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Sexual Health and NASH

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By Editorial Team

3 min read

Reviewed by: HU Medical Review Board | Last reviewed: August 2024

Editor’s note: For simplicity and ease of reading, we use the terms “men” and “women” in this article. But we want to acknowledge that not all people identify with these genders and some people are nonbinary. Health Union strives to create an inclusive space while providing accurate health information.

Sexual dysfunction is common among people with chronic liver diseases like nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), and cirrhosis. This link between sexual health and NASH is often overlooked when managing the disease. But it is a crucial area that can greatly affect quality of life.1

Sexual dysfunction is the medical term for problems with sexual health. Read on to understand why it happens, how it affects men and women differently, and how you can manage it.

What causes sexual dysfunction in people with NASH?

There are various causes for sexual dysfunction in people with NASH and other chronic liver diseases. They include:1-3

  • Hormonal imbalances – The liver breaks down (metabolizes) hormones such as estrogen and testosterone. Liver damage can lead to an imbalance of these hormones.
  • Physical limitations – Symptoms of NASH include fatigue and general weakness. A lack of energy can reduce sexual desire and performance.
  • Mental health – Living with a chronic illness can take a toll on mental health. Depression and anxiety are common. These emotional struggles play a large role in sexual dysfunction.
  • Sarcopenia – Reduction in muscle mass has been linked to sexual dysfunction in men.
  • Side effects of medicines – Some drugs can lead to sexual dysfunction in men. Propranolol, which is used to treat portal hypertension, is an example. Portal hypertension is a complication that can occur with NASH.
  • Other health problems – Some comorbidities of NASH can also cause sexual dysfunction. These conditions include diabetes, high blood pressure, and obesity.

How does NASH affect sexual health?

Sexual dysfunction related to liver disease can show up differently in men and women.1

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In men, sexual dysfunction can include:1-3

  • Reduced sexual desire (libido) – Lower testosterone levels can lead to a decrease in sexual desire.
  • Premature ejaculation – Ejaculating sooner than desired has been reported in people with liver disease.
  • Erectile dysfunction (ED) – ED refers to the inability to have or keep an erection. Many men with liver disease experience ED due to reduced blood flow, reduced muscle mass, and hormone imbalances. ED rates are much higher in men with liver disease than in the general population.
  • Infertility – Low testosterone levels can lead to infertility in men with chronic liver disease.

In women, sexual dysfunction can include:1

  • Reduced libido – Hormonal imbalances, fatigue, and depression can lead to a decrease in sexual desire.
  • Inability to orgasm – Difficulty having an orgasm has been reported in women with chronic liver disease.
  • Vaginal dryness and pain – Hormonal changes can also cause vaginal dryness. Sex, then, can be uncomfortable or painful for women with NASH.
  • Menstrual irregularities – Liver disease can cause changes in menstrual cycles. The result can be irregular periods or even amenorrhea (having no period).

Managing and treating sexual dysfunction

Dealing with sexual dysfunction alongside liver disease can be challenging. Here are some ways to manage it:1

  • Hormone therapy – For those with hormonal imbalances, hormone replacement therapy (HRT) can help restore balance and improve sexual function.
  • Medicine for ED – Men with ED may benefit from medicines like sildenafil (Viagra®) or tadalafil (Cialis®).
  • Treating liver disease – Proper management of liver disease can improve overall health and reduce sexual dysfunction. Treatment options include lifestyle changes, medicines, and possibly surgery.
  • Therapy – Counseling or therapy can help address depression, anxiety, and relationship issues that may lead to sexual dysfunction. Joining support groups for liver disease can also provide emotional support and practical advice from others facing similar challenges.

Talk to your doctor

Sexual dysfunction is an often overlooked issue for those with liver diseases like NASH. But it is treatable. If you are struggling with your sexual health, talk with a medical professional for advice and support.1