Sex and Heart Disease

Like most everybody else, people with heart disease spend a lot of time thinking about sex. But if your heart's in trouble, those thoughts can turn dark. You may worry that sex could finish you off. You may also wonder what happened to your desire. If heart trouble has cast a shadow over your sex life, talk to your doctor. With a little help and reassurance, many people with heart disease can lead full, satisfying lives -- sex included.

Is sex safe for people with heart disease?

Some people have suffered heart attacks while having sex. People have also suffered heart attacks while driving to the grocery store, watching the evening news, or playing with their grandchildren. A heart attack can occur at any time, and most heart attacks occur without any physical exertion. Simply put, life itself can put you at risk.

Thankfully, when it comes to sex, the risk is incredibly small. Sex may get the heart pumping, but not any more than a brisk walk around the block or a climb up two flights of stairs. By the best estimates, intercourse causes less than 1 percent of all heart attacks. And among people with heart disease, the odds of suffering a heart attack within two hours of intercourse are roughly one in 50,000. At that point, you'd be better off worrying about lightning.

For a small number of patients, however, sex can be a real threat. According to a report in the American Journal of Cardiology, you may need to abstain from sex -- at least temporarily -- if you have any of the following conditions:

• Unstable angina. Doctors use this term to refer to angina (chest pain) that is either severe, becoming more frequent, or occurring during rest
• The onset of angina (chest pain caused by heart problems)
• Uncontrolled hypertension (high blood pressure)
• Advanced heart failure (marked by shortness of breath at rest)
• A heart attack within the last two weeks
• Certain arrhythmias (abnormal heart rhythms, especially in the ventricles of the heart)
• Cardiomyopathy (weak heart muscle)

All of these conditions can raise the risk of heart attack or death during sex, but they don't necessarily mean the end of your sex life. With proper treatment, for example, medications to control blood pressure or prevent angina, you may once again be healthy enough for sex.

To a lesser extent, sex may also be risky if you have mild angina, early-stage heart failure, a history of stroke, a heart attack within the last two to six weeks, or at least three major risk factors for coronary heart disease (such as obesity, high cholesterol, and hypertension).

If there's any question about your ability to withstand sex, your doctor will take a close look at your heart and your overall health. He or she may order a stress test, an exam that monitors your heart while you exercise on a treadmill or a stationary bike.

With your doctor's blessing, you may be able to resume a full sex life. However, you may have to take some precautions, such as using less strenuous positions or taking heart medications right before intercourse. Very few people have to give up sex completely, and everyone can enjoy hugging, kissing, and caressing. There's no reason you shouldn't enjoy closeness and intimacy all your life.

Why don't I feel like having sex anymore?

Sex may be safe for most heart patients, but it isn't always plentiful or pleasurable. A survey of more than 500 men and women who survived heart attacks found that both the frequency and satisfaction of sex dropped significantly in the first few months after the attack.

Among heart patients, a sagging libido often stems from a depression, which afflicts up to 1 in 3 of all patients recovering from a heart attack. The condition often saps sexual desire and, among men, can contribute to erectile dysfunction.

For many people, time is the best remedy. After a few months, your mood will probably improve and your desire will return. Some patients, however, need counseling or medications to break out of their depression. Keep in mind that some antidepressants such as fluoxetine (Prozac) can dampen your sex drive. If you've overcome your depression but still don't feel like having sex, talk to your doctor about switching medications or lowering the dose.

Can heart medications interfere with my sex life?

Ironically, drugs that are good for your heart can be hard on your sex life. Many blood pressure medications, including diuretics (such as hydrocholorothiazide and chlorthalidone) and beta blockers (such as carvedilol and propanolol) can sap desire in both men and women and cause erection problems in men. Digoxin, used to treat heart failure and some arrhythmias, can have the same effects.

You can lower the risk of sexual side effects by taking the medicine exactly as prescribed. If you still have problems, talk to your doctor. He or she may be able to lower your dose or switch you to a medication that's less likely to hamper your sex life. ACE inhibitors such as captopril (Capoten) or enalapril (Vasotec) can lower your blood pressure but rarely cause sexual side effects.

Finally, it is important to stay active. Exercise can not only improve your heart condition but may help your sex life as well.

References

American Heart Association, Sexual Activity Declines for Heart Patients Not Getting Doctors Advice

American Heart Association, Sexual Activity After Heart Disease or Stroke.

Debusk, Robert, MD, et al. Management of Sexual Dysfunction in Patients with Cardiovascular Disease: Recommendations of the Princeton Consensus Panel. American Journal of Cardiology, Vol. 86(2):175-181

Drory, Yaacov, MD, et al. Comparison of Sexual Activity of Women and Men After a First Acute Myocardial Infarction. The American Journal of Cardiology

Stein, Richard A, MD. Cardiovascular Response to Sexual Activity. American Journal of Cardiology; 86:27F-29F

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