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Is There Sex After Heart Disease?

Doctors have good news for heart patients hoping to resume sexual activity.

Erectile Dysfunction

Although heart disease is a risk factor for erectile function, erectile dysfunction can be an early warning sign of cardiovascular disease. The reason: the tiny arteries that go into the penis are about half the diameter of the ones that go into the heart, so they "clog up" first, says Craig Niederberger, MD, a urologist at the University of Illinois at Chicago. "The penis is like a red flag...You generally get about three years between symptoms of erectile dysfunction and symptoms of heart disease. Every man with ED should be considered a man with potential heart disease."

People with heart disease also likely have other risk factors for ED such as hypertension, diabetes, smoking, and obesity.

Medications

Beta-blockers, used for irregular heart beats after open heart surgery and to lower blood pressure, are the biggest culprit that can interfere with sex after heart disease. They lower blood pressure -- and the "hemodynamic fill of the penis," says Paul Turek, MD, a retired professor of urology at the University of California at San Francisco and director of the Turek Clinic in San Francisco. "Think of it as a hose. If you lower the pressure, you're effectively ... turning off the hose. The inflow is lower."

Doctors also can try to adjust the drug's dosage over time, which can also help, or switch patients to a different medication.

An erectile dysfunction drug may help, but some men may not be able to take ED drugs because of other medications.

Using ED Drugs

Viagra, Levitra, and Cialis are OK -- with some exceptions. Phosphodiesterase inhibitors (Viagra, Cialis, and Levitra) do not increase heart attack or death rates and are considered safe for most men wishing to have sex after heart disease. One exception is in men taking nitrates (usually for angina, the sense of tightness in the chest), because the combination of the two drugs can cause a large and sudden decreases in blood pressure.

Another caveat: "the pill enables them to perform activities that will tax the heart the way it hasn't been before," Turek says. Many men feel timid and hesitate to ask about these types of medications, Niederberger says. He reassures them by explaining that the erection problem is related to the heart problem and that "sexual activity is a healthy thing to do." Sometimes a man will say, "my wife is afraid for me to take it," Niederberger says.

If ED drugs don't work, doctors may offer alternatives such as injections (which patients give themselves five or 10 minutes before intercourse and which last 15 to 60 minutes), vacuum-erection devices (a plastic cylinder that draws blood into the penis, and then a ring is placed at the base of the penis) or surgery (a prosthesis can be surgically implanted).

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