Sexuality and Reproductive Health Counseling in Adolescent Renal Transplant Recipients

Abstract

Normal adolescence marks a period of significant physical, cognitive and psychosocial change. It is characterized by transition from concrete to abstract thought processes and concern for risk taking behaviors. Adolescents and young adults with chronic conditions are at a particular disadvantage and tend to be more vulnerable to risky behavior than their healthy peers. While there currently exists no information on the burden of sexually transmitted infections (STIs) in adolescent renal transplant recipients, they present a particularly worrisome population as they are likely to engage in risk taking behavior when they feel “normal” following transplantation to compensate for poor quality of life endured on dialysis. This is further compounded by adolescents’ false perception that they are unlikely to acquire such infections, and the likely improvement in libido and sexual functioning after transplantation. The potential for acquiring a sexually transmitted infection is concerning given their immunocompromised status, and complex treatment regimens which might have unfavorable interactions with STI treatments. Also, unintentional pregnancy is likely to have a significant impact on their overall medical condition and social functioning thereby impacting their long term allograft outcomes. As the pediatric nephrologist assumes a primary care provider role for these patients following their renal transplant, it becomes increasingly important to be familiar with basic reproductive health counseling techniques and available contraceptive methods on the market. Until consensus guidelines and specific recommendations for reproductive health counseling are developed for adolescent renal transplant recipients, this review provides a brief summary of available knowledge in those areas.

Sexual and reproductive health screening and counseling in adolescent and young adult transplant recipients

“…Only a few reports can be found in the literature about STI in SOT recipients, and they are limited by the low number patients 38,39 . A small cross‐sectional review of 49 adolescent renal transplant recipients found a 30% STI prevalence in targeted screening of symptomatic patients compared to 15% prevalence in the general adolescent clinic population offering universal screening 40 . In the review of a large database of SOT recipients, the highest frequency of STI was seen among patients transplanted during adolescence, 41 suggesting that screening and counseling efforts should be focused on AYA.…”

Pregnancy after transplant in the older adolescent: Anticipatory guidance for the pediatric provider

“…[5][6][7][8] This is also recommended in transition to adult care models, so AYA can feel comfortable with their caregivers discussing sexual health. 3,14 It is crucial that AYA realize that pregnancy is possible very soon after transplant and that they must take precautions if they are sexually active and not desiring a pregnancy. Depending on the age of onset and type of organ failure, many young transplant candidates may have amenorrhea or irregular periods as transplant candidates and are surprised and unprepared for the onset of menses and fertility immediately after transplant.…”

“…During normal adolescence, children are exploring their sexuality and may engage in risky behaviors. Adolescent and young adult (AYA) transplant recipients are especially important to manage as they have an increased risk of non‐adherence to their complex medical regimen 1 in addition to exploring other risky or unsafe behaviors 2–4 . It is critical to inform AYA that there is the potential for pregnancy if they are sexually active and that effective contraception can prevent pregnancy 5 …”

“…5 As data regarding these topics are scant for AYA SOT recipients, most information is extrapolated from adult care. 3,[5][6][7][8][9][10][11][12][13][14][15] Adult and AYA SOT recipients report that they want additional information…”

“…Adolescent and young adult (AYA) transplant recipients are especially important to manage as they have an increased risk of non-adherence to their complex medical regimen 1 in addition to exploring other risky or unsafe behaviors. [2][3][4] It is critical to inform AYA that there is the potential for pregnancy if they are sexually active and that effective contraception can prevent pregnancy. 5 Contraception is a vital part of transplant education for persons of childbearing potential.…”