Following a heart attack, patients and their partners understandably have a lot of questions. The one they typically save for last is: “When is it safe to have sex?”
Some patients are embarrassed to bring up the topic at all, and studies suggest many physicians avoid it, too, particularly with their female patients. But it’s perfectly normal – and important – to discuss sex post-heart attack with your cardiologist.
Sexual activity has definite physical effects on the heart. It makes your heart work harder, increases the heart rate, elevates blood pressure, and causes an increase in oxygen consumption.
But exercise has those same effects, and an exercise program – begun slowly and gradually increasing in intensity – is a key part of cardiac rehabilitation.
So, the short answer is: Yes, most people can and should eventually resume sexual activity after experiencing a heart attack. In fact, research collected over a 22-year period found that heart attack survivors who had sex more than once a week were 35% less likely to die than those who abstained from sex or reduced its frequency.
Unfortunately, there are no standard guidelines for when it’s OK to resume sexual relations because the answer depends on the severity of the heart attack, the effect on heart function, and the progress made during the recovery period. A patient who had a mild first heart attack and had a stent inserted shortly afterward may be able to resume intimacy with a partner within a couple of weeks while others might be advised to wait for six weeks or more.
In other situations, recovery – and the ability to resume having sex – will take more time. Someone who had a massive heart attack and is dealing with heart failure, for example, may find sexual activity too challenging. But you should never hesitate to discuss the topic with your doctor and cardiac rehabilitation team. For many patients, having sex again is an important part of their recovery.
Heart meds, hormones, and ED drugs
The ability of the heart to cope with increased demand following a heart attack is only part of this story. Medication interactions also must be considered.
Women who take vaginal hormones to reduce genitourinary symptoms associated with menopause (vaginal dryness and discomfort, for example) are often worried the medication will increase their risk of another heart attack. But a large international study found no increased risk of cardiovascular disease and cancer related to vaginal hormones. In fact, vaginal hormone therapy reduced the risk of death from a heart attack.
Men who take medications for erectile dysfunction often ask about the risks associated with them post-heart attack. A study in Sweden showed these drugs, known as phosphodiesterase type 5 (PDE5) inhibitors, are generally safe after myocardial infarction and patients actually had better morbidity and mortality outcomes compared with nonusers.
Occasionally, ED drugs can have interactions with other medications that are prescribed for heart conditions. Nitrates are commonly prescribed for relieving angina, or chest pain brought on by exertion, and they act by expanding blood vessels. Drugs for erectile dysfunction also affect blood flow, and the two drugs should not be taken together.
Other medications commonly prescribed for heart disease, such as drugs to reduce blood pressure and control atrial fibrillation, also can have dangerous interactions with ED meds. Consult with your physician or cardiologist if you have any questions about the effects of multiple medications.
Healing hearts and minds
After a heart attack, physical limitations are not the only obstacles patients face in resuming sexual activity. Psychological barriers exist, too. Many patients and their partners are afraid that sex might trigger another cardiac event.
Studies have shown that 51% of female patients expressed fear about resuming sex after a heart attack, and 44% of their partners did as well. Beyond that, patients may experience fatigue or anxiety caused by medications. This is normal and shouldn’t last long.
The best way to address your concerns is to discuss them with the medical professionals involved with your care. Accurate and complete instructions regarding sex after a heart attack should be a standard part of your follow-up visits with your cardiologist.
Your cardiac rehabilitation specialist should be able to advise you if there are medication issues to consider. If anxiety or depression are impacting your quality of life, including sexual health, we can help you consult with a physician or counselor.
Just remember, it’s completely natural and healthy to wonder about having sex after most heart problems. For more information, you can request an appointment with one of our cardiologists or call 214-645-8000.