Sexual health and contraception with chronic kidney disease

Sexual health issues are common in people with CKD. Your healthcare team will be happy to talk over any concerns that you may have to help improve the situation for you and your partner.

How can CKD affect my sexual health?

You may find that your sex drive reduces with CKD. There are several reasons for this, including emotional, physical and psychological factors.

Having a long-term illness like CKD can affect your job, income and family life. These added stresses and lifestyle changes can all impact on your body image and level of sexual desire.

CKD and its treatments can affect your weight, which may make you see your body in a different way.

If you are on dialysis, you may worry that your catheter tube or fistula is unattractive or that you may damage your dialysis access during sex.

What help is available?

The first step is to talk though any concerns with your partner so that they understand what you are feeling and can try to help.

If you are suffering from fatigue, your kidney team may be able to help by checking your iron levels and blood count (haemoglobin) and adjusting your dialysis schedule if needed.

It is rare that dialysis access is damaged during sex and your kidney team can advise you on protection.

You can ask your healthcare team to refer you for psychosexual counselling. This is a specific type of counselling that deals with sexual problems. It can be very helpful in exploring your feelings and re-gaining your confidence.

How can I stay safe?

If you take medicines to suppress your immune system to treat your kidney disease or to prevent the rejection of a kidney transplant, you will have an increased risk of infection. This includes sexually transmitted infections (STIs) such as gonorrhoea, syphilis, chlamydia and HIV.

It is recommended that you are screened for STIs between relationships or sexual partners. The only exception would be where neither of you has have had any sexual contact before. Remember that both oral sex and intimate touching can lead to infection.

The only effective method of preventing STIs is by using a barrier contraception in the form of condoms or a dam (mouth guard) for oral sex. These are available for free at sexual health clinics or from pharmacies.

What happens if I get an STI?

Talk to your GP or kidney team if you think you have an STI. They can test you and discuss treatment options that do not interfere with your kidney medicines.

You can also visit a walk-in sexual health clinic. You should tell them that you have CKD as it could affect your treatment.

What else can I do to protect myself?

The HPV vaccine helps protect against human papillomavirus (HPV). Some types of HPV are linked to an increased risk of certain types of cancer. It’s recommended for children aged 12 to 13 years old and people at higher risk from HPV. It is designed to be given before you become sexually active.

Women between the ages of 25 and 65 are strongly advised to attend all cervical cancer screening (smear test) appointments.

Women should also always see their GP or a sexual health clinic if they have any change in their periods, altered discharge, bleeding between periods or bleeding after going through the menopause.

What type of contraception should I use?

Talk to your GP or kidney team about the different types of contraception to find one that is right for you.

Barrier methods such as condoms are safe to use as contraceptives for both men and women with CKD. The intrauterine device (IUD or coil) has also been shown to be safe for women with CKD.

Contraceptive pills which have low levels of oestrogen may be suitable for women with CKD. You will need to have your blood pressure checked regularly as this type of pill can cause high blood pressure (hypertension) and increase your risk of developing blood clots.

Progesterone-only contraceptives are safe and effective, even in women with high blood pressure. You can take these as pills (the ‘mini-pill’), injections every three months, implants or an intrauterine device (‘Mirena coil’). Talk to your GP about these options. Like every medication they can have side effects but can also be safe and effective forms of contraception. Women with severe CKD or on dialysis may be advised to avoid the injection as it can cause bone thinning and fractures. This is not seen with the pill, implant or Mirena coil.

Surgery. Female sterilisation is an operation to prevent pregnancy by blocking or sealing a woman’s fallopian tubes. A vasectomy involves blocking the tubes that carry a man’s sperm. These procedures cannot easily be reversed and should therefore only be considered if you are certain that you have completed your family.

Men's sexual health

I want to have sex but can’t get an erection. Is this common?

Erectile problems (difficulty getting or maintaining an erection) are very common in men with CKD. You may feel embarrassed talking about this, but treatment is often straightforward and is available on the NHS.

Your healthcare team can review your medicines to see if they may be contributing to your erection problems.

General lifestyle measures such as drinking less alcohol, stopping smoking, maintaining a healthy weight and taking regular exercise may also help.

What are the other options for me if this doesn't work?

If these changes do not work for you, there are several treatment options.

Your GP may be able to prescribe you medication or can refer you to a specialist sexual health clinic. You can also make an appointment with the clinic without going to your GP.

Viagra® is one of the treatments that you can try to improve erections. It is available on prescription as the generic drug sildenafil or to buy over-the-counter after a discussion with a pharmacist.

Always make sure that you get your tablets from a registered doctor and pharmacist.

Other treatments may be available if Viagra® does not work. If you have a transplant kidney or are receiving dialysis, you may be able to get some of these treatments for free. Talk to your GP about the options.

Remember that many men are in this position, and it is nothing to be embarrassed about.

Women's sexual health

It hurts when I have sex. What can I do?

Lower hormonal levels can make it difficult for some women to become aroused or may cause them to experience vaginal dryness or painful intercourse. Using vaginal moisturisers or water-based lubricants may help but you should discuss any concerns with your doctor. They can examine you for specific physical causes, prescribe treatments or refer you to a gynaecologist if needed.

Adjustments to your blood pressure medications, hormone supplements or anaemia treatment may also help.

Can I get pregnant with CKD?

Even if your periods are irregular, you should still use contraception if you are sexually active and do not want to become pregnant.

Talk to your kidney team if you are thinking of trying for a baby, as they can give you personalised advice that is right for your situation. Early discussion with your doctor can help increase your chance of a successful pregnancy and allow appropriate treatment decisions to be made.

Pregnancy can cause a sudden loss of your kidney function, especially if you have a pre-existing kidney disease. If you are pregnant and have high blood pressure or are overweight, you are at greater risk of developing pre-eclampsia. This can cause temporary kidney failure known as acute kidney injury (AKI). If you have had pre-eclampsia or AKI during pregnancy, you are at higher risk of developing high blood pressure and CKD later in life.

If you have CKD or are on dialysis while pregnant, your baby may be born early or be smaller than expected. This is often due to high blood pressure during pregnancy which can also affect your kidney function.

Some medications are not safe to take during pregnancy so you may need to change your treatment before you try to conceive. Talk to your doctor or pharmacist to see if your medicines are safe to take if you get pregnant.

Do not stop your medications without taking medical advice.

Some research has suggested that women with CKD may go through the menopause early compared to the general population, but there is a lack of robust data to confirm this. If your periods stop while on dialysis this does not necessarily mean you are going through menopause. Your periods are likely to come back if you have a transplant.