Patients with liver disease often experience sexual dysfunction, and clinicians should routinely ask about symptoms, according to a recent guidance statement by the American Association for the Study of Liver Diseases (AASLD).
The guidance, which focuses on management of reproductive health in men and women as well as the history, risk factors, evaluation, and management of liver disease during pregnancy and after birth, was developed by an expert panel and is based on formal review and analysis of the literature. It was published Sept. 18 by Hepatology.
Regarding pregnancy planning, the guidance said that clinicians should routinely inquire about sexual activity and pregnancy intentions in all reproductive-aged adolescents and women with chronic liver disease or liver transplant. Estrogen-containing agents should be avoided in patients with decompensated cirrhosis, Budd-Chiari syndrome, hepatocellular adenomas, and transplant recipients with graft failure, the statement said.
Patients using agents other than long-acting reversible contraceptives, especially women taking teratogenic medications, are encouraged to combine them with a barrier method given their higher failure rates, the guidance said. All forms of emergency contraception may be used in patients with chronic liver disease, according to the guidance.
Menopausal hormone therapy should not be used in women with decompensated liver function, Budd-Chiari syndrome, or hepatocellular adenomas, the guidance said. Testosterone replacement may be used in hypogonadal men with chronic liver disease.
Other topics covered in the guidance included assisted reproduction in patients with liver disease, evaluation of liver disease in pregnancy, management of chronic liver disease during pregnancy and lactation, liver conditions that require special management in pregnancy, cirrhosis, liver diseases unique to pregnancy, and reproductive health and pregnancy in transplant recipients. The guidance also highlighted several areas where further research is required, including the safety of medications to treat sexual dysfunction in patients with liver disease; the effects of hormonal therapies on liver-related health, including in transgender patients; and the safety of hormonal contraception in patients with chronic liver disease and liver transplantation.