Sexual Activity and Heart Disease

By Dr. Annette Owens from SexualHealth.com website

Cardiovascular disease can involve:

1) Atherosclerosis
Atherosclerosis is a narrowing of small blood vessels. Changes may be confined to blood vessels in the heart, reducing the blood supply for the pumping heart. This is called "ischemic heart disease." If the heart’s pumping action is increased during exercise or stress, the blood supply through the coronary arteries may not be sufficient, and pain (angina) occurs. If one or several of the coronary arteries become blocked off completely, myocardial infarction (heart attack) occurs.
Atherosclerotic changes of small blood vessels can also occur in the legs, causing pain during walking or exercise ("intermittent claudication"). If blood flow to the penis is affected, problems with erections may occur.

2) High blood pressure

3) Breathing problems

If the heart has trouble pumping blood through the body and the lungs, breathing may be affected. The effects of this condition and other chronic lung diseases on sexual wellness are covered in a separate section (Lung Disease).
General suggestions related to sexual problems and their management If you have hypertension (high blood pressure) you may fear that sexual activity will increase your blood pressure to dangerously high levels. Unless sex occurs with a new partner in unusual or unfamiliar surroundings or involves a high level of physical activity, it should be tolerated as well as any other kind of moderate physical activity of a non-sexual kind.

See your doctor regularly in order to keep your blood-pressure under control and discuss possible side effects of your medication. Depending on which medicine you are taking, possible side effects include decreased lubrication in women and diminished erections in men. Do not stop taking your medicine if side effects occur. Your doctor may be able to improve the timing, lower your dose and/or combine several medications in order to reduce the side effects you are experiencing.
Women with decreased vaginal lubrication can use water-soluble lubricants (K-Y jelly, Astroglide, etc.), sold over the counter in most pharmacies.

Erectile dysfunction can have psychological and/or physical causes. Sometimes, erectile problems are resolved after the medication has been adjusted. Sexual counseling or sex therapy may be helpful. Various treatment options for physical erectile insufficiency exist.

Remember that erectile dysfunction does not prevent you from being sexually active and giving towards the one you love. This may be a good time to explore alternative ways of being loving and intimate with your partner without having firm erections.
If you feel a reduced interest in sex, remember that you still can have a loving relationship with your partner without sexual activity. There are many ways of expressing your love and fondness without having sex, including cuddling and kissing each other.

If you feel very tired, try to plan intimate time with your partner at times when you are most rested.

Angina (pain) during sexual activity should be judged in the same way as angina during exercise. Coronary dilators can be used before intercourse. Activity should not continue if ischemic symptoms persist. In this case, you should slow down or take a short rest until the pain has resolved completely.

If you have experienced a myocardial infarction (heart attack), you and your spouse may fear that sex will put too much stress on your heart. Research has shown that patients after a MI benefit from enrolling into a cardiovascular rehabilitation program. The low risk of triggering a MI during sexual activity is nearly unchanged whether you have a history of heart disease or not. Regular exercise can even reduce the risk further (Muller et al. 1996).

Use the positions during intercourse that feel most comfortable and relaxing. The stress on your heart differs little whether you are on top, or on bottom. If the male is on top it may require less muscle activity if he is prone on his elbows, rather than extending his arms to support his upper body. A side-by-side position, or use of a low wide chair may be comfortable. Some of these positions are well illustrated in the reference book by Sipski & Alexander.

When is it safe to return to sexual activity? If you have had a coronary artery bypass grafting (CABG) it is recommended that you wait at least four weeks before resuming sexual activity. This will allow the sternum to heal and prevent pain from the incision.
It is strongly recommended that you enroll in a cardiac rehabilitation program. The results of an exercise stress test are good predictors for how well your heart tolerates physical stress, including sexual activity.

Fertility & pregnancy If you are in the reproductive age and have cardiac problems, your doctor may advise you against certain oral contraceptives because of potential blood-pressure increases. Alternative methods for birth control include diaphragm, intrauterine device, cervical cap, condoms, and sterilization.

Women with heart disease (congenital or acquired) can have normal pregnancies. If you have had a heart valve replacement, your doctor can advise you about the risks of using anticoagulants during pregnancy. Some women may need more instrumental help (including caesarian section) during labor and delivery. Sometimes, the birth weight of babies born to mothers with heart problems are in the lower range.

Avoid sexual activity:

  • After substantial intakes of food or alcohol
  • When fatigued When under time pressure
  • During emotional outbursts
  • When under emotional stress
  • Under temperature extremes.

Be sure to report to your doctor if the following symptoms should occur: persistent angina during intercourse

  • Rapid heart rate or difficulty breathing that persists for 7 to 10 minutes after orgasm
  • Feelings of extreme fatigue after orgasm
  • Development or persistence of other sexual difficulties.

References:

Bancroft, J. (1989) Human sexuality and its problems. Churchill Livingstone, ISBN: 0-443-03455-9

Milsten, R. & Slowinski, J. (1999) The sexual male. Problems and solutions. Norton, ISBN: 0-393-04740-7

Muller, J.E. et al. (1996) Triggering myocardial infarction by sexual activity. Low absolute risk and prevention by regular physical exertion. Journal of the American Medical Association; 275: 1405-1409

Schover, L.R. & Jensen, S.B. (1988) Sexuality and chronic illness. A comprehensive approach. The Guilford Press, ISBN: 0-89862-715-X

Sipski, M.L. & Alexander, C.J. (1997) Sexual function in people with disability and chronic illness. Aspen Publishers, Inc., ISBN: 0-8342-0886-5

The Sensuous Heart: Sex after a Heart Attack or Heart Surgery Suzanne Cambre This cartoon-style booklet explains the emotional and physical needs of persons who have had heart attacks or heart surgery. It answers questions about frequency of sexual activity; suggests comfortable positions; and covers the effects of alcohol, prescribed drugs, stimulants, and illegal drugs. 1990, 21 pp., $5.75 plus $1.50 postage and handling. Pritchett and Hull Associates, 3440 Oakcliff Road NE, Suite 110, Atlanta, GA 30340-3079; 800-241-4925.

Sexual Concerns When Illness or Disability Strikes Carol Sandowski This book discusses the possible effects of various medical conditions (arthritis, diabetes, spinal cord injury, alcoholism) on sexual functioning, relationships, self-esteem, and communication. The author explores treatments for sexual dysfunction. 1989, 281 pp., $56.75 plus $5.50 postage and handling. Charles C. Thomas Publisher, 2600 South First Street, Springfield, IL 62794-9265; 217-789-8980, 800-258-8980.

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