Do sexual dysfunctions get better during dialysis? Results of a six-month prospective follow-up study from Turkey

Dialysis improves most symptoms of end-stage renal disease (ESRD), yet many patients continue to experience sexual dysfunction (SD) during the dialysis treatment. The aim of this preliminary study was to evaluate the frequency and the course of SD during a 6-month dialysis treatment. Additionally, relationships between the level of depression, cognitive impairment and biochemical parameters of SD were also assessed. The subjects were 43 ESRD (25 male and 18 female) on dialysis treatment for at least 12 months. SD was assessed using the Arizona Sexual Experiences Scale (ASEX); the level of depression and cognitive impairment were assessed using the Hamilton Depression Rating Scale (HDRS) and Mini Mental Status Exam (MMSE). Several biochemical parameters were also assessed. All assessments were carried out at baseline and repeated at 6-month follow-up. Of 43 patients, 20 (47%) and 18 (42%) complained of SD at baseline and at 6-month assessments, respectively. Of 25 males, nine (36%) and seven (28%) patients described SD at baseline and 6-month assessments, respectively; erectile dysfunction was the most frequent complaint. Of 18 females, 11 (61%) and 11 (61%) patients reported SD at baseline and 6-month assessments, respectively; difficulties with arousal and reaching orgasm were the most frequent complaints. Both total and item-by-item comparisons of baseline and 6 months ASEX scores did not reveal any significant changes during 6-month period, indicating that patient's sexual functions do not improve with dialysis treatment. For female patients, HDRS scores were significantly higher in patients with SD at baseline (t = 2.15, P = 0.05) and at 6-month follow-up (t = 2.44, P = 0.03) assessments; after excluding the effects of age and duration of dialysis for females using regression analysis, HDRS still significantly (t = 4.02, P = 0.003) associated with the SD. This preliminary prospective study suggests that SD is frequent in dialysis patients, does not remit with dialysis treatment, associated with depression in female patients, and much clinical attention is indicated.