Heart Conditions and Sex

From Encyclopedia of Sex and Sexuality

People who have suffered acute myocardial infarction (heart attacks) or with angina pectoris often raise questions concerning sexual activities with respect to their condition. What sexual activities are permitted? When are they permitted? Are there any restrictions on activities? Should special medication be taken to make sex either possible or less dangerous for them? These questions are also raised by patients following invasive cardiac procedures, such as coronary artery bypass operations or “balloon” angioplasty (percutaneous transluminal coronary angioplasty, PTCA).

In fact, sexual function disturbances do exist in many patients with cardiac disease. Difficulties are most common in patients after heart attacks or with angina pectoris. The dysfunction is due to one or more of three major problems: psychological—fear on the part of the patient or the patient’s partner that sexual activities might lead to a worsening of the patient’s general condition or even sudden death; cardiac dysfunction—mainly angina or dyspnea; and drug-related side effects, especially from beta-blockers and diuretics, on sexual function.

There have been many studies on the problem of sexual activity after heart attack: at least half of all patients interviewed reported changes in their sexual activities. There was a significant reduction in the frequency and duration of intercourse, often because of decreased libido, depression, anxiety, a partner’s reluctance, fear of symptom relapse, angina, and impotence. Erectile difficulties occurred in almost half the patients: permanent impotence was found in approximately 10 percent, although ejaculatory difficulties were rare. A similar decrease in sexual activity was found in women: anorgasmia was a common complaint.

Complaints of cardiac origin, such as angina, shortness of breath, or palpitation, occur at all four stages of sexual response (excitement, plateau, orgasm, and resolution; see sexual response cycle). They are markedly increased in the resolution phase of these patients.

[edit] Therapeutic Approach

Resuming sexual activities, as part of rehabilitation following a cardiac event or cardiac intervention, must be based on four factors:

• Medical assessment of the patient’s cardiac condition, particularly heart function (left ventricular function) and residual ischemia. Ventricular function assessment can be achieved by echocardiography (ultrasound of the heart) or nuclear mapping of the heart. Ischemia can be assessed by an exercise test, with or without adjacent nuclear mapping, or by prolonged electrocardiogram (ECG) monitoring;
• Reassurance of the patient by the family physician or a cardiologist, based on the patient’s medical condition, and providing more detailed recommendations on what activities are possible. It is important to be aware of recommended positions during intercourse—usually the most familiar to the patient, or side-by-side;
• Reevaluation of the patient’s medication and, if possible, attempting to change any medication that might be impairing their sexual function. The list of drugs associated with sexual dysfunction is long, headed by beta-blockers and diuretics. However, no medications should be changed or stopped without first consulting a physician;
• If the above steps have failed to improve the patient’s sexual dysfunction status, a sex consultant or therapist should be consulted.

In conclusion, sexual dysfunction in coronary heart disease patients is not unusual, especially in post-myocardial infarction patients. Very often this unpleasant situation is at least partially reversible. Reasonable medical evaluation, treatment and reassurance play a critical role in this aspect of rehabilitation.