Sexual Dysfunction and Satisfaction in Kidney Transplant Patients

The effect of psychosocial interventions on depression, anxiety, and quality of life in hemodialysis patients: a systematic review and a meta-analysis

PURPOSE

Hemodialysis has become a standard therapy for adults with end-stage renal diseases. Adults undergoing hemodialysis have to cope with unique psychological issues that make their care journey particularly fatiguing. In this systematic review and meta-analysis, we aimed to summarize and evaluate the effects of psychosocial interventions on the reduction of anxiety and depression in adults with HDs.

METHODS

We included randomized controlled trials and quasi-experimental studies that measure change in depression, anxiety, and quality of life.

RESULTS

We identify three categories of psychosocial interventions delivered to adults undergoing hemodialysis. Based on our analysis, there was a medium effect of psychosocial intervention on depression (SMD - 0.85, 95%CI - 1.17; - 0.52, I² = 80%, p < 0.01) and anxiety (SMD - 0.99, 95%CI - 1.65; - 0.33, I² = 88%, p < 0.01) in adults undergoing hemodialysis.

CONCLUSIONS

Psychosocial interventions, such as psychological support or relaxation-based therapy, seems all to reduce depression and anxiety in adults undergoing HD. Preliminary evidence suggests that there may be a benefit of psychosocial interventions on the quality of life for adults undergoing HD.

The impact of renal transplantation on sexual function in males with end-stage kidney disease: a systematic review and meta-analysis

INTRODUCTION

Patients with end-stage kidney disease (ESKD) on dialysis have a special profile, including constant uremic status and frequent comorbidities, such as diabetes mellitus, arterial hypertension and coronary artery disease, as well as complications related to dialysis. All listed factors can influence or be the cause of sexual dysfunction in both men and women. There is a high incidence (70%) and prevalence (82%) of erectile dysfunction in men with CKD.

PURPOSE

In this meta-analysis, we aimed to evaluate the impact of renal transplantation in patients with end-stage chronic kidney disease and erectile dysfunction, using the same study population before and after transplantation.

DATA SOURCES

we searched MEDLINE (PubMed), Embase, Scopus and Cochrane Library (Inception to August 2022) and clinicaltrials.gov (Inception to August 2022) without language restrictions.

STUDY SELECTION

eligible studies evaluated the same patients with end-stage kidney disease before and after renal transplantation using IEEF questionnaire.

DATA EXTRACTION

reviewers working independently and in duplicate extracted data and assessed the risk of bias.

DATA SYNTHESIS

the final analysis included 28 cohort studies, comprising 2252 participants.

RESULTS

Our results showed improvement in erectile function after renal transplantation. Our study shows a 13% improvement in erectile dysfunction after renal transplantation.

CONCLUSIONS

The results of this meta-analysis would suggest improvement in erectile dysfunction after renal transplantation.

Sexual dysfunction, depression, and marital dissatisfaction among Brazilian couples

BACKGROUND

Health professionals treating sexual dysfunction and relational dissatisfaction recognize that they are multifactorial phenomena, and depression can be bidirectionally associated with both.

AIM

The purpose of this study was to investigate sexual dysfunction in heterosexual couples in relation to the quality of their marital relationship and depression symptoms.

METHODS

The sample consisted of 100 heterosexual couples recruited in Brazil. Both partners of each couple completed the Golombok-Rust Inventory of Sexual Satisfaction and the Golombok-Rust Inventory of Marital Satisfaction, which were translated and adapted, and the Beck Depression Inventory, which was validated for the Brazilian population. Both partners completed their questionnaires separately, and the couple's surveys were linked to preserve conjugal data for dyadic analysis. The Actor-Partner Interdependence Model was used to understand how sexual dysfunction in couples is related to depression and relationship quality among and between partners.

RESULTS

Sexual dysfunction was found to be strongly associated with dissatisfaction in the relationship (husbands, β = 0.57, P < 0.001; wives, β = 0.60, P < 0.001), and a positive association was found between depressive symptoms and marital dissatisfaction (husbands, β = .32, P < .001; wives β = .40, P < .001).

CLINICAL IMPLICATION

The results suggest that it is important for health professionals to be aware of the dyadic impact of struggles with both sex and the relationship and the presence of depression symptoms in patients who seek care for sexual complaints or depression and who are in a marital relationship.

STRENGTHS AND LIMITATIONS

The different results found for men and women may shed light on the biopsychosocial dimensions of human sexuality. When treated as a purely physical experience, sex is myopic. In this study we demonstrated psychosocial aspects associated with gender and sexuality, and the partner's variables were found to have a greater impact on women than they did on the men. A limitation of this study is that the sample is not generalizable as it is not demographically representative of all socioeconomic groups in Brazil. Furthermore, the participants in this sample did not have clinical levels of depression, so the results cannot be extended to couples in which one or both spouses have depressive disorder.

CONCLUSION

It was found that sexual dysfunction is strongly associated with the quality of the couple relationship, and that the quality of relationship plays a mediating role between depression and marital quality, especially for the women.

Who seeks sex therapy? Sexual dysfunction prevalence and correlates, and help-seeking among clinical and community samples

Sexual dysfunctions (SD; e.g., female sexual interest/arousal disorder, erectile disorder, female orgasmic disorder, delayed ejaculation, genito-pelvic pain/penetration disorder, etc.) affect up to a third of individuals, impairing sexuality, intimate relationships, and mental health. This study aimed to compare the prevalence of SDs and their sexual, relational, and psychological correlates between a sample of adults consulting in sex therapy (n = 963) and a community-based sample (n = 1,891), as well as examine barriers to sexual health services for SD and the characteristics of individuals seeking such services. Participants completed an online survey. Analyses showed that participants in the clinical sample reported lower levels of sexual functioning and sexual satisfaction and higher levels of psychological distress than participants in the community-based sample. Moreover, higher SD rates were related to lower relational satisfaction and higher psychological distress in the community sample, and to lower sexual satisfaction in both samples. Among participants in the community sample who sought professional services for SD, 39.6% reported that they were unable to access services, and 58.7% reported at least one barrier to receiving help. This study provides important data regarding the prevalence of SD and the link between SD and psychosexual health in clinical and nonclinical samples, as well as barriers to treatment access.

The Quality of Sex Life Among Patients Before and After Lung Transplantation: A Single-Center Study

BACKGROUND

Lung transplantation (LTx) is the only effective method of treatment for patients with end-stage lung diseases; LTx prolongs and increases the quality of life (QoL). An important aspect of QoL that changes in the course of severe diseases is the quality of sex life. This aspect is yet to be discussed in relationship to LTx. We aim to compare patients' quality of sex life at the qualification process with patients' who underwent LTx.

METHODS

The studied group consisted of 100 patients (24 women before and 16 after LTx, 39 men before and 21 after LTX) who were admitted to the lung transplantology department for qualification or to control the function after LTx. To assess the patients' quality of sex life, we used The Changes in Sexual Functioning Questionnaire (CSFQ) and World Health Organization (WHO) QoL-BREF. To assess lung function, patients underwent a 6-Minute-Walk-Test (6MWT).

RESULTS

Patients after LTx obtained higher results-compared to patients qualified for LTx-in the WHO QoL-BREF in every domain (somatic, psychological, social, and environment). Men after LTx got more points in every domain and better total score (53 ± 5.62 vs 44.23 ± 10.28 point; P < .05) in CSFQ. Women before and after LTx obtained comparable results in CSFQ. Results of 6-Minute-Walk-Test were better among patients after LTx than in qualified patients (523.62 ± 95.71 vs 333.14 ± 145.38 and 524.12 ± 56.17 vs 317.20 ± 141.6, respectively for men and women).

CONCLUSIONS

Patients after LTx show better pulmonary function and quality of sex life than qualified. Preliminary results encourage us to conduct research on a larger group.

Sexuality, Contraception, and Pregnancy in Kidney Transplantation

Sexual dysfunction is defined as any abnormality in sexual arousal, libido, intercourse, orgasm, or satisfaction. It is prevalent in patients with chronic and end-stage kidney disease, with 70% to 84% of men and 30% to 60% of women reporting some form of sexual dysfunction. Although kidney transplantation improves the overall quality of life for patients receiving dialysis, it can have unexpected effects on sexual function owing to the use of immunosuppressive medications and comorbid illnesses. It is important to recognize these adverse effects and pre-emptively discuss them with patients to help mitigate consequent psychosocial discontent. Women of reproductive age will often recover fertility after kidney transplantation and therefore need to be empowered to prevent unwanted pregnancies and plan for a safe pregnancy if desired. Complications such as preeclampsia, pregnancy-induced hypertension, gestational diabetes, ectopic pregnancy, still birth, low birth weight, and preterm birth are more common in pregnant women with a kidney transplant. Careful monitoring for infection, rejection, and immunosuppressive dose adjustment along with comanagement by a high-risk obstetrician is of utmost importance. Breast-feeding is safe with most immunosuppressive medications and should be encouraged.

Sexuality in Kidney Transplant Recipients: A Qualitative Study

End-stage kidney disease has a negative impact on patients’ quality of life. People who receive a kidney transplant experience an improvement in many areas of their daily life. Sexuality is a general component of health, which can be affected by end-stage kidney disease and kidney transplant. The aim of this study was to explore and understand the experiences and perspectives of kidney transplant recipients regarding their sexuality. A qualitative study based on Gadamer’s hermeneutic philosophy was carried out. Two focus groups and nine interviews were conducted with 18 kidney transplant recipients. Data were audio-recorded, transcribed, and analyzed with the help of qualitative analysis software. Two main themes emerged from the data: (1) “The impact of a kidney transplant on sexuality”, with the subthemes “sexuality is relegated to the background”, “physical decline acts as a sexual inhibitor”, and “changes in sexual activity following a kidney transplant”; (2) “Sexual education in kidney transplant recipients” with the subthemes “sexuality: a hidden concern amongst kidney transplant recipients” and “talking about sexuality with healthcare professionals”. Sexuality is a frequent concern among kidney transplant recipients. The physiological and emotional changes experienced after kidney transplant exert a great influence on their sexuality. Healthcare professionals rarely discuss sexuality concerns with kidney transplant recipients. Professional sexual education and assistance are necessary to improve sexual health satisfaction of kidney transplant recipients.

Transcultural Adaptation and Validation of the Spanish Version of the Sexual Satisfaction Scale for Women (SSS-W-E)

Background: Sexual satisfaction is a complex and multidimensional concept. It encompasses physical, emotional, relational and cultural dimensions, and constitutes an essential component of sexual health, as well as an indicator of quality of life and wellbeing. The Sexual Satisfaction Scale for Women (SSS-W) was designed in the United States, and it is a valid and reliable tool to measure women’s sexual satisfaction. Aim: The aim of this study was to culturally adapt and translate the SSS-W into Spanish and analyze its psychometric properties. Methods: First, the original instrument was culturally adapted and translated from English to Spanish. Then, we tested the psychometric properties of the instrument in its Spanish version in a sample of 316 women who attended a family planning clinic in Logroño, Spain. Internal consistency reliability of the whole scale and each subscale separately was measured using Cronbach’s alpha. Factorial validity of the SSS-W in its Spanish version was analyzed using exploratory factor analysis through the Kaiser–Meyer–Olkin measure of sample adequacy and Bartlett’s Sphericity test. Results: The Cronbach’s alpha coefficients of the total scale and each subscale were satisfactory (>0.7). Exploratory factor analysis confirmed the five hypothetical dimensions of the scale in its Spanish version. The five dimensions (contentment, communication, compatibility, relational concern, and personal concern) explained 60% of the total variance of the scale; factor analysis using varimax rotation revealed strong loads in each of the five components. Conclusions: The SSS-W in its Spanish version is a valid and reliable tool to assess sexual satisfaction in Spanish women of reproductive age and, therefore, can be used both in clinical practice and for the investigation of sexual health.

Sexual dysfunction and activity avoidance in female kidney transplant patients

Sexual dysfunction is common after kidney transplantation and has an adverse effect on patients' quality of life. This paper aims to evaluate the female sexual function, activity avoidance, and kidney function among a convenience sample of patients who had a kidney transplant. A cross-sectional study was conducted that included 250 patients had undergone a kidney transplant procedure >3 months ago, from multiple transplant centers and answered a self-reported sociodemographic questionnaire, the female version of the Arizona Sexual Experience Scale, and the Tampa Scale for Kinesiophobia-13. A correlation was found between sexual function and activity avoidance (r = .361, p < .001, n = 250) as well as between activity avoidance and kidney function (r = .198, p = .012, n = 250). Less education, having no child, post-transplant time for <36 months, and smoking (active and passive) were risk factors for female sexual dysfunction after kidney transplantation. The results suggest that physicians that the importance of recognize the relationship between fear of sexual activity and sexual function and that they should provide patients with more education and guidance on post-transplant sexual behaviors.

Sexual relationship, self-esteem, dysfunction, and sexual satisfaction in treatment naïve men with heroin dependence

Heroin use, a prevalent and disabling condition, affects sexual functioning and the sexual quality of life. While there is adequate literature on sexual dysfunction with heroin use, the literature is scarce on the emotional aspects of sex, like the perception of sexual relationship, self-esteem, and satisfaction amongst heroin users. The study assessed these parameters among treatment-naïve, sexually active, married, male patients with heroin dependence. We interviewed 63 treatment-naïve men seeking treatment for heroin dependence using Self-esteem and Relationship Questionnaire (SEAR), New Sexual Satisfaction Scale-Short form (NSSS-S), Sexual Quality of Life Questionnaire-Male (SQoL-M), Index of Premature Ejaculation (IPE), and International Index of Erectile Function (IIEF). Overall scores in SEAR, NSSS-S, SQoL-M, IIEF, and IPE were low, suggesting poor self-esteem and relationship, poor sexual quality of life and sexual satisfaction, higher premature ejaculation, and erectile dysfunction. Injecting drug use was associated with lower scores on confidence domain of SEAR, partner activity focused domain of NSSS-S, intercourse-satisfaction, and overall sexual quality of life. Sexual dysfunctions, poor sexual relationship, and sexual quality of life are common among men seeking treatment for heroin dependence. Treatment strategies must not lose focus on this dimension of health during the treatment process.

Current Status for Semirigid Penile Prosthetic Devices

PURPOSE OF REVIEW

The goal of this paper was to evaluate the current use of semirigid penile prosthesis (SRPP), surgical techniques for insertion of SRPP, and how to prevent and approach surgical complications.

RECENT FINDINGS

SRPP is a valid option for those who are refractory to medical therapy for erectile dysfunction (ED) and even more appropriate for specific subsets of patient populations. It is important for urologists to know which patient population SRPP is preferred for. Several studies have shown good patient outcomes and patient satisfaction with those who underwent SRPP.

Erectile function after kidney transplantation: a meta-analysis

Background

Erectile dysfunction (ED) is common in patients with end-stage renal disease (ESRD). Whether kidney transplantation can improve erectile function in patients with ESRD is still controversial. We conducted a meta-analysis on the relationship between kidney transplantation and erectile function.

Methods

A literature search was conducted on PubMed, Embase, Cochrane Library, and Web of Science until May 31, 2019. Primary outcomes were ED prevalence and each domain score of the International Index of Erectile Function (IIEF) questionnaire. We used age-matched dialysis patients or patients before kidney transplantation as a control group and compared them to kidney transplant recipients.

Results

A total of 9 articles were finally enrolled in the study. Compared with the control group, the kidney transplantation group had a lower prevalence of ED (OR 0.49, 95% CI: 0.28–0.86) and higher domain scores for erectile function (SMD 0.53, 95% CI: 0.12–0.94) and sexual desire (SMD 1.19, 95% CI: 0.11–2.27). While there were no significant variations in domain scores for orgasmic function (SMD 0.27, 95% CI: −0.10–0.63), intercourse satisfaction (SMD 0.26, 95% CI: −0.10–0.61), and overall satisfaction (SMD 0.17, 95% CI: −0.21–0.56). Patients in the kidney transplantation group had higher serum testosterone (SMD 1.20, 95% CI: 0.86–1.54) and lower prolactin (SMD −1.46, 95% CI: −2.22 to −0.69) and luteinizing hormone (SMD −0.97, 95% CI: −1.39 to −0.55).

Conclusions

Kidney transplantation may be associated with improved erectile function in patients with ESRD. This may be attributable to the correction of endocrine hormone disorders in patients after kidney transplantation.

Effect of Foot Reflexology on Pain, Fatigue, and Quality of Sleep after Kidney Transplantation Surgery: A Parallel Randomized Controlled Trial

Materials and Methods

The study was a parallel randomized controlled trial. Patients admitted to the transplantation ward participated in the study. Fifty-three eligible patients were allocated into the foot reflexology group (n = 26) and the control group (n = 27) by using the stratified randomization method. Finally, 25 participants in each group finished the study. The intervention group received foot reflexology for 30 minutes once a day for three consecutive days, and no reflexology was applied in the control group. The intervention started on the second day after surgery. Pain, fatigue, and quality of sleep were measured on the first, second (before intervention), third, fourth, and eleventh days after surgery. Data were collected using visual analogue scale for measuring pain and fatigue and Verran and Snyder-Halpern sleep scale for measuring quality of sleep.

Results

In each group, 25 patients finished the study. The mean pain score in the foot reflexology and control groups decreased from 9.44 ± 0.96 and 9.36 ± 0.91 on the day of surgery to 1.32 ± 0.94 and 4.32 ± 1.68 on the eleventh day after surgery, respectively. The mean fatigue score in the reflexology and control groups decreased from 8.76 ± 1.27 and 8.6 ± 1.26 on the day of surgery to 1.24 ± 1.2 and 3.92 ± 1.63 on the eleventh day after surgery, respectively. The mean sleep score in the foot reflexology and control groups increased from 33.38 ± 11.22 and 39.59 ± 12.8 on the day of surgery to 69.43 ± 12.8 and 56.27 ± 8.03 on the eleventh day after surgery, respectively. While pain, fatigue, and sleep quality scores improved in both groups, those in the intervention group showed significantly greater improvement compared with the control group (P < 0.001). No significant difference was found between the two groups in the use of acetaminophen on the first, second, third, fourth, and eleventh days after surgery (P > 0.05).

Conclusion

Foot reflexology may reduce pain and fatigue and improve sleep quality of patients after kidney transplantation.