Women's Heart Advisor October 2015 Issue

Is Sex Too Stressful for a Damaged Heart?

Itís a common question, but the answer may surprise you. The key is to talk with your doctor about sex and all forms of physical activity.

Heart disease doesnít have to mean an end to intimacy. Just share your concerns with your doctor.

If you have had a heart attack, or have undergone angioplasty and stenting or coronary artery bypass grafting (CABG), sex may be the last thing on your mind. But sexual intercourse is an important component of many relationships. No woman should be afraid to snuggle up to her partner for fear intercourse will be painful or cause another heart attack.

Because women often don’t broach the topic with their cardiologist (and many cardiologists don’t volunteer the information), questions they might have about resuming sexual activity generally go unanswered. Fortunately, the American Heart Association (AHA) has answers. In 2012, the AHA issued guidelines on the topic after gathering information from published studies. Earlier this year, they incorporated more evidence-based advice into a second document.

The take-home message is that most women do not need to worry.

“Intercourse does not place a huge workload on the heart,” says Cleveland Clinic cardiologist Julie Huang, MD.

Not as stressful as expected

There’s no doubt that foreplay and intercourse cause heart rate and blood pressure to rise. However, the maximum increase lasts only 10 to 15 seconds. Less than 1 percent of heart attacks occur during intercourse. Although a small percentage of heart-attack deaths occur during sex, 93 percent of these happen to men, most of whom are having an extramarital liaison fueled by copious amounts of food and alcohol.

The AHA guidelines say that if you have no symptoms of heart disease, can pass a stress test or have had CABG, you are at very low risk of having a heart attack during sex. Dr. Huang feels these “guidelines” might be overly cautious.

“You don’t have to pass a stress test to have safe sex. The average person does not expend much energy during intercourse,” she says. “For most people, intercourse is quite safe, even within a few days of having a heart attack.”

Caution after revascularization

After blood flow to the heart has been improved by a revascularization procedure, an increase in physical activity should be no concern. How well you are healing from the procedure will dictate how quickly you can resume sexual activity.

If you had angioplasty and stenting performed from the groin, the puncture site will heal in a few days.

After CABG, you can resume sexual activity any time you want. However, you will need to wait until your breastbone has healed before assuming any position that puts pressure on your chest. For most women, six to eight weeks after CABG is a reasonable timeframe for liberalizing activity.

“If you are ready to go to cardiac rehabilitation, you are definitely ready for sex,” says Dr. Huang.

Lower your risk even further

Although the risk of heart attack or death from sexual activity is low, a sedentary lifestyle increases the risk—particularly for women. You can lower this risk by improving your overall health and stamina.

For many women, a heart attack or diagnosis of severe coronary artery disease is a wakeup call. They are motivated to improve their health by reducing their risk factors: for example, lowering their blood pressure, cholesterol or weight through diet and exercise and quitting smoking. If they have never exercised, cardiac rehab is the place to start.

“Cardiac rehab is an excellent way to improve your stamina and begin incorporating exercise into your daily habits,” says Dr. Huang.

When sex might be unsafe

Unfortunately, sexual activity may not be safe for women with certain forms of advanced heart disease. If you have unstable angina, advanced or decompensated heart failure, symptomatic valve disease or an uncontrolled arrhythmia, you should not engage in any physical activity—including sex—until your condition has been stabilized.

Anyway, you may not be interested. “Any woman with uncontrolled heart disease is probably not physically or emotionally able to participate in sexual activity,” says Dr. Huang. “I think patients have good judgment about when they are ready and capable.”

No matter whether you know you have heart disease or not, stop if you experience chest pain during sex and make an appointment to see your doctor right away.

Who, me?

Many women find their interest in sex declines after menopause. But women who take Revatio for pulmonary hypertension may find their desire for sex increases. That’s because Revatio is basically the same drug as Viagra, which is used to treat erectile dysfunction in men.

Be sure your cardiologist knows if one of your doctors has prescribed Revatio. You will not be able to take nitrates for heart disease, due to risk of a dangerous blood pressure drop.

Libido linked to heart rate

Not interested in sex? Your resting heart rate variability (HRV) may be slow. This simply means it takes your heart longer than normal to accelerate in response to stimulation. Low HRV is often found in women with depression, anxiety and alcohol abuse, in addition to low libido. If this sounds familiar, talk with your doctor.

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