Sexual Wellness Resource Center
For Adults over 50.

Heart Disease and Sexuality

happy senior couple
By Michael Bates, M.D.

Heart disease is the leading of cause of death for both men and women in the U.S., responsible for about one of every three or four deaths annually. That comes to 610,000 deaths per year. Heart disease in women becomes more common after menopause. The average age for a first heart attack in men is 65. However, 4-10% of all heart attacks occur before the age of 45, this statistic includes both sexes but by far most of these are in men.

Certain medical conditions and lifestyle choices increase the risk for heart disease.

  • Smoking
  • Overweight and obesity
  • Physical inactivity
  • Excessive alcohol use
  • High blood pressure
  • High cholesterol
  • Diabetes

A 2014 study conducted by the British Heart Foundation found that 75% of those with heart disease said that their heart condition had affected their sex life. Decreased sexual activity and function are often related to anxiety and depression. Following an acute cardiac event like a heart attack, many patients and spouses feel frightened about having sex because they fear they will cause another event.

In this article, we will separate fear from the facts regarding heart disease and sexuality. Sex is an important part of life, and it is not necessary to stop sexual intimacy because of heart disease. The benefits of sex are numerous.

Discuss the timing of resumption of sex with your heart doctor. Since many partners of heart patients are worried about causing recurrent heart problems with sex, be sure to include your partner in the discussion.

First, what are the different types of heart disease? How do they correlate with sexual activity?

There are many types of heart disease and we will talk about the most common.

  • Angina is chest pain or discomfort caused when your heart muscle doesn’t get enough blood. It may cause chest pressure, or shoulder, arm, neck, jaw or back pain. It can feel like indigestion. This usually happens because one or more of the heart arteries is narrowed or blocked.

  • Heart attack, also known as myocardial infarction (MI), is permanent damage to heart muscle caused by lack of blood supply. The blood supply is blocked by a blood clot secondary to a gradual narrowing and hardening of the arteries. Sex is rarely a cause of MI and most patients can safely resume sexual activity after a heart attack. The risk of having a second heart attack provoked by sexual activity is minimal.

  • Congestive heart disease, also called heart failure, is a condition in which the heart is unable to pump enough blood flow to meet the body’s needs and is usually the result of high blood pressure or narrowing of the arteries. Sexual activity is correlated the symptomatic status, the two flights of stairs test. More about that later.

  • Cardiac arrhythmia means your heartbeat is irregular, too fast, too slow or skipping beats. With ventricular arrhythmias, your heart rate is too fast (tachycardia), and this can cause sudden death.

    Arrhythmias have a variety of causes: an electrolyte imbalance (such as sodium or potassium), damaged heart muscle following a heart attack, or the healing process after MI.

    Here is an interesting bit of information. Two studies of sudden death caused by ventricular arrhythmias during sex showed that it is rare. Of those that occurred, 75% were having extramarital sex, in most cases with a younger partner in an unfamiliar setting and/or after excessive food and alcohol consumption. Don’t miss the message!

    A slow heartbeat (bradycardia) is defined as a heart rate of under 60 beats/minute and is usually caused by a defect in the heart’s electrical conduction system. It may cause fatigue, weakness, dizziness, sweating, and fainting. Runners can have a slow heart rate due to high physical conditioning and is not considered heart disease.

Sexual activity and cardiovascular effects

Men and women have similar blood pressure and heart rate response during sexual activity. Many studies have shown that sexual arousal and intercourse cause the blood pressure and heart rate to increase mildly. The greatest increase is during the 10-15 seconds of orgasm with a rapid return to baseline.

Such studies have also shown that the physical activity of sexual activity is about equal to climbing two flights of stairs. If you can do that without getting too short of breath, you can safely be confident that you can be sexually active. That is known as the “two flights of stairs” test.

Sexuality activity after angina MI, heart failure or arrhythmias

If you can do the “two flights of stairs” test without causing angina the risk of angina with sexual activity is very low.

Patients who suffered MI and recovered with no symptoms with stress testing are at low risk of recurrent MI, even with sexual activity. As soon as the patient begins a cardiac rehabilitation program resuming sexual activity seems reasonable, perhaps as early as a week after MI. In fact, resuming sexual activity may be considered part of the rehab program.

With your doctor’s consent, sexual activity can be resumed days after successful stent placement. Open bypass heart surgery requires delaying sexual activity for 6 to 8 weeks, primarily because of the surgical site.

Stable heart failure patients can safely have sex as long as it does not induce excessive shortness of breath or fatigue. They generally are more comfortable in the bottom position during intercourse because this decreases the level of physical exertion. Mild shortness of breath that responds to rest is not a danger sign.

Sexual activity is safe for patients with pacemakers. It is also safe for those with defibrillators, as long as the activity doesn’t cause shocks.

Medications after angina, MI, heart failure or arrhythmias

Never stop or alter how you take cardiovascular medications without discussing it with your doctor.

Viagra and like medications used for erectile dysfunction can be used with your doctor’s knowledge and approval. However, they should not be used in patients who are using nitrates (nitroglycerin) for angina, nor should nitrates be used within 24 hours of Viagra use. Remember the hilarious ER scene in the movie Something’s Gotta Give starring Nicholson and Keaton?

Systemic estrogen therapy for the menopause after a heart attack should be considered on an individual basis with one’s doctor; it does not have to be discarded out of hand. Topical vaginal estrogen for vaginal dryness and painful intercourse is safe.

Sexual aids

A good sex life at any age isn’t just about intercourse. It is also about intimacy, touching, and kissing. Sexual aids (sex toys) such as vibrators can be safely used following MI, heart failure or arrhythmias. Vibrators provide excellent stimulation with little physical exertion.

Toys that deliver an electrical impulse to the body should not be used in patients who have pacemakers or defibrillators.

What’s the take home message?

  • Heart disease does not end your sex life, discuss the timing of resumption of sex with your heart doctor.
  • The health benefits of sex are numerous and have been well discussed in other X’s and O’s sexual health articles.
  • As stated before in this series on chronic disease and sexuality, sexual intimacy may be the only time one really feels “normal” after recovery from a serious health event like MI or other heart disease.
  • You and your partner can be confident that a fulfilling sex life following MI or a diagnosis of other heart disease is safe after treatment and recovery.
  • Talk about your concerns and fears with your partner and your doctor.
  • Never stop or alter how you take cardiovascular medications without discussing it with your doctor.

As per our Terms of Use, this article is for general educational and informational purposes only and is not meant to serve as a substitute for professional medical advice. Consult with your own physician or health care practitioner regarding the use of any information received here before using or relying on it. Your physician or health care practitioner should address any and all medical questions, concerns and decisions regarding the possible treatment of any medical condition.

References

About the Author

Michael Bates, M.D.

Dr Bates practiced obstetrics and gynecology for 34 years in Wichita, Kansas, until his retirement in 2011.

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