ESRD)

Background: Sex is a basic activity in the human life. Any defect in this important function leads to a lot of social and psychological troubles. A common problem that remains difficult to diagnose and treat in patients with chronic renal failure is sexual dysfunction. Erectile dysfunction is often the result of multi-system disease processes involving the hypothalamic-pituitary-gonadal axis, vascular supply, and penile tissue damage from either infections or trauma. Psychological factors such as fatigue, stress and depression may result from chronic illness and contribute further to the patient’s loss of erections. Sexual dysfunction is a subject that patients find difficult to approach with healthcare practitioners. Common disturbances include erectile dysfunction in men, menstrual abnormalities in women, and decrease libido and fertility in both sexes. These abnormalities are primarily organic in nature and are related to uremia as well as the other comorbid conditions that frequently accompany the chronic renal failure. Hyperprolactinaemia has been reported in 25-57% of male End-Stage Renal Disease (ESRD) and has implicated in impotence, hypogonadism, and reduced desire. ESRD results in an acceleration of atherosclerosis and may lead to vasculogenic erectile dysfunction by occluding large vessels and their arterial tributaries. The treatment of this problem includes psychological, emotional, medical and sometimes surgical interferences. Although there were numerous therapies that could be injected intracavernosally for treating ED. Sildenafil has become the first-line therapy in treatment of impotence because it is the first oral agent discovered.Sildenafil is the first approved non-surgical treatment for erectile dysfunction that does not have to be either injected or inserted directly into the penis to achieve and maintain erection. The oral medication was approved by the US Food and Drug Administration (FDA) for prescription sale in 1998. Successful management of sexual dysfunction in immunosuppressed renal transplant recipients should provide a quality erection, adequate for the mutual satisfaction of the patient and his partner, with minimal risk of infection, and without compromising the current or future function of the transplanted kidney. Improved sexual function has been reported within a few months of successful renal transplantation.Objectives: Our aim of this essay is better understanding of the problem of sexual dysfunction in End-Stage Renal Disease (ESRD). Furthermore, we hope to provide some possible opinions to reduce and treat as much as possible this common complication.