La sexualidad luego del trasplante renalUn estudio cualitativo con perspectiva de género entre profesionales de salud y personas con trasplante

Abstract

Introduction: In 2021, 92,532 kidney transplants were performed worldwide, but less than 10% of the global need was met. Kidney transplantation is often the best treatment for acute or chronic kidney failure. These conditions are mainly caused by diabetes, high blood pressure and obesity, which are based on risk factors such as increased weight, glucose, blood pressure, salt intake, use of non-steroidal anti-inflammatory drugs (NSAIDs) and inactivity, especially among women. This has led to the continued global rise of Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD). The scientific literature indicates that both diseases disrupt many human physiological systems, including those associated with sexual function. While patients who undergo a kidney transplant recover considerably, their sexuality is not routinely addressed after the procedure. In fact, it is largely unexplored compared to other aspects of health such as nutrition, physical activity, sleep habits, lifestyles, etc. In order to gain a better understanding of this issue, three studies were conducted: the first on the social representations of sexuality in people who have undergone kidney transplants, the second on kidney transplant recipients’ sexuality, and the third on healthcare professionals’ perceptions of kidney transplant recipients’ sexuality. Objective: To understand male and female kidney transplant recipients' experiences of sexuality, as well as the perceptions of the healthcare professionals who care for them. Methodology: Three qualitative studies were conducted. The first was based on Merleau-Ponty's existentialist phenomenology and the second on Gadamer's interpretative phenomenology. Both studies were carried out on people who had undergone kidney transplants. The third was a descriptive qualitative study based on Braun and Clarke's Reflective Thematic Analysis, which was carried out on healthcare professionals. The sample of kidney transplant recipients for the first two studies was non-probabilistic, selected at convenience and comprised 18 people (10 women and 8 men) aged between 22 and 55 years old. A total of 9 in-depth interviews were conducted with 5 women and 4 men. Two focus groups were held with 5 women (FFG) and 4 men (MFG) respectively. All participants self-identified as heterosexual. The third study used a purposively selected non-probability sample of 20 healthcare professionals (12 women and 8 men) aged between 25 and 60 years old. A total of 12 in-depth interviews were conducted with 9 women and 3 men. A focus group was held with 8 participants, of whom 2 were women and 6 were men. Results: In the first study, four analytical themes were developed through data analysis of the individual interviews and focus groups to understand the social representations of sexuality in women and men who have had kidney transplants: 1. Conceptions of sexuality; 2. Differences in how men and women experience sexuality; 3. The objectives and contents of the sex education received by kidney transplant recipients; 4. Family and social support. In the second study, two analytical categories were developed through data analysis of the individual interviews and focus groups to understand the perceptions and experiences of both male and female kidney transplant recipients in relation to their sexuality. In the third study, three analytical themes were developed as result of analysing the data from the individual interviews and focus groups, which allowed us to understand the perceptions of healthcare professionals with respect to the sexuality of patients who have undergone renal transplants: 1. The biological and emotional dimensions of sexuality in people who have had kidney transplants; 2. The influence of gender and intersectionality in kidney transplant recipients' perception of sexuality; 3. Sexuality in the care process of people who have had kidney transplants. Conclusions: The first study concludes that people who have had kidney transplants perpetuate traditional conceptions of sexuality and gender, placing more focus on male sexuality. Healthcare professionals can help to ensure that sexuality is considered crucial for both men and women from the diagnosis of end-stage renal failure up to post-transplant, placing equal importance on male and female sexuality, which would allow kidney transplant patients to regain their quality of life. The second study concluded that the physiological and emotional changes experienced after kidney transplantation have a strong influence on the recipients' sexuality, yet healthcare professionals rarely discuss sexuality concerns with them. Furthermore, professional sex education and support is considered necessary in order to improve kidney transplant recipients' satisfaction with their sexual health. The third study concluded that for both the kidney transplant recipients and the professionals who care for them, transplant survival appears to be more important than anything else, suggesting that they may be willing to compromise on sexuality and reproductive health if it is problematic for transplant maintenance. Indeed, the primary concern of the healthcare professionals is to prevent infection and advise against getting pregnant, which undermines the more holistic view of the issues affecting kidney transplant recipients' lives. Relevance for clinical practice Healthcare professionals must refrain from the practice of 'hidden prescriptions', which consists of not allowing women of childbearing age who are going to undergo or have undergone a kidney transplant to get pregnant. It is necessary to incorporate an evaluation of sexuality in the regulations and instruments of clinical records, care protocols and clinical practice guidelines. Moreover, the same importance should be placed on sexuality as on nutrition, physical activity, sleep habits, adherence to treatment etc., as this will allow for a better understanding of the patients' lives and will influence therapeutic practice