Sexual Dysfunction in Men and Women with Chronic Kidney Disease

Erectile dysfunction is one of the most common manifestations of sexual dysfunction in men with chronic kidney disease. The prevalence of this disorder has been reported to be as high as 70-80% and is similar between patients on hemodialysis and peritoneal dialysis. The high prevalence of this disorder is not surprising, given that many of the diseases such as atherosclerosis, diabetes, and hypertension that are associated with erectile dysfunction are commonly found in patients with chronic kidney disease. Normal male sexual function is achieved through the integrative response of the vascular, neurologic, endocrine, and psychologic systems. Men with chronic kidney disease can exhibit abnormalities in any one or all of these systems. Significant portions of chronic kidney disease patients display abnormalities in the function of the autonomic nervous system. Such derangements are due to comorbid conditions, such as diabetes, but also directly result from uremic toxicity. Given the importance of the sympathetic and parasympathetic nervous systems in normal sexual function, disturbances in the autonomic nervous system are likely to participate in the genesis of erectile dysfunction. Reductions in nocturnal penile tumescence and the frequency of sexual intercourse are positively correlated with disturbances in autonomic function as assessed by the Valsalva maneuver.