Sexual Dysfunction in Women With End-Stage Renal Disease: A Systematic Review and Meta-Analysis

Abstract

Background: In women with end-stage renal disease (ESRD), female sexual dysfunction (SD) remains underestimated.

Aim: To explore the prevalence, correlates, diagnostic approach and treatment modalities of sexual symptoms in females with ESRD.

Methods: We performed a systematic review and meta-analysis to estimate both the prevalence of SD and the pooled Female Sexual Function Index (FSFI) scores in ESRD females. Similarly, for studies reporting the FSFI score before and after renal transplantation (RT), we estimated the effect of RT on sexual function. Further assessment of heterogeneity was conducted via subgroup and sensitivity analyses, cumulative meta-analysis and univariate meta-regression of important correlates. Records were identified through searching PubMed, Cochrane Library and Scopus databases as well as sources of grey literature until November 2020 (PROSPERO ID: CRD42020215178).

Outcomes: We included 47 studies with 61 patient group entries and 3490 ESRD female individuals (median age: 45.2 years, ΙQR: 40.4-50.6).

Results: The SD prevalence in all females with ESRD was 74% (95%CI: 67%-80%, I² = 92%) and the FSFI total score 16.1 points (95%CI: 14.3-17.8, I² = 98%). The female SD prevalence was 63% (95%CI: 43%-81%, I² = 92%) in renal transplant recipients, 80% (95%CI: 72%-87%, I² = 91%) in hemodialysis patients and 67% (95%CI: 46%-84%, I² = 90%) in peritoneal dialysis patients. The total FSFI score improved by 7.5 points (95%CI: 3.9-11.1, I² = 92%) after RT. Older age and menopause were associated with higher SD prevalence.

Clinical translation: Female SD is highly prevalent in all ESRD women, but renal transplant recipients reported improved sexual function.

Strengths & limitations: We provide the first study about SD in females and assessed the role of RT on sexual function. Contrary, none of the included studies evaluated the concomitant presence of distress with SD. The levels of heterogeneity were substantially high for all outcomes and we could not adjust for further correlates, which might have affected our measures.

Conclusions: Sexual symptoms negatively affect the quality of life and warrants appropriate clinical attention, as they are an underdetermined and undertreated clinical entity in females with ESRD. Studies on treatment modalities of female SD in patients with ESRD are mandatory, as currently no relevant studies or clinical recommendations exist. Pyrgidis N, Mykoniatis I, Tishukov M, et al. Sexual Dysfunction in Women With End-Stage Renal Disease: A Systematic Review and Meta-Analysis. Sex Med Rev 2021;18:936-945.

Keywords: End-stage renal disease; Female sexual dysfunction; Hemodialysis; Meta-analysis; Peritoneal dialysis; Renal transplantation.