A few months ago I had finished a consultation with one of the patients in clinic, when he raised something, almost as his ‘hand was on the door handle’. He brought up the fact that his GP had told him a few years back that he wasn’t suitable for Viagra as a kidney patient. I sat him back down and asked to hear a bit more about his story.
When he had finished I was able to confirm to him that drugs that treat erectile dysfunction (an inability to sustain satisfactory erection to complete intercourse) is a pretty common problem in lots of long term conditions, and that use of the drugs that revolutionised treatment for these (like Viagra), is definitely not off bounds for kidney patients. I also explained that it did require a bit of careful liaison between the kidney specialists and family doctors to get the right dose and sometimes to change some background medications, such as blood pressure tablets, for safety reasons.
I came away feeling really glad that he had brought it up, and wondering whether we make this health concern – that is so common – something that is easy for patients to raise with us, or whether like this chap, unfortunately, years had gone by without us knowing it was a problem for him.
Sexual problems are very common in conditions like severe kidney failure but even with a condition like this, more problematic from midlife onwards. Both men and women are affected by a loss of interest in sex or a loss of libido, having sex less often, and inability to have an orgasm. For men the most worrying feature is often getting or keeping an erection. This can happen despite sex drive sometimes being present or not so much changed and therefore lead to a lot of frustration. Clearly it has an impact on a man’s partner, no matter how understanding she or he may be.
Not being able to keep an erection is usually down to several factors at once – the blood circulation and blood supply is often abnormal over time in kidney patients, particularly those with diabetes. There can be hormone disturbances found in kidney failure, for example of the male sex hormone testosterone. The nerve supply to the penis is also involved in getting an erection and these can be damaged in conditions like kidney failure and diabetes. Some tablets can contribute to sexual problems and the biggest culprits are things that are known as Beta blockers (ending in “olol”). Tiredness can have a big impact, whether caused by anaemia, iron deficiency, under dialysis or other problems such as heart problems. Of course not least, the psychological impact of having long-term health conditions may wax and wane over your journey with kidney failure, but for most people is a challenge in its own right at certain times.
Viagra is one of the treatments now famous for helping with impotence. A little blue pill, it was launched in the US in 1998 and there are now a couple of similar pills on the market. Trials of Viagra show about 8 out of 10 men benefit with improvements in erection, orgasmic function and satisfaction with intercourse. It doesn’t in itself appear to improve desire for everyone. There are reported side effects such as occasional headaches, indigestion and muscle aches. Whether it’s safe for you to take has to be a decision made in combination with your kidney specialist and your GP who will take into account your other health conditions. For instance some of the other tablets you take may need to be changed to allow you to trial it safely.
If you have been worried about your sexual health and function – I hope this blog reaches out to you and helps you to realise that it is actually a very common complication from kidney problems. Your medical and nursing staff have sympathy for you and experience in dealing with this. Sometimes the first thing to do is to speak to someone, rather than suffering in silence.
Dr Janet Hegarty
Consultant in Kidney Medicine
Salford Royal NHS Foundation Trust
Honorary Lecturer University of Manchester