Is sex safe after a heart attack?

Having a heart attack is often a
wake-up call for people to change their lives,
whether that means quitting smoking, eating
healthier or simply focusing on doing the
things they enjoy.
But surviving a heart attack can trigger
anxiety, too: What if it happens again? And
while many men and women may worry that
their heart will give out during a vigorous
exercise session, an even bigger concern
seems to be sex.
To address this fear, the American Heart
Association recently released its first-ever
guidelines for helping health care providers
advise patients about resuming a healthy sex
life following a heart attack, stroke, heart
transplant or other cardiovascular procedure.
It may sound pretty standard, but the truth is
that, until now, patients have received little
to no counseling about this important issue.
In fact, a study last year of 1,900 heart
attack patients suggests that just one-third
of women and less than half of men received
instructions about resuming sexual activity
after they left the hospital -- and were 44%
more likely to report that they still hadn't
had sex a year later.
Another recent study found that very few
female heart attack patients are given advice
from their physicians about resuming sex.
The new AHA guidelines are
aimed at educating health care
professionals about the
importance of discussing sex
with their cardiovascular
patients, but they also offer
insight for patients themselves.
"These are important
recommendations that
acknowledge the hesitancy of couples to
resume their sexual activity, even though the
actual risk of worsening with sexual activity
is extremely low," says my colleague Dr.
Madeleine Castellanos .
Does your relationship need a 'love drug'?
Here are some highlights from the guidelines:
Sex isn't as risky as you fear. It's natural
to be concerned about being sexually active
after a heart attack or other cardiovascular
problem. But it's unlikely that sex will trigger
another attack in most people. According to
the AHA, if you don't experience cardiac
symptoms (such as chest pain, shortness of
breath, and dizziness) during exercise, you
probably won't experience them in bed.
It's helpful to think of sex the way you might
think of other activities that require exertion,
such as walking up stairs, exercising, or
returning to a generally active lifestyle. If
your doctor doesn't offer, ask for an exercise
"stress" test: If you can walk on a treadmill
at a pace of about 3 to 4 miles per hour, you
should be fine, says the AHA.
Your sex life may change -- and that's OK.
As I mentioned earlier, many people take a
cardiac event as an opportunity to make some
changes to their lifestyle. While you certainly
may be able to return to the same sex life
you had before, you may want to reassess
things between the sheets.
The AHA recommends considering positions
that are comfortable -- the partner on top
during intercourse usually exerts more
energy, for example. If you're not ready to
return to sex completely, don't miss out on
other forms of physical intimacy, such as
hugging, kissing, cuddling, and touching each
other. Masturbation can be a healthy way of
easing back into things, too.
When your child walks in during sex
Women are not small men. Research
suggests that rates of erectile dysfunction
among men with cardiovascular disease are
twice as high as those without the condition.
But women may experience their own sexual
challenges, both before and after a heart
attack.
"I appreciate that the AHA was careful to
point out that women's sexuality can often
get marginalized, and that their sexual
complaints regarding lubrication and
excitation should be seen as a serious
indicator of possible cardiovascular disease,
just as it is in men with ED," says
Castellanos.
Communication is key. The major takeaway
message from the AHA guidelines is that
doctors and patients must put aside any
embarrassment and talk about sex openly.
"I hope that all health professionals will
recognize the importance of sexual
counseling and appreciate the importance
that it has for people's quality of life," says
Castellanos.
Unfortunately, not all doctors and nurses may
feel comfortable broaching the subject, so
you may have to raise it yourself. Just think
of your sexuality as part of your overall
health, and be sure to ask all of your
questions, from when can you have sex again,
to how to deal with fears and anxieties.
It may not be easy at first, but talking with
your doctor -- and your partner -- about your
concerns can go a long way to helping you
get back in the swing of things.