You've had a heart attack, and suddenly your outlook on sex is very different. You used to relish intimacy and pleasure with your partner. But now it seems like a scary proposition. Could sex trigger another heart attack? Will your sex life ever be the same? Portland cardiologist James Beckerman, MD, answers the most common questions about how sex and heart health are connected.
Q. What worries heart patients when it comes to sex?
A. After a heart attack, some men and women fear that any type of sexual activity will provoke another one. People feel that if they've had a heart attack, it's not a good idea to stress their bodies with sexual activity. But fewer than 1% of heart attacks come from having sex. It makes sense to think of sex as a form of exercise: If your doctor clears you for physical activity, you're also likely safe for sex.
Q. Do you find patients are embarrassed to ask a doctor about sexual concerns?
A. Yes, and I think doctors are too. But sexual issues are important to discuss. Doctors have to read their patients well. You have to get a sense of their comfort level with you and how willing they are to talk about personal issues. I think when the doctor does bring it up, it shows it's OK to talk about sex. Sometimes the patient is surprised -- or even relieved -- that the doctor raises the subject because it means they don't have to.
Q. Do cardiac rehabilitation programs address sex?
A. They may do that indirectly. When heart patients worry about sexual function, a lot of their concerns are related to confidence and fear. After a heart attack, they feel that if they try to go for a run, they'll drop dead. Cardiac rehab, through structure and supervised exercise programs, teaches people that it's OK for them to exercise, OK for them to exert themselves and get back in the game. I think once they have that confidence, they can go out and use it, whether it's on the treadmill or in the bedroom.
Q. What are some of the warning signs to stop sex right away?
A. Similar to any type of exercise, if you begin to feel symptoms such as chest pain, abnormal shortness of breath, fatigue, dizziness, or palpitations, it definitely makes sense to slow down what you're doing, whether you're a man or a woman. If you're pretty certain it's angina, which is temporary pain or pressure in the chest when the heart doesn't get enough oxygen, it might help to take your nitroglycerin.
The exception to that advice is for men who use medication for erectile dysfunction -- it's dangerous to take nitroglycerin, too. Your blood pressure can fall to dangerously low levels, and there's an increased risk of heart attack and even death. If you're on an erectile dysfunction drug and have heart-related symptoms during sex, call your doctor.
Q. Do some men and women lose sexual interest after being diagnosed with heart disease?
A. Yes, and it's often related to the emotions that follow a diagnosis of heart disease. It influences people's lives in many different ways, and sexual activity is one of them. A new diagnosis of heart disease -- or even a surgical scar -- can make people feel less attractive. Some drugs have side effects that diminish sexual interest and performance. When patients feel angry and frustrated, it affects not only their sex lives but also their "couple" relationships.
For many people, heart disease is the first significant diagnosis they ever have. Think of individuals in their 40s or 50s who have a sudden heart attack; they didn't know they had this disease process going on, and now they do. That realization of mortality and potential limits and imperfections is really hard to take. Many people with heart disease feel that shift so abruptly. They question themselves and what they're capable of doing. And that's part of the reason there are anxieties and concerns about sexual activity. We know depression is extremely common after a heart attack, especially for women.
Q. Sex is obviously part of an overall healthy life -- and it's also a sign of a healthy heart, right?
A. Yes. It shows that you're capable of doing physical activity in which your heart rate and blood pressure go up. In a sense, you're doing a stress test on your heart. If you tolerate that well and you feel good doing it, it suggests good things about your overall level of fitness and therefore your risk of heart disease.
Sex can also be a sign of healthy relationships and social supports. It shows you have the opportunities, frankly, and that you're interested and engaged. I think sex is a barometer for overall health.