Sexual Functioning Following Renal Transplantation

********** End-stage renal disease (ESRD) occurs when kidney function is insufficient to maintain chemical and fluid balances and cleanse the body of toxins. ESRD requires replacement therapy, or death will occur. Hemodialyis, peritoneal dialysis, and kidney transplantation are the options for renal replacement therapy. Although each intervention has advantages, studies report longer survival and better outcomes related to quality of life for individuals who have undergone transplantation. Kidney transplantation was received by 13,546 individuals during 2000 (Organ Procurement Transplant Network [OPTN], 2001). On December 14, 2001, 50,651 people were on the United Network for Organ Sharing waiting list for a kidney transplant at one of the 245 kidney transplant programs in the United States (OPTN). Section 2991 of the 1972 Social Security Amendments (P. L. 92-603) established guidelines for Medicare coverage for dialysis and transplantation. One Medicare requirement is that psychosocial services be provided by a master's-level social worker (Thomas, 1994). The Council of Nephrology Social Workers (CNSW) is one of the professional organizations of the National Kidney Foundation. The first of two components of its mission is "to assist patients and families in dealing with the psychosocial stresses and lifestyle readjustments and facilitate a treatment program that will maximize rehabilitation potential" (National Kidney Foundation, Council of Nephrology Social Workers, n.d.). This is consistent with two of the goals of social work adopted by the Council on Social Work Education in 1992. The first goal addresses the restoration and enhancement of social functioning for individuals, families, and other social systems. The second goal calls for the development of "social policies, services, resources, and programs needed to meet basic human needs and support the development of human capacities." (Norlin & Chess, 1997, p. 5). Examples of services provided to this population by social workers include psychosocial assessment and intervention, discharge planning and rehabilitation counseling. Social workers support individuals throughout the transplant process in maximizing their quality of life. Sexual functioning is one component of quality of life to be addressed by the transplant team and social worker. As presented in Maslow's hierarchy of needs, sex can be viewed as a basic survival need and a need related to belongingness and love. Diemont and colleagues (2000) distinguished between sexual problems and sexual dysfunction. They defined sexual dysfunction as "a disturbance in the sexual response cycle" regardless of whether the disturbance is experienced as problematic by the individual(similar to the definition in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987), but in contrast to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) (p. 845). However, a sexual problem is based on the subjective experience and evaluation of sexual functioning by the individual (Diemont et al.). Thus, the perception of the individual determines whether a problem exists in a particular dimension of sexual functioning. This subjective perception of sexual problem guides the present analysis and discussion. The purpose of this study was to describe the prevalence of sexual problems in a sample of individuals following successful renal transplantation and explore variables associated with sexual problems in this sample. LITERATURE REVIEW Studies on Sexual Function Despite the focus on improvement in quality of life following kidney transplantation, literature regarding sexual function for this population is limited. A literature review was conducted using Medline (1966 to present). Key words used for the review included renal transplant and kidney transplant combined with sexual function, sexual dysfunction, sexual problems, and quality of life. …