Sexuality is a fundamental part of being human. It’s a big part of our quality of life and a significant source of pleasure and intimacy. So it’s no surprise that concerns about sexual activity are common among people living with heart disease or recovering from a cardiac event.
The worries and concerns of patients or their partners can interfere with the resumption of a satisfying sexual relationship. Fortunately, cardiac events and medications may have less impact on sexual health than previously thought. The wait time to resume sexual activity is shorter and medications that were thought to cause or exacerbate erectile dysfunction may have gotten a bad rap.
Shedding Light on Some Myths
In speaking with experts at treating heart disease, one thing becomes clear: if you enjoyed a healthy sexual relationship with your partner before a cardiac event, you will be able to return to that relationship. And if you are newly diagnosed with a heart condition, you can continue to have an active sex life. That’s important, pointed out Bonnie Quinlan, Advanced Practice Nurse in Cardiology at the Ottawa Heart Institute, because sex is not just physical. It’s also about warmth and intimacy.
Many of the received truths about sexuality after a cardiac event turn out to be less clear cut than they appeared. For instance, beta blockers, one of the most common medications for heart patients, were thought to cause or worsen erectile dysfunction (ED) in men. They seem to have less of an impact than once thought.
A study by a German cardiologist, published in 2009, found that when male patients weren’t aware they were taking beta blockers, they were no more likely to experience ED than men on any other medication for heart failure or hypertension. When they were aware of the potential side effects of beta blockers, though, their negative expectations about the medication led to anxiety and ED symptoms.
Heart Institute psychologist Heather Tulloch, PhD, confirmed the finding, noting that a recent meta-analysis of several studies examining the link between beta blockers and ED found little evidence that the medication caused the condition.
More of a problem, said rehabilitation physician Michele de Margerie, MD, may be anti-depressants, which can take away libido. It’s a huge issue, she said, especially for women. But, she added, it’s not a foregone conclusion and there are ways to help restore libido.
Another common myth revolves around when you can resume having sex. It used to be that, after a heart attack, patients were told to wait six weeks. Now, patients are advised that they can resume sex in as little as one week after a heart attack if the attack was mild and certain conditions are met.
But some cautions are not myths. For example, patients need the OK from their doctor before resuming Viagra® after a heart attack, and special rules apply for Viagra® and other ED medications if you are taking nitroglycerin medications.
Overcoming Fear and Anxiety
Despite reassurance that they can safely resume sexual activities, many patients or their partners are anxious. They fear the physical exertion of sex could cause another heart attack—probably the most common fear, said Dr. Tulloch. Or they may be concerned about reopening or damaging surgical sites, or that they won’t be able to satisfy their partner. The list of worries goes on.
Really, said Dr. Tulloch, the big thing is fear. And, as in so much else, enhanced communication is vital to overcoming this fear.
It may help to know that sex is a low-exertion activity, equivalent to walking at about 3 miles per hour on level ground, and involves much less exertion than playing golf, gardening or cycling. Weekly sexual activity will raise the risk of a heart attack from 1% to only 1.01% according to Dr. de Margerie. And if you engage in regular physical activity of other kinds, the risk is even lower.
Or it may not help. The psychological aspects of problems with sexual health are emotional, and they need an emotional response, said Dr. Tulloch. Rafts of facts, such as those about the energy required for sexual activity, don’t necessarily help.
For patients recovering from heart surgery, the emotional aspects of sexual health may not be as important—at least at first, said Anne Stolarik, Advanced Practice Nurse in Cardiac Surgery. In the aftermath of surgery, the two most common concerns are the incision site, which can be both painful and restrict overall activity until it mends, and fatigue.
“Fatigue is a huge factor in looking at the physical act of sex,” she said. But both of these issues disappear with time. “You can’t even vacuum for six weeks after heart surgery,” she said. “And patients have other priorities early on.”
There also can be a reluctance to talk about sex, especially among older patients. Stolarik said she uses humour to open up communication, and that once the conversation starts, it always is an active one.
For some groups, it’s not hard to break the ice at all. Younger patients are very interested, Quinlan said, and, in general, so are men. “Sex is a big part of their agenda,” she said. “Men are generally more open about this and it can be more of a focus than anything else.”
Dr. Tulloch leads relationship enhancement groups for cardiac couples and, she said, the topic of sexual health always comes up. In fact, it’s the most important thing participants want to know about. And the message really is, she added, “You can do it.”
“It is just physical activity,” she tells participants. “Don’t get freaked out because it’s sex.”
Resources for Getting Back on Track
Of course, that’s easier said than done. That’s why the Heart Institute, as part of its patient care and rehabilitation programs, supports patients and their partners in a variety of ways in dealing with the physical and psychological aspects of returning to sexual health.
As a physician in the Cardiac Rehabilitation program, Dr. de Margerie is happy to talk about sexual health with her patients, but she added that it is helpful for them to voice their concerns. The rehabilitation process, she noted, includes one 45-minute appointment with a physician such as herself and, with an agenda that could easily take twice as long, covering things like medication, exercise, stress, smoking cessation and diet, it is helpful to know what patients’ priorities are so they can be addressed.
That is why inpatients have access to other options such as discharge classes, where at least one session is devoted to questions of sexual health. Interest is high, said Stolarik, second only to returning to work.
“I cover it with everybody,” added Quinlan. “I’ve never had anyone say they don’t want to discuss it.”
Stolarik also observed that many patients are already having problems with sex before heart disease enters the picture. In that case, one of the challenges is to incorporate whatever they’ve done in the past, such as taking a drug such as Viagra® or Cialis®, into their new medication regimen.
If patients are having difficulties with their sexual health, the Heart Institute will provide referrals—to a psychologist such as Dr. Tulloch or to a urologist specializing in ED, where multiple solutions are available beyond the “little blue pill.”
Importantly, Dr. de Margerie pointed out, “Sexual health is part of a healthy life. But there can also be no sex in a healthy life.” If neither partner wants sex, “it’s a non-issue.” But while couples can survive without sex, they rarely do without a sense of physical intimacy, which is why the Heart Institute treats sexual health as a vital part of patient care and rehabilitation.