Safer Sex After Open Heart Surgeryby Nicole Van Hoey, PharmD Health Professional
As soon as you or a loved one hears the words “open heart surgery,” questions flood in. The first one usually is not about sex and intimacy. Eventually, though, you will wonder, when is the “right time” for intimacy after open heart surgery?
First, realize that intimacy does not equal sex alone. Even directly after surgery, closeness can continue just by holding hands. Also know that doctors, nurses, and caregivers are there to guide you as you resume all normal activities, including sex. These providers may only know that intimacy is a concern if you bring it up, but they are always ready to listen and help you through any worries.
Typically, patient handbooks for open heart surgery offer consistent recommendations on this topic: Sex after surgery is considered okay whenever you feel comfortable after about four weeks of recovery. You might be surprised to learn that sex is okay even before things like lifting weights or starting rehabilitation. In fact, sex doesn’t have to be as strenuous as your usual exercise routine.
So how do you know when you are ready or feel comfortable? Consider these three factors to help you decide:
Sternal rest—a way to protect the broken bone as it heals after surgery—is a longstanding part of post-op recovery. Without these precautions, there’s a chance that the sternum will separate during healing, develop an infection, or otherwise irritate the surrounding tissues. For at least six to eight weeks, and sometimes up to 12 weeks, standard guidelines suggest that you should avoid lifting; pushing and pulling yourself out of chairs, up the stairs, or out of bed; and reaching above your elbow level or behind your back.
During intimacy, extra sternal precautions are all about your comfort and confidence. Everyone heals differently from wounds, and the recovery from damage to the chest wall is no different. Even if your six to eight weeks of precautions are past, your collarbone, ribcage, and muscles around the broken bone may still be sensitive to pressure or sudden movement. Likewise, nerve pain in the same areas might cause sharp pains with activity that feel scary.
These lingering chest wall pains are not always discussed in detail before discharge, but they are so important to your quality of life. Attending a good outpatient cardiac rehab program often begins around the time that your activity improves and your sternal pain decreases. The professionals in rehab are great resources for questions about sternal safety during intimacy and about anxiety from chest soreness that may develop.
To find a way to intimacy while you wait for your nerves, muscles, and bones to rebuild, try to initiate sex slowly and keep exertion low throughout. Try positions that avoid extra pressure on top of your chest, especially in the first few months. Using extra pillows to support your shoulders and neck can reduce strain, too. Women especially may experience nerve or muscle pain in the chest area long after the sternum heals; over-the-counter pain relievers can minimize these irritations.
Immediately after your return home, getting plenty of rest is a primary concern. As the days and then weeks pass, you will get stronger, stay awake longer, and be more active between naps. But, it’s important not to do too much activity too soon and to pace yourself. Restful periods are especially important after some physical activity: Spread activity throughout the day, and balance these active periods, including sex, with periods of rest to keep yourself on a healthy recovery track. During recovery, spontaneity is less important and sleep is a priority, especially at night after a full day. Consider making time for sex or intimate moments earlier in the day, or after you’ve just rested, before other events tire you out.
Medicines after surgery can be a surprising source of intimacy problems for both men and women. Many different types of drugs can decrease the libido in either partner, or even increase feelings or intimacy and sexual desire can results. After heart surgery, it’s common to need medicines to keep blood pressure low and heart rate steady.
For heart pressure and rate
Two types of post-op blood pressure medicines often cause sexual side effects. Diuretics reduce extra body water and reduce blood flow to sexual organs in men and women. These drugs, like HCTZ or spironolactone, also can reduce testosterone production to decrease libido in men. Beta blockers like propranolol and metoprolol affect both men and women, too. Beta blockers keep the heart rhythm slow and steady, but they also increase tiredness and block nerves that help arousal.
When you are in the hospital after surgery, you might receive drugs to reduce stomach acid. H2 blockers like famotidine or ranitidine (Pepcid or Zantac) are usually used for only a short time after surgery. If they are needed longer or at high doses, men may experience impotence and low sperm count — and more often with cimetidine (Tagamet) than the other H2 blockers.
Depression and anxiety are normal after a stressful experience like open heart surgery. Antidepressants can be used to treat both, and it seems logical that reducing depression or anxiety would improve intimacy. These drugs can change how you feel about personal connections, though.
Two common classes — SSRIs like fluoxetine (Celexa) and tricyclic antidepressants — can decrease men’s and women’s feelings of closeness with partners. SSRIs also cause physical problems, usually within the first week of treatment: erectile dysfunction in men, vaginal dryness in women, and challenges to achieving orgasms in both genders.
Recovery from open heart surgery is hard enough without giving up on intimacy, too. Remember to trust yourself and your body as you add more physical — and sexual — activity. Talk with your partner to find ways to stay intimate and to be honest about anxieties or other emotions that reduce closeness, too.