Social Workers Talk About Sex at the Council of Nephrology Social Workers' Chapter Conference in Portland

Linda wih Yasuyo Tsunamine, MSW

Kidney failure impacts sexual function, and social workers talk with dialysis patients about the most personal aspects of their lives! I had the chance to speak with a group of very committed social workers at the Chapter Conference of the Council of Nephrology Social Workers in Portland, Oregon last week. (If you look closely at the picture above, you'll see Dori Schatell and John Agar's book cover ("Help! I Need Dialysis!") on the screen in the background.

So, how does renal failure impact sexual function - and what can be done to help our clients?

• The two most common causes of renal failure are diabetes and high blood pressure - both of which can impact sexual function.
• Medications commonly used (e.g., beta blockers for hypertension, SSRIs for depression) may adversely impact sexual function.
• One study indicated that 85% of hemodialysis patients have some degree of erectile dysfunction!
• Kidney failure doesn't affect men only; information on sexual response in women is more difficult to find.
• A variety of medications may be useful in sexual dysfunction (always check with kidney center pharmacy or nephrologist).
• Intimacy, of course, doesn't have to be sexual.
• Don't forget the importance of "dates," and making time for a relationship in an already busy schedule.
• Social workers and other health care providers are encouraged to consult with sex therapists, or contact the helpful staff of Babeland in Seattle for detailed (sometimes X-rated) suggestions (www.Babeland.com). They can answer specifc questions - or suggest a product that may help your client immensely!

Happy Bunnies from Babeland

Two excellent books may provide further guidance for providers and their clients. These are:

• "The Ultimate Guide to Sex and Disability: For All of Us Who Live with Disabilities, Chronic Pain, and Illness" by Miriam Kaufman, MD, Cory Silverberg, and Fran Odette

• "Help! I Need Dialysis" by Dori Schatell and John Agar, MD.

Both books are particularly candid, and user-friendly. And, it's about time! Find them both on Amazon.com.

We also discussed how to talk to a patient about sex, and the importance of breaking through our own discomfort, should any exist.

• Starting a discussion with euphemisms may help, e.g., "How have you find ways to enjoy yourselves as a couple?" or "How has dialysis impacted your relationship?" (That way, your patient isn't cornered into talking about sex if that's not where they want to go!)
• Normalizing the experience helps, e.g., "Many people find that kidney trouble decreases their sexual appetite."
• Recognizing any discomfort you have is okay, e.g., "This is a little awkward for me, but I wanted to ask you some more personal questions. Is that okay with you?"

Remember, intimacy and sex aren't frills. They are critical to a healthy relationship. By having open discussions - and good resources, we can prevent intimacy from becoming yet another loss that kidney failure brings!

Take care,
Linda Gromko, MD

Future Blogs: Linda's trip to Japan!