Sexuality and Reproductive Health Counseling in Adolescent Renal Transplant Recipients

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.