Assessment of Sexual Dysfunction and Sexually Related Personal Distress in Patients Who Have Undergone Orthotopic Liver Transplantation for End-Stage Liver Disease

Abstract

Introduction Sexual dysfunction (SD) status post-orthotopic liver transplant (OLT) for end-stage liver disease (ESLD) has long been recognized. To date, there are no studies examining how sexually related personal distress (SRPD) impacts sexual function in this population. Aims To assess SD and SRPD in men and women who have undergone OLT for ESLD and to compare them with previously published reports on subjects without SD. Methods 283 subjects (182 men and 101 women) who underwent OLT since 2005 were mailed a survey. Men received the International Index of Erectile Function (IIEF) and Female Sexual Distress Scale—Revised (FSDS-R). Women received the Female Sexual Function Index (FSFI) and the FSDS-R. All surveys asked about the presence of a current sexual partner. Main Outcome Measures Total and subscale scores on the IIEF, the FSFI, and the FSDS-R. Results Ninety-six patients (33.9%) completed and returned the surveys consisting of 34 women (33.7%) and 62 men (34.0%). Also, 83.9% of men and 88.2% of women reported having an available sexual partner. Two-thirds of men and three-quarters of women were sexually active. In all domains, IIEF demonstrates that men have mild to moderate SD. FSFI demonstrates that women also have SD. Both genders reported relatively mild SRPD based on FSDS-R. Compared to previously published controls, all domain values were lower in both genders. Conclusion The IIEF, FSFI, and SDS-R results demonstrate that men and women who undergo OLT do exhibit mild to moderate SD. Their distress, though, is also mild to moderate, as evidenced by a high rate of continued sexual activity after OLT. Therefore, although SD may be widely prevalent in people who undergo OLT, aggressive intervention may not be warranted so long as the level of sexual distress remains low.

Erectile dysfunction in cirrhosis is impacted by liver dysfunction, portal hypertension, diabetes and arterial hypertension

“…Regarding measurement of overall testosterone in cirrhosis, TT seems to be the more effective marker because it measures testosterone levels independently of alterations in protein production (SHBG‐bound, albumin‐bound and free). Studies evaluating sexual dysfunction before and after orthotopic liver transplantation (OLT) found controversial results and the prevalence seems to be similar to prior OLT . Arterial hypertension and diabetes have been previously associated with ED and also studies in other chronic disease such as chronic obstructive pulmonary disease found high prevalence rates .…”

“…Studies evaluating sexual dysfunction before and after orthotopic liver transplantation (OLT) found controversial results [35][36][37][38] and the prevalence seems to be similar to prior OLT. 39 Arterial hypertension and diabetes have been previously associated with ED 10,40,41 and also studies in other chronic disease such as chronic obstructive 44 were associated with ED in chronic hepatitis C patients and we could show in our cohort that low libido, most likely owing to the burden of the disease, is significantly decreased in patients with ED.…”

Symptom Distress in Patients With End-Stage Liver Disease Toward the End of Life

“…Inhibited sexual desire and decreased sexual activity have received little attention in this population. Previous studies focused on patients with stable liver disease (Simsek, Aslan, Akarsu, Koseoglu, & Esen, 2005) or patients pre and post liver transplant (Burra et al, 2010; Park & Villanueva, 2011; Sorrell & Brown, 2006), not on patients toward the end of life. According to Sorrell and Brown (2006) the effects of ESLD on sexual function is complex (p. 1473).…”

Influence of Age and Gender Before and After Liver Transplantation

“…82 Although female transplant recipients do exhibit mild to moderate sexual dysfunction, they continue sexual activity at a high rate. 68,131 Pregnancy outcomes are favorable after LT, although there is an increased risk of obstetric complications for both mothers and infants. 83,132 Female LT recipients have higher rates of cesarean delivery and preterm labor than general obstetrical patients; nevertheless, no differences have been reported in the premature rupture of membranes or placenta previa or in the overall rate of fetal death.…”