By: Steven Nissen, MD
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Sometimes I’ve told a patient that recovery from a heart attack is progressing well. Then as they turn to leave the office they say to me, hesitantly, “I meant to ask you about sex. I mean, can I still have it?” They’re one of thousands of people who ask their doctors this common question every year—and good for them for “putting it out there”—yet many more won’t ask because they’re simply embarrassed.
A research study from December 2014 confirms that few patients are receiving counseling about resuming sexual activity after a heart attack.
Doctors don’t always start this conversation, either, because they might also find it a bit uncomfortable, so it’s important for patients to ask for help when they need it. After all, sex matters. Making a list of questions before your appointment can be really helpful, too.
Sex is safe for your heart
A healthy sex life contributes to overall quality of life for the patient and the partner. This subject of sex after a heart attack has actually been very well studied, and it turns out that sex is safe after you’ve recovered from a heart attack, whether you’re a man or a women. Even though some memorable movie scenes depict men dying while having sex, it’s just not that common, and is more screen fiction than fact. A 2012 American Heart Association Scientific Statement on sexual activity and cardiovascular disease found that, in fact, sexual activity rarely is the cause of all acute heart attacks.
Although sex may escalate emotions and passion to a fevered pitch, stress on the heart is what I’d call “modest.” In fact, it’s about the same as what you’d experience while climbing a few flights of stairs. Sex is actually considered moderate exercise and is likely good for you.
Getting back to those movie scenes when someone dies while having sex—in reality, research has shown that when this occurs, the couple is typically having an encounter “outside the normal relationship” or in an “extramarital relationship. This is most likely due to the added levels of stress causing increased heart rate and blood pressure.
We know that certain other factors really can trigger a heart attack, but sex isn’t usually on that list. Rather, too much exertion too quickly, cold temperatures, too much emotion—including grief and anger—and eating a big meal are more usual culprits.
When you don’t want sex
Oh, and while we’re on the subject, if you want to have sex and you can’t, or know that you should be wanting to have it but you don’t, I encourage you to bring that up with your doctor. For women, causes may include problems with the relationship, stress from many factors, medications such as antidepressants, and even simply age. For men, sexual dysfunction causes can be similar—either psychological or physiological—and we have a variety of effective ways to treat it. The most common causes of sexual dysfunction in men include ejaculation disorders, erectile dysfunction , inhibited sexual desire and even vascular disease such as atherosclerosis (or hardening of the arteries) and diabetes. Lack of confidence about performance can often be helped by simply participating in cardiac rehabilitation, which puts you “back in the game.”
Finally, if you have questions about sex after your heart attack, you deserve answers. So yes—let’s talk about it.