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All about sex...despite dialysis.

For patients on maintenance hemodialysis, "sex, too, is a wash-out"(1). Although information on the sexual functioning of renal patients is minimal, current studies paint a rather gloomy picture. For the majority of dialysis patients, sexual functioning worsens with the progression of uremia and improves only slightly with maintenance hemodialysis(2,3,4). In addition, sterility, amenorrhea, and impotence are not infrequent(5). Before hemodialysis, patients with chronic renal disease seldom lived long enough to be concerned with the emotional and social consequences of their illness. Today, for many of the 25,000 patients in the U.S. on dialysis, life has been extended, living can be relatively normal, and questions of sexual function are of increasing concern. We recognized this when our adult patients on home dialysis at the Artificial Kidney Center of Eugene Talmadge Memorial Hospital began asking us about sterility, diminishing potency, and a lack of interest in sex. The staff was unaccustomed to discussing sexual adjustment, and before assisting patients, we had to become better informed and learn the techniques of counseling. We designed a series of mini-seminars-informal lectures and group discussions-entitled "Sexual Adjustment and the Nephrology Patient." Lesson plans were organized as guidelines, such books as The Joy of Sex and The Pleasure Bond were made available to patients and staff, and charts and diagrams were collected to illustrate human sexual response. The mini-seminars were held twice weekly during the regularly scheduled nephrology outpatient clinic. All adult home dialysis patients, both married and single, and their partners were invited to participate. We offered individual sessions for those who could not attend or who did not