Sex and the Heart- Frequently asked questions

Sex and the Heart : Some FAQ’s
Recently, the American Heart Association (AHA) released a scientific statement to address this issue, which was published in the journal Circulation January 19, 2012.
One of the main purposes of the statement was to make physicians and healthcare providers aware that this is a real issue that is not appropriately addressed with the patient and partner and which truly should be. The recommendations have been compiled by experts from various fields, including cardiology, exercise physiology, sexual counseling, and urology.

Below are frequent questions that arise in the minds of patients with regards to sex and heart disease and the answers based on the now available recommendations:

Q.How great is the risk of heart attack during or after a sex act ?

The risk of heart attack is only extremely modestly increased during sexual activity and represents only a miniscule amount of a person's overall risk.
Sexual activity is the cause of <1% of all heart attacks. In an autopsy report of 5559 instances of sudden death, 34 (0.6%) reportedly occurred during sexual intercourse. Two other autopsy studies reported similarly low rates (0.6%– 1.7%) of sudden death related to sexual activity. Of the subjects who died during coitus, 82% to 93% were men, and the majority (75%) was having extramarital sexual activity, in most cases with a younger partner in an unfamiliar setting and/or after excessive food and alcohol consumption

Q. Is it safe for a heart patient to resume sexual activity ? How does one know it is safe?

Patients with any kind of cardiac disease, wishing to initiate or resume sexual activity must be evaluated with a thorough medical history and physical examination. Sexual activity is reasonable for patients with cardiac disease who, on clinical evaluation, are determined to be at low risk of cardiovascular complications, like patients who do not have symptoms on usual activities such as walking at moderate speed or climbing 2 flights of stairs. For patients who are not at low cardiovascular risk or have unknown cardiovascular risk, exercise stress testing is advisable to assess exercise capacity and development of symptoms, ischemia, or rhythm disturbances on exercise

Q. How does one judge the safety of sexual activity based on exercise testing?

If you can can exercise on the treadmill test up to a certain level (in medical terms more than 3 to 5 METS) without experiencing anginal chest discomfort, excessive breathlessness, ECG changes, fall of blood pressure or rhythm abnormalities, you can safely resume sexual activity.

Q What can a patient with heart disease do to further reduce his/her risk of a heart attack during or after sexual activity ?

Besides taking proper cardiac medications and adopting a prudent lifestyle including diet, cardiac rehabilitation and regular physical activity can reduce the risk of cardiovascular complications in people with heart disease. Sedentary individuals have a relative risk of sex related heart attack of 3.0, whereas physically active individuals have a relative risk of only 1.2. In other words when a sedentary individual indulges in sexual activity, his risk of a heart attack is 3 times more as compared to the risk of having a heart attack when he is at rest, whereas when a physically fit or trained person does so, his risk is only 1.2 times more.

Q. I had a heart attack 3 weeks ago and doctors have said I am stable and allowed to walk in my compound at moderate pace. Is it safe for me to resume sex?

Sexual activity is reasonable 1 or more weeks after an uncomplicated heart attack if you are without cardiac symptoms during mild to moderate physical activity.

Q. Which type of heart patients should not resume sexual activity ?

Sexual activity is safe for the majority of heart disease patients and that doctors—as well as patients and their partners—should endeavor to bring up the subject of sex in discussions. The only patients who should refrain from sex are those with acute or unstable heart disease or severe symptoms; they should be assessed and stabilized with appropriate treatment before engaging in sexual activity. Also patients with heart disease who experience heart symptoms precipitated by sexual activity should defer sexual activity until their condition is stabilized and optimally managed

Q. My friend has been put on cardiac drugs for treatment of his heart condition, which the doctors say is severe. He has difficulty in sexual activity. Should he stop the cardiac drugs?

No. Drugs used to protect the heart should not be stopped altogether. If a patient being treated with a cardiovascular drug complains of sexual dysfunction, it could also be due to other reasons like : 1.underlying arterial or cardiac disease itself, 2.the nocebo effect (which is due to a patient’s knowledge that a drug has been associated with erectile dysfunction) or 3. anxiety or depression. So these conditions should be sought and treated first before stopping or altering any drug. Drugs like thiazides, spironolactone and beta blockers are known to cause sexual dysfunction and a doctor may substitute them by drugs like frusemide, eplerenon and nebivolol respectively.

Q Can this above mentioned friend of mine be put on drugs like Sildenafil or Tadalafil to improve his sex life?

The answer is yes, with some STRICT provisions. 1. If his usual medications include any form of nitrates, then giving Sildenafil like drugs is extremely dangerous and could be fatal due to the severe and sudden blood pressure lowering effect when Sildenafil like drugs are given in a patient who is already on nitrates. Hence he should be off nitrates (even a spray) at least for 24 hours before starting Sildenafil. 2. If his cardiac medications include an alpha blocker, its dose should be lowered lest it should cause severe lowering of BP. 3. Conversely, if a person is on regular usage of Sildenafil or Tadalafil, and now requires a nitrate drug due to his heart disease, Sildenafil or Tadalafil should be stopped for 24 or 48 hours respectively before a nitrate can be started.

Q. When can a patient who has undergone balloon angioplasty, resume sex?

Sexual activity is reasonable for patients who have undergone angioplasty and may be resumed several days after the procedure if the artery puncture site (usually the groin or the wrist) are without complications.

Q. When can a person resume sex after bypass surgery ?

Sex can be resumed 6 to 8 weeks after standard coronary artery bypass graft surgery, provided the sternal wound is well healed.

Q. I have been told I have ‘compensated’ or ‘stable’ heart failure. Can I indulge in sex ?

Yes, sexual activity is reasonable for patients with compensated and/or mild heart failure but not advised for patients with decompensated or advanced heart failure until their condition is stabilized and optimally managed.