| Background:Male sexual dysfunction is one of the common complications of end-stage renal disease,which not only affects the normal sexual life of male patients,but also may lead to anxiety,depression and loss of self-esteem,and seriously affects the physical and mental health of patients.Kidney transplantation is considered the best treatment option for patients with end-stage renal disease and is increasingly used worldwide.With the development of society and the improvement of people’s living standards,the sexual dysfunction of male patients undergoing kidney transplantations surgery has attracted more and more attention from people.In previous studies,male sexual dysfunction has also negatively affected the sexual function of their female partners.For male patients with sexual dysfunction,their partners should also be evaluated simultaneously while evaluating and treating their disease.However,there are no domestic and foreign reports on the sexual function investigation of female partners of men with kidney transplantations.Purpose:This study aims to examine the effects of kidney transplantations on male sexual function and analyze the sexual function status of male patients undergoing kidney transplantations and their female spouses.We used nighttime erectile function monitoring,penile Doppler ultrasound,international erectile function questionnaire,premature ejaculation function score,penile sensitivity measurement,and female sexual function index questionnaire as the means of sexual function assessment.Meanwhile,we simultaneously included healthy couples with no history of chronic kidney disease as a control group,to comprehensively analyze and explor the status of the sexual function of male patients and their partners before and after kidney transplantations to provide a new theoretical basis for the diagnosis and treatment of sexual dysfunction in kidney transplant men and their spouses.Methods:This study was approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University.A total of 125 male patients who underwent kidney transplantations,and their female partners were included,and questionnaires were used as the primary method to evaluate the patients and their female partners.Demographic data include sexual history,past medical history,place of residence,monthly income,educational status,occupational status,marital status and age,etc.At the same time,we included 100 healthy couples with no history of chronic kidney disease as a control group,and also used a questionnaire to investigate their above conditions.For the evaluation of sexual function,we used the International Index of Erectile Function-15(Chinese version)to evaluate the patients’ overall satisfaction with sexual life,sexual desire,orgasm function,sexual satisfaction and erectile function.Nocturnal penile tumescence and rigidity were performed to screen for an organic etiology of erectile dysfunction.In addition,we used the premature ejaculation diagnostic tool to evaluate the male ejaculation control ability.We judged whether the patient had premature ejaculation and the psychological impact of premature ejaculation on the patient through the scores of the five parts of the premature ejaculation diagnostic tool questionnaire.At the same time,we used the Chinese version of the Female Sexual Function Index,an essential tool for evaluating female sexual dysfunction,to evaluate female sexual function in six dimensions,including female sexual desire,vaginal lubrication function,sexual arousal function,orgasm function,sexual satisfaction and pain during intercourse.Results:The results of the first part of the study showed that after kidney transplantations,34.4%(43/125)of the male patients indicated that their sexual life frequency increased,26.4%(33/125)of the patients reported that their sexual life frequency decreased,and 39.2%(49/125)of the male patients indicated no change in their sexual life frequency.Regarding sexual life satisfaction,42.4%(53/125)of men felt that their sex life was more satisfactory than before the operation,while 38.4%(48/125)of men felt that their sex life was worse than before operation.Male patients who underwent kidney transplantations had significantly lower IIEF-15 total scores than controls and lower erectile function scores than those before kidney transplantations.The results of NPTR showed that compared with the control group,the organic erectile function of patients after kidney transplantations was not as good as that of normal men.Fourteen patients had organic erectile dysfunction,while further penile Doppler ultrasonography revealed penile arterial insufficiency in 1 patient,veno-occlusive dysfunction in 1 patient,and nonvascular ED in 12 patients.The results of the second part of the study showed that the PEDT total score of male patients who underwent kidney transplantations was significantly higher than that of the control group(11.47±3.44 vs 8.57±2.60,P<0.001).The PEDT scores of male patients after kidney transplantations were significantly higher than before the operation(11.47±3.44 vs 9.00±1.34,P<0.001).The sensitivity of the four points of the glans of patients after kidney transplantations is higher than that of normal men.Compared with before kidney transplantations,the glans stimulation threshold of patients after kidney transplantations decreased significantly.The results of the third part of the study showed that the questionnaire results of the evaluation of the sexual function of female partners in the two groups showed that the incidence of sexual dysfunction in female partners of male patients in the kidney transplantation group was significantly higher than that of normal females in the control group(78.4%vs.52.0%,P<0.001).In addition,female partners of male patients in the kidney transplantation group had significantly lower female sexual function index questionnaire scores than normal women in the control group(22.80±5.46 vs 26.15±4.64,P<0.001).The scores of 6 parts,including female libido,vaginal moisturizing ability,sexual arousal function,orgasmic function,sexual satisfaction,and sexual pain,were lower than those of normal women in the control group.The results of the study also showed that the total score of the female sexual function index questionnaire was positively correlated with the score of the International Questionnaire of Erectile Function of the male partner(r=0.231,P=0.010),and the score of the premature ejaculation assessment tool questionnaire was negatively correlated.(r=-0.246,P=0.006).Conclusion:The erectile function scale score and organic erectile function of male patients after kidney transplantations decreased compared with those before the operation and were worse than those of normal men,and the erectile dysfunction of postoperative patients was mainly due to insufficient blood supply of penile arteries The ejaculation control ability of male patients after kidney transplantations is reduced compared with that before the operation,and the ejaculation control ability is worse than that of normal men.The sexual function of female partners of male patients after kidney transplantations is worse than that of normal women;in addition,the worse the sexual function of the male partner,the lower the sexual satisfaction and sexual performance of the female.While assessing and treating male sexual dysfunction patients after kidney transplantations,more attention should be paid to their female partners.Both husband and wife should receive assessment and treatment as a whole,so as to better improve the quality of sexual life of both husband and wife. |
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