Sexual dysfunction in women with ESRD requiring hemodialysis

Abstract

Background and objectives: The few existing studies of sexual dysfunction in women on hemodialysis are limited by small sample size. This large, cross-sectional study evaluated the prevalence and correlates of female sexual dysfunction in advanced kidney disease. DESIGN, SETTING, PARTICIPANTS, METHODS: A total of 1472 women with ESRD undergoing hemodialysis were recruited to a multinational, cross-sectional study conducted within a collaborative dialysis network in Europe and South America. Sexual dysfunction was identified by the Female Sexual Function Index. Correlates of self-reported sexual dysfunction were identified by regression analyses.

Results: Of the 1472 women, 659 completed questionnaires (45%). More than half (362 of 659 [55%]) lived with a partner, and 232 of 659 (35%) reported being sexually active. Of these 659 respondents, 555 (84%) reported sexual dysfunction. Women with a partner (282 of 362 [78%]) were less likely to report sexual dysfunction than those without a partner (273 of 297 [92%]) (P<0.001). Sexual dysfunction was independently associated with age, depressive symptoms, less education, menopause, diabetes, and diuretic therapy. Nearly all women who were not wait-listed for a kidney transplant and were living without a partner (249 of 260 [96%]) reported sexual dysfunction. More than half (128 of 232 [55%]) of sexually active women reported sexual dysfunction, associated with age, depressive symptoms, menopause, low serum albumin, and diuretic therapy.

Conclusions: This descriptive study suggests most women on hemodialysis experience sexual problems. Additional research on the relevance of sexual dysfunction to symptom burden and quality of life in these women is needed.

Figure 1.

Sociodemographic and clinical correlates of self-reported female sexual dysfunction (n=659), displayed as multivariate-adjusted odds ratios. The multivariate model included depressive symptoms (Center for Epidemiologic Studies-Depression score [CES-D]), partner and menopausal status, smoking, housing, educational attainment, geographic region (Europe, South America), comorbid conditions (cardiovascular or cerebrovascular event, diabetes, or hypertension), cause of kidney disease (hypertension, diabetes, or other), neurologic conditions (spinal cord lesions, multiple sclerosis, Parkinson disease, or Alzheimer disease), previous kidney transplant, wait-listing for kidney transplant, medication, dry weight, interdialytic weight gain, time on dialysis, dialysis adequacy (expressed as Kt/V), dialysis blood flow, parity, and laboratory variables (including hemoglobin, parathyroid hormone, calcium, phosphorus, albumin, and ferritin).

Figure 2.

Identification of subgroups of women requiring hemodialysis who had different risks for sexual dysfunction: results of recursive partitioning and amalgamation method analysis. A tree-growing algorithm modeled age-adjusted odds ratios (AORs) for predicting risk for self-reported sexual dysfunction. The splitting variables are shown between branches, and the characteristic assigning women to different groups is above the corresponding branch. Premenopausal women wait-listed for a kidney transplant had the lowest prevalence of sexual dysfunction and were designated as the reference category. Circles indicate subgroups of patients. Shaded squares indicate women with different combinations of clinical and sociodemographic characteristics and the associated correlation with sexual dysfunction (e.g., women without a partner who are not wait-listed for a kidney transplant had an adjusted risk of 21.91 compared with the lowest-risk category of premenopausal women wait-listed for a transplant). Numbers inside circles and squares represent numbers of patients with (upper number; dark border) and without (lower number) sexual dysfunction, respectively.

Figure 3.

Sociodemographic and clinical correlates of self-reported female sexual dysfunction in sexually active women (n=232), displayed as multivariate-adjusted odds ratios. The multivariate model included depressive symptoms (Center for Epidemiologic Studies-Depression score [CES-D]), partner and menopausal status, smoking, housing, educational attainment, geographic region (Europe, South America), comorbid conditions (cardiovascular or cerebrovascular event, diabetes, or hypertension), cause of kidney disease (hypertension, diabetes, or other), neurologic conditions (spinal cord lesions, multiple sclerosis, Parkinson disease, or Alzheimer disease), previous kidney transplant, wait listing for kidney transplant, medication, dry weight, interdialytic weight gain, time on dialysis, dialysis adequacy (expressed as Kt/V), dialysis blood flow, parity, and laboratory variables (including hemoglobin, parathyroid hormone, calcium, phosphorus, albumin, and ferritin).