Body image and sexuality

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Body image and sexuality may be taboo for some people, but that didn’t stop members of The Scarborough Hospital’s Home Dialysis Peer Support Group from choosing the subjects as the focus of its annual Patient Symposium this past spring.

Dr. Edward Woods, Chief of Urology at TSH, discussed the impact that physical challenges faced by dialysis patients has on sexual performance, while Psychiatrist Dr. David Gratzer spoke on self-image and barriers to social interaction.

For 59-year-old Roger Stonell, a hemodialysis patient living with polycystic kidney disease, it is a part of life that’s worthy of discussion in an open forum. In fact, Roger participated in the panel discussion on body image and sexuality.

“When I was first diagnosed in the early 1980s, it didn’t impact my relationship with my wife or affect my lifestyle because the condition was in a relatively early stage,” he recalls. “I had been living with polycystic kidney disease all my life, but it only manifested itself as high blood pressure when I was about 26.”

A systems analyst who now has had to cut his workweek down to two days because of dialysis, Roger still maintains an active lifestyle with his wife of 29 years, Nancy, and their three dogs.

The real changes for Roger have occurred in the last three or four years as the disease and dialysis itself create more symptoms.

“Two things happen when you’re on dialysis: first, just having to do hemodialysis does take you out of circulation for about six hours or so three times a week,” he explains. “The other is fatigue. It means I have less energy in the evenings, and I often have far less energy when I might have some free time.”

Dialysis patients must also deal with catheters, which can be problematic for body image.

“My wife was concerned about accidentally pulling out the catheter while we were intimate,” Roger explains. “But we worked it out by placing a gauze over it.”

Between their respective careers (Nancy is a medical researcher) and Roger’s home dialysis, it hasn’t been easy maintaining an active sex life.

“It is more difficult to make specific plans for any evening because we are not sure if Roger will have the energy after dialysis,” Nancy adds.

“A lot of times, what we do now is give each other a good hug in the morning. It’s not the same thing, but it is close contact and sometimes, that has to do,” Roger adds.

While the Stonells haven’t felt the need to pursue any medical interventions for their sex life, there are solutions, according to Dr. Woods.

“Sexual function in men and women with renal failure is something we don’t often think about as much as we should because, as doctors, we’re so busy preserving life,” Dr. Woods says. “But we should be working towards improving quality of life, too. Sexual function is not a luxury item; it’s a natural part of life.”

More than 70 per cent of dialysis patients suffer from sexual dysfunction.

“The reasons are complex, but the most common cause of sexual dysfunction is a combination of underlying chronic diseases such as diabetes, high blood pressure and hardening of the arteries,” Dr. Woods explains.

The side effects of medications used to treat those underlying chronic diseases also have an impact on sexual performance, along with symptoms related to renal failure and its treatment, such as fatigue, depression and anemia.

People battling renal failure additionally have special challenges with hormone imbalance. That’s because the pituitary gland – which controls the sex organs – doesn’t work very well for both men and women in renal failure. Unfortunately, doctors aren’t sure why, and Dr. Woods says this area needs more research than it is getting.

“Women and men who are in renal failure may suffer from a hormone imbalance, which causes low sex drive, depression and poor response,” Dr. Woods adds.

Drugs prescribed to treat ED, such as Viagra or Cialis, can help.

“We can also replace those medications which may have an anti-Viagra effect with medications that don’t,” Dr. Woods adds. “In the past decade, new drugs for chest pain have also been used to treat ED. And of course, kidney transplants can reverse many ED issues.”