الفهرس 
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Abstract
Gonadal dysfunction is a frequent finding in men with ESRD on chronic hemodialysis, and erectile dysfunction is one of the most common manifestations of sexual dysfunction, which was reported to be as high as 70–80% of hemodialysis patients. Gonadal dysfunction in hemodialysis patients has many causes: endocrinal, vascular, neurological, pharmacological, and psychological factors.
The endocrinal causes are the most important and common causes of erectile dysfunction. Uremia affects the hypothalamic-pituitary-gonadal axis, causing disturbances of sex hormone levels, including serum testosterone deficiency and an increase in serum prolactin.
There are different ways to manage uremic hypogonadism and reduce its severity, but the only effective therapy that reverses sexual dysfunction in uremic men is renal transplantation.
The current study enrolled a total of 56 male patients on regular hemodialysis aged 18–60 years (sexually active males). The aim of this study was to assess the prevalence of sexual dysfunction in male patients on hemodialysis by IIEF score and its relation to serum prolactin, free testosterone level, and semen analysis quality.
This study was conducted at the Nephrology and Hemodialysis Unit, Department of Internal Medicine, Assiut University Hospitals, Assiut University. from November 2020 to November 2021.
Based on the results of the current study, 100% of patients showed decreased libido, and 71.4% of them had erectile dysfunction after starting hemodialysis.
The IIEF score shows a significant decrease in erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction.
In this study, semen analysis results showed reduced volume, total count, concentration, vitality, and total motility, presenting evidence that uremia affects spermatogenesis and total sperm quality, which consequently cause adverse effects on patient fertility. In severe advanced cases, there is no ejaculate at all or complete azoospermia.
Free testosterone level was markedly decreased in 78.6% of patients, and serum prolactin level was significantly increased in 82.8% of patients. Testosterone deficiency and increased prolactin level were significantly correlated with sexual dysfunction in the IIEF score as erectile dysfunction, orgasmic function, and decreased sexual desire.
Low free testosterone and high prolactin levels were also significantly correlated with different semen quality parameters such as semen volume, motility, and total count.
In this study, there was a significant correlation between duration of HD and the prevalence of erectile dysfunction, increased serum prolactin, and semen quality impairment. But insignificant with a low testosterone level.
Based on this study, there was a significant relationship between the age of the patients and erectile dysfunction and semen parameter abnormalities such as concentration, total count, and sperm motility. But insignificant relation between age and serum low free testosterone and high prolactin levels.
Sexual dysfunction (SD) receives very limited attention in follow-up of dialysis patients, and despite the importance of these issues, the attention given to this problem from physicians remained low, so we carried out this study in order to determine the prevalence and severity of sexual dysfunction in hemodialysis male patients, which adversely affect the quality of life.