Saturday, April 27, 2013

Sexuality and Renal Failure? Nephrology Social Workers Talk About It!

I was honored to present a discussion on "Sexuality and the Dialysis Patient" for the Conference of the Northwest Chapter of Nephrology Social Workers on April 25, 2013.

These Social Workers are deeply invested in their clients' wellbeing, and they know what they're doing.

Here are some important take-home messages:
  • Sexual function is like the "canary in the coal mine." When the body isn't working well, sexual function suffers.
  • The majority of End Stage Renal Disease is caused by Type II Diabetes and/or Hypertension (high blood pressure). Both of these conditions impact a person's over-all health.
  • Many medications - including those used to treat high blood pressure and depression - may impair sexual function. But there may be alternative medications available.
  • Kidney transplant is the Renal Replacement Therapy that is associated with the best sexual function.

Steve with his niece and kidney donor, Teresa
  • The frequency and quality of dialysis both impact sexual function. Peritoneal dialysis and home hemodialysis may be superior to in-Center dialysis for greater normalcy of life in general - including sexual interest and functioning. 
  •  Body image is critical to a healthy sex life, and there are some tricks for concealing and protecting a PD catheter or a precious fistula!
  • Medications for erectile dysfunction can often be used in kidney patients, with two important caveats: they are contraindicated with certain BP medications (nitrates), and they must be dosed appropriately with impaired kidney function in mind.

Helpful tips for talking about sexual issues include the following:
  • Rehearse if you're uncomfortable talking about sex
  • Start with euphemisms ("How has your kidney disease impacted your marriage?")
  • Normalize the situation ("Many people with kidney disease find that they are less interested in sex. What has your experience been?")
This group of excellent Nephrology Social Workers "got it" that sexuality isn't a "frill!" It's part of living a normal healthy life.

Take care,
Linda Gromko, MD


  1. I knew Steve back in high school when he lived on 28th Ave. W. in Magnolia. Of course, that is way before his success with Speaker Lab. Sorry to hear of his passing.

    As a former employee (11 years) of Northwest Kidney Ctrs, it has been the government's policy to push patients into dialysis centers. NKC used to have 140 home patients, probably about 40 home patients left when I left in 1998. Obamacare and the clandestine proponents of palliative care (manufacturers) love in-center care. That's why Fresenius NA has 1800 centers nationwide and grosses about $10 billion/yr. Da Vita follows at about 1600 centers. Hemodialysis is big business. I don't know if home dialysis is better than in-center dialysis, though some patients are too sick for in-center dialysis. As for peritoneal dialysis, there is also the possibility of infection from the catheter.

  2. Dr Kabo,

    Thank you for your comments; I only saw them today. Yes, I do recognize that in-Center dialysis is huge business. I also find it compelling that when a large group of nephrologists was asked, "what form of treatment would you want with CKD-5 and five years to wait for a transplant" - only 6% specified in-Center dialysis. Knowing that the national standard of care is NOTwhat nephrologists would select for themselvs is very telling. Thank you for making contact. Linda 10/22/13.