Sexuality and intimacy are broad subjects that can have very different meanings for different people. Some general themes include:

• Intimacy and connections; this can include spiritual, mental and physical connection with others
• Sexual desire and libido
• Self-perceptions of "sexiness"
• Self-image, appearance, confidence

While living with kidney disease, or being with a partner who has kidney disease, you may experience changes related to sexuality and intimacy, and this is normal. Some physical examples, especially in the later stages of kidney disease, include:

• Hormone imbalances in men, which reduce libido (desire for sex) and cause difficulty with erections
• Hormone changes in women, which may reduce libido (desire for sex) or may cause painful intercourse; it's also possible to experience changes in ovulation or menstruation
• Blood vessel damage, which may cause men to have difficulty in getting an erection
• Side effects from medication, which can cause loss of libido, erectile dysfunction and delayed ejaculation

Not everyone will experience these changes, or to the same extent. If some aspect of kidney disease or treatment is impairing your ability to be intimate with a partner, you can consult your doctor or other members of your care team (ie., registered nurses or social workers) about ways to stay sexually active and/or intimate.

Many psychological factors, such as anger, worry, fear, guilt or anxiety, can also affect intimacy and sexuality between partners. For example, some people are self-conscious about scars or fistulas, which may affect how "confident," "sexy" or "desirable" they feel. In addition, partners of someone with kidney disease may be worried about physically hurting their loved one when engaging in sex or intimate interactions. Some tips for talking to your partner about these concerns are in the next tab.