Patient Resources 9 min read·Updated 22 July 2026 Clinician-reviewed

Sex, Intimacy and CKD

A UK Consultant Nephrologist on a topic patients rarely raise in clinic but often want to discuss — sexual function, intimacy and fertility with chronic kidney disease.

  • Clinically Reviewed
  • NHS & NICE Aligned
  • UK Evidence-Based
  • Last Reviewed 22 July 2026

Professor Mohammed Mahdi Althaf

Consultant Nephrologist & Acute Physician

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Professor Mohammed Mahdi Althaf

MD, MSc, PgDip (Clin Ed), FRCP, FHEA, FASN

Consultant Nephrologist & Acute Physician · GMC 7216325

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Direct answer

Sexual difficulties affect most adults with advanced CKD but are very treatable. Talk to your renal team — there are safe medications, hormone treatments, counselling and practical adjustments. You are not alone, and you do not have to live with it.

Key recommendation: ED affects ~70% of men with advanced CKD.

Quick answer

✓ Best choices

  • Home-cooked meals built around vegetables and whole grains
  • Lower-potassium fruit between meals
  • Hydration spread across the day (within your fluid allowance)
  • Movement most days — even a 20-minute walk

✓ Foods to limit

  • Ultra-processed snacks and ready meals
  • Sugary and energy drinks
  • Salt at the table

Key takeaway

Sexual difficulties affect most adults with advanced CKD but are very treatable. Talk to your renal team — there are safe medications, hormone treatments, counselling and practical adjustments. You are not alone, and you do not have to live with it.

Who should be cautious

People on dialysis, post-transplant, pregnant or breastfeeding, or taking prescription medication — confirm with your renal team before changes.

Sex, Intimacy and CKD

Why CKD affects sexual function

Multiple factors combine:

  • Hormonal: low testosterone, raised prolactin, disturbed oestrogen cycles.
  • Vascular: endothelial dysfunction reduces blood flow to genitals.
  • Neurological: autonomic neuropathy from diabetes/uraemia.
  • Medication side-effects: beta blockers, diuretics, some antidepressants.
  • Psychological: depression, body image (catheters, fistulas, PD line).

Treatments for men

  • PDE5 inhibitors (sildenafil, tadalafil): first line. Reduced doses in advanced CKD.
  • Testosterone replacement if confirmed deficient (check trough morning level twice).
  • Vacuum devices, intracavernosal injections, penile implants — second/third line.
  • Treat depression and anaemia simultaneously — often improves libido alone.

Kidney Vitality is a daily multivitamin developed by a UK Consultant Nephrologist using renal nutrition principles. It contains no added potassium, magnesium, phosphorus or iron, and no herbal blends. See the formulation.

Treatments for women

  • Vaginal moisturisers and lubricants for dryness — water-based for daily use, silicone-based for intercourse.
  • Low-dose vaginal oestrogen is safe even after transplant (discuss with team).
  • Pelvic floor physiotherapy for arousal and orgasm difficulty.
  • Psychosexual counselling — often available through your renal unit or via Relate.

Contraception and fertility

  • Avoid combined oral contraceptive pill if uncontrolled BP or proteinuria — use progestogen-only or copper coil.
  • ACE inhibitors and ARBs are teratogenic — switch to labetalol/nifedipine before pregnancy.
  • Mycophenolate (MMF) must be stopped 6 weeks before conception (both men and women).
  • Tacrolimus, ciclosporin, azathioprine and prednisolone are pregnancy-compatible.
  • Fertility usually returns within 3–6 months after kidney transplant.

Talking to your team

Most renal units in the UK now ask about sexual function as part of annual review. If yours doesn't, ask to be referred to a renal counsellor, urologist, gynaecologist or psychosexual therapist. Many issues are easily addressed — they are not 'just part of having kidney disease'.

CKD and Mental Health
Related reading: CKD and Mental Health.

Key practical tips

Designed for quick scanning — what to order, what to avoid, sensible portions, common mistakes.

  • Batch-cook two kidney-friendly meals on a quiet evening
  • Keep a shortlist of go-to snacks for tired days
  • Tell your renal team about any new symptom early

Clinical guidance

TL;DR summary

Sexual difficulties affect most adults with advanced CKD but are very treatable. Talk to your renal team — there are safe medications, hormone treatments, counselling and practical adjustments. You are not alone, and you do not have to live with it.

Key takeaways
  • ED affects ~70% of men with advanced CKD.
  • PDE5 inhibitors (sildenafil) are safe with dose adjustment.
  • Vaginal dryness and low libido are common in women.
  • Pregnancy is possible at all CKD stages with planning.
  • Anaemia and depression treatment often improve libido.
Kidney Diet & Nutrition Considerations

Lifestyle and nutrition reinforce each other in kidney disease. Even small changes — cooking more meals at home, swapping ultra-processed snacks for whole-food alternatives, walking after meals — add up. The underlying pattern is the same Mediterranean-style, reduced-salt plate recommended across UK renal guidance.

Foods to prioritise

  • Home-cooked meals built around vegetables and whole grains
  • Lower-potassium fruit between meals
  • Hydration spread across the day (within your fluid allowance)
  • Movement most days — even a 20-minute walk

Foods to limit

  • Ultra-processed snacks and ready meals
  • Sugary and energy drinks
  • Salt at the table

Potassium, phosphate and protein needs vary between individuals — please confirm personal targets with your renal team or dietitian. Browse the Kidney Diet Hub for more guides in this cluster.

Frequently asked questions

Why does CKD affect my sex life?

CKD lowers testosterone and oestrogen, raises prolactin, contributes to anaemia and fatigue, and causes autonomic neuropathy. Together these reduce libido, cause erectile dysfunction (ED) in around 70% of men with advanced CKD, and cause vaginal dryness and reduced arousal in many women.

Can I take Viagra (sildenafil) with kidney disease?

Yes — sildenafil, tadalafil and vardenafil are generally safe in CKD, but the starting dose is reduced in eGFR < 30 ml/min and in dialysis patients. Always tell your GP about all kidney medications first. Nitrates (e.g. GTN spray) are an absolute contraindication.

Is it safe to have sex on dialysis?

Yes — sex is safe on both haemodialysis and peritoneal dialysis. For PD patients, drain the abdomen first for comfort. For HD patients, avoid pressure on the fistula arm. Many patients find sex more comfortable on a non-dialysis day.

Can I have children with CKD?

Many people with CKD have successful pregnancies, especially in stages 1–2. Stages 3–5 carry higher risk and require pre-conception planning with a renal-obstetric team. Several CKD medications (ACE inhibitors, ARBs, MMF) must be stopped before conception.

What lifestyle changes help kidney disease?

The most evidence-based lifestyle changes for kidney disease are stopping smoking, keeping blood pressure and blood sugar in target, staying physically active most days, maintaining a healthy weight, drinking sensibly within UK low-risk limits, and eating a Mediterranean-style, reduced-salt diet.

Nutritional challenges in kidney disease

Many people living with kidney disease have to limit foods because of potassium, phosphate, diabetes, dialysis, appetite changes or simply the time it takes to cook from scratch every day. That can make it harder to keep daily nutrition balanced — particularly for vitamins and minerals that food alone may not fully cover.

Kidney Vitality is a UK-formulated daily nutritional support product designed by Consultant Nephrologist Professor Mohammed Mahdi Althaf with renal nutrition in mind from the start. It keeps doses moderate, leaves out added potassium, phosphate and magnesium, and avoids megadose vitamin A — sitting alongside a kidney-friendly diet, not replacing it.

Why Kidney Vitality fits this need

Built around UK renal guidance

Aligned with NICE NG203, UK Kidney Association sexual health guidance and Renal Association pregnancy guidelines.

Designed by a UK Consultant Nephrologist

Formulated and reviewed by Professor Mohammed Mahdi Althaf (GMC 7216325).

Evidence-based by design

Plain, non-judgemental language with practical UK NHS pathways.

Designed by a UK Consultant Nephrologist

Ready to support your kidney health?

If you have been researching kidney health, supplements, CKD nutrition or kidney-friendly living, Kidney Vitality was developed specifically around those principles by Professor Mohammed Mahdi Althaf (GMC 7216325). Nephrologist Developed Daily Multivitamin.

  • No Added Potassium
  • No Added Magnesium
  • No Added Phosphorus
  • No Added Iron
  • One capsule daily
  • UK GMP — BRCGS, NSF GMP, Halal
Subscribe & Save — £20.39/monthCheck your current multivitamin

✓ Free UK tracked delivery  ·  ✓ Delivered every 30 days  ·  ✓ Pause or cancel anytime  ·  ✓ Never run out

ComparisonKidney VitalityTypical high-street multivitamin
Added potassiumNoneOften included
Added phosphateNoneOften included (E338–E452)
Vitamin A (retinol)No megadoseOften high-dose retinol
Kidney-focused formulationYesNo — general population
Consultant Nephrologist involvementYes (GMC 7216325)No
UK GMP manufacturedYes (BRCGS, NSF GMP)Varies

Food supplement. Not a medicine and not a treatment for kidney disease. Speak with your GP, pharmacist or renal team before starting any new supplement, especially in advanced CKD, on dialysis, post-transplant, pregnant or breastfeeding.

Clinical reviewer

Professor Mohammed Mahdi Althaf

Consultant Nephrologist

Acute Physician

GMC 7216325

View Full Biography

Professor Mohammed Mahdi Althaf is a UK Consultant Nephrologist and Acute Physician with a special interest in chronic kidney disease, AKI prevention and renal nutrition. He combines hospital practice with patient education and clinical guidance review.

View professional profile →
View Credentials
  • MD
  • MSc
  • PgDip (Clin Ed)
  • FRCP
  • FHEA
  • FASN

About this article

Written for UK patients and based on:

  • NICE guidance
  • NHS resources
  • British Dietetic Association guidance
  • Kidney Care UK resources
View methodology

Each article is researched against current UK clinical guidance (NICE NG203, NG118, NG136), NHS patient resources, KDIGO and KDOQI international guidelines, and the British Dietetic Association Renal Nutrition Group. Drafts are written by the Kidney Vitality editorial team and reviewed by a UK Consultant Nephrologist before publication. Content is reviewed on a rolling basis and updated when guidance changes.

Editorial standards

  • Clinically reviewed
  • NHS-aligned
  • NICE-aligned
  • Evidence-based
  • Reviewed before publication
View full editorial process

Every article is researched and written by the Kidney Vitality editorial team using current UK clinical guidance (NICE NG203, NG118, NG136), NHS patient resources, KDIGO/KDOQI international guidelines, and British Dietetic Association renal nutrition guidance. Drafts are reviewed for clinical accuracy by Professor Mohammed Mahdi Althaf, MD, MSc, PgDip (Clin Ed), FRCP, FHEA, FASN (Consultant Nephrologist & Acute Physician, GMC 7216325) before publication. Content is updated when UK guidance changes.

References (4)View Sources
  1. NICE NG203: Chronic kidney disease — assessment and management
  2. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD
  3. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update
  4. British Dietetic Association — Renal Nutrition Group

Medical disclaimer

This content is educational only and does not replace personalised medical advice.

Read full disclaimer

This page is general information, not personal medical advice. If you have chronic kidney disease, are on dialysis, have had a kidney transplant, are pregnant or breastfeeding, or take prescription medication, please confirm any supplement with your GP, pharmacist or renal team before starting.

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