Agarwal Krishna A, Pavlakis Martha
Beth Israel Deaconess Medical Center, Boston, MA.
Kidney Med. 2021 Jul 29;3(5):837-847. doi: 10.1016/j.xkme.2021.05.009. eCollection 2021 Sep-Oct.
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.
性功能障碍被定义为性唤起、性欲、性交、性高潮或性满足方面的任何异常。它在慢性和终末期肾病患者中很普遍，70%至84%的男性和30%至60%的女性报告有某种形式的性功能障碍。尽管肾移植改善了接受透析患者的整体生活质量，但由于使用免疫抑制药物和合并症，它可能对性功能产生意想不到的影响。认识到这些不良反应并与患者预先讨论以帮助减轻随之而来的心理社会不满情绪很重要。育龄期女性肾移植后通常会恢复生育能力，因此需要赋予她们权力以防止意外怀孕，并在有意愿时为安全怀孕做好计划。先兆子痫、妊娠高血压、妊娠期糖尿病、异位妊娠、死产、低出生体重和早产等并发症在肾移植孕妇中更为常见。密切监测感染、排斥反应和免疫抑制剂量调整，并由高危产科医生共同管理至关重要。大多数免疫抑制药物在母乳喂养时是安全的，应予以鼓励。
