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Sex and Heart Health


Sexual activity is safe for many people with heart conditions and cardiovascular disease, according to a recent statement published by the American Heart Association (AHA).

The statement, published January 19, 2012 in the journal Circulation, provides clinical guidelines and recommendations from a wide range of experts, including cardiologists, urologists, exercise physiologists, and sexual counselors.

Many heart patients and their partners avoid sex because of concerns about heart attack or death.

However, if patients can walk briskly for a short duration or climb two flights of stairs without having chest pain, irregular heartbeat, or shortness of breath, then sex is probably safe.

Generally, sexual activity is “reasonable” for people with mild angina, controlled irregular heartbeat, and pacemakers. It is also “reasonable” for those with mild or moderate valvular heart disease with no or mild symptoms.

According to the AHA, fewer than 1% of heart attacks are caused by sexual activity. For people who stay physically active, the chances of sex causing a heart attack is even lower.

Death from heart problems during sex is rare. When it does happen, it often involves men having extramarital sex with younger partners, in unfamiliar surroundings, and after large consumption of food and alcohol.

While sex has been deemed safe for many heart patients, people should still talk to their doctors about sexual safety. Some patients, such as those recovering from surgery, need to build up endurance through an exercise program and have a stress test before starting sexual activity again. Others may need to stabilize their heart symptoms first.  

Women with heart conditions and cardiovascular disease should consult their doctors about contraception and pregnancy.

The statement also made recommendations about medications. For example, many men with heart problems and cardiovascular disease may take PDE5 inhibitors to treat erectile dysfunction. However, men who take nitrates should not take PDE5 inhibitors because of potentially dangerous side effects.

Estrogen therapy is safe for many female heart patients as long as it is applied topically or locally (inserted into the vagina).

The statement recommends caution for patients considering herbal remedies for sexual dysfunction. Such remedies might contain drugs (including PDE5 inhibitors) or other substances that can interfere with heart medication. They can also raise or lower blood pressure.

Heart patients should not avoid taking cardiovascular medications because of sexual side effects, the authors note.

Sexual counseling for heart patients and their partners is also recommended, as many experience depression and anxiety over sexual relations and heart issues.

“Sexual activity is a major quality of life issue for men and women with cardiovascular disease and their partners,” said Dr. Glenn N. Levine, lead author of the statement, in a press release. “Unfortunately, discussions about sexual activity rarely take place in the clinical context.”

Dr. Levine is a professor of medicine at Baylor College of Medicine and the director of the Cardiac Care Unit at the Michael E. DeBakey Medical Center in Houston.