Like most people with coronary heart disease, you’ve probably talked with your doctor about what types of physical activity are right for you. You may also have discussed the potential psychological effects of your diagnosis, including anxiety and depression. But have you discussed the question of sex?
Your sex life can affect both your physical and your emotional well-being, yet many people hesitate to bring up the subject with their doctor. That’s unfortunate, since misconceptions abound about coronary heart disease and sexual activity.
The good news is that most people with stable coronary heart disease can enjoy a healthy sex life. And if you’re unsatisfied with yours, there are ways to address the problem.
Is sex safe?
Many people believe that sex is a common trigger of heart attacks and cardiac arrest. In reality,
however, sexual activity is a factor in less than 1 percent of heart attacks, and cardiac arrest during sex is rare. Of course, even if you know the statistics, you or your partner may still worry that the physical strain of sexual activity might be too much for your heart.
While sex does boost your heart rate and blood pressure, it is no more strenuous than moderate-intensity activities like taking a 20-minute walk, carrying heavy groceries from the car to the house, or climbing a couple flights of stairs. If you can perform these activities, there may be no cardiovascular reason to avoid sex, though it is important to check with your physician first.
The American Heart Association (AHA) agrees. A scientific statement published in Circulation
in 2012 indicates that sexual activity is safe for most heart disease patients.
Some potential benefits
A healthy sex life might even do your heart good. Sex is, after all, a form of exercise. In addition,
intimacy with your partner may have a calming effect over the long term. One study followed
about 50 married couples and found that those who reported more intimacy—whether it was
intercourse or hugging and hand holding—generally had lower levels of the stress hormone cortisol.
This finding may partly explain why studies link happy marriages to lower blood pressure levels
and other heart-health benefits. Evidence also suggests that having sex can lower the risk of
developing erectile dysfunction (ED), a problem that commonly goes hand-in-hand with coronary heart disease and its risk factors like high blood pressure, diabetes, and obesity.
A study of nearly 1,000 men ages 55 to 75 found that those who had sex at least once a week
were less likely to develop ED over five years—even if they had coronary heart disease—than men who had sex less often.
Some important precautions
All of that said, some precautions are necessary, particularly after a heart attack or a revascularization procedure. For example, heart attack patients should wait about a month before becoming sexually active again. After bypass surgery, you will need time for the chest incision to heal—about four to six weeks. If you’ve had elective angioplasty, you may be able to resume sexual activity after a couple of weeks.
These are just general guidelines, and you should always get specific advice from your doctor.
You may also need to pass an exercise stress test before your doctor gives the go-ahead to return to sexual activity.
Take it slowly
Once you’ve received the medical green light, there’s no need to rush into having sex. The best
time to resume your sex life is when you and your partner are both comfortable with it. For a low-stress, comfortable experience, follow these tips:
• Choose a setting that is familiar and peaceful.
• Select a time when you feel rested and relaxed, such as in the morning after a good night’s
• Wait a few hours after a full meal to allow time for digestion.
• Ask your doctor about taking your angina medication before sexual activity to reduce the likelihood of chest pains.
Managing sexual difficulties
While many people with coronary heart disease continue to have a satisfying sex life, sexual difficulties—whether physical or emotional—are fairly common. If you and your partner are having issues, do not hesitate to discuss them with your doctor. Many cardiac rehabilitation programs also offer counseling on sexual health.
• Erectile dysfunction. ED is common among men with coronary heart disease, as dysfunction in the blood vessels can affect blood flow to the penis as well. Most men with heart disease can safely take ED drugs like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra).
However, it’s very important not to take an ED drug if you use any type of nitrate medication, because the combination can cause a dangerous drop in blood pressure. Also, if you develop angina after using an ED drug, do not take a nitrate to relieve the angina pain. Other ED treatment options include the synthetic hormone alprostadil (Caverject, Edex), which is injected just before sex to enhance blood flow to the penis, and penis pumps, which pull blood into the penis to achieve an erection.
• Female sexual dysfunction. Problems like low sex drive, difficulty with arousal, pain during intercourse, and inability to achieve orgasm are more common than average in women with coronary heart disease. The reasons are not clear, but problems with blood flow to the vagina may be involved. If vaginal dryness is causing pain during sex, using a lubricant can help minimize the problem. The AHA advises that it’s generally safe for postmenopausal women with cardiovascular disease to use estrogen that’s topically or vaginally inserted for the treatment of painful intercourse.
• Drug side effects. Certain medications, in particular blood pressure drugs like beta-blockers
and diuretics, can cause both ED and female sexual dysfunction. If you think your medication is
causing you problems, talk with your doctor. It might be possible for your doctor to switch your
medication or alter the dose.
• Psychological factors. Anxiety, stress, and depression are fairly common among people with coronary heart disease, particularly if they have recently had a heart attack or other health scare. These psychological issues, in turn, can dampen sex drive and the ability to enjoy sexual activity. If you feel your mental well-being is at the root of any sexual problems, counseling (possibly involving your partner as well) might help.
If you have significant depression, antidepressant medication might be recommended although some antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), can actually diminish sexual desire.
Don’t be embarrassed
Some couples find that they can get around problems with sexual intercourse. For instance,
other forms of intimacy, including touching, hugging, and kissing, can be just as satisfying for
However, if your sexual problems are distressing for you or your partner, talk with your physician. The topic can be difficult to bring up, but remember that satisfaction with your sex life is an important part of your overall well-being, and it is something your physician can help you address.