This site uses cookies to store information on your computer. I'm fine with this Cookie information

Sexual Relationships

Sexual relationships

The impact of sexual activity on the heart

Recommencing sexual relationships

Loss of libido

Commencing new sexual relationships

The impact of medication on sex life

Sex after cardiac illness: some common sense guidelines

Sexual relationships

Having heart disease does not mean the end of an enjoyable and satisfying sex life.  Many people believe that having sex increases the chances of having a heart attack.  This is a common myth.  The risk of having a heart attack during sex is actually very low and no higher than during any other daily activity.  A fulfilling sex life is important to many people.  Denying yourself and your partner of your usual activities could lead to frustration, resentment and marital discord.  We have tried to address some of the major issues regarding sexual relationships following cardiac illness.  If you have any additional or more specific questions concerning resumption of sexual activity you should contact cardiac rehabilitation staff or your GP.

back to top

The impact of sexual activity on the heart

It is important to be aware that sex is simply another form of exercise.  Sexual activity is no more, and often a lot less, stressful to the heart than other daily activities.  In fact, the physical demands of sex are relatively mild.  We place the same stress on the heart when walking briskly up two flights of stairs or walking one mile on the flat in 20 minutes.  If you are able to do tasks such as these relatively comfortably, without pain or significant breathlessness, then participating in sexual activities should not be a problem.

Some people experience angina pains, even when participating in light exercise.  This pain is often alleviated through the use of sub-lingual nitrates tablets or spray.  If nitrates are effective in reducing angina pains during exercise, they can be taken before sex.  Nitrates should not be used if Viagra has been taken (see below).
 
As mentioned, you should consider sex as a form of exercise.  Like any exercise, sex will cause physical symptoms.  When sexually active you become aroused.  This arousal involves an increase in heart rate, blood pressure and may cause you to breathe a little faster.  These symptoms of arousal reach their peak at orgasm.  Following climax, you should expect your heart rate, blood pressure, and breathing to settle back to normal after about three minute's rest. 

back to top

Recommencing sexual relationships

After cardiac illness many patients ask when they can resume intimate relations.  The answer to this question depends on the nature of your cardiac health.  Following a heart attack, providing there were no complications, it is typically recommended that sexual activity can be resumed in 2 to 3 weeks.  As you recover from a heart attack and return to normal activities, you should be able to return to the normal activity of sex.  If you have doubts ask your doctor and use a stair, walking or treadmill test as your guide.  The advice is the same whether the patient is male or female.

After heart surgery you can resume as soon as you feel able.  Chest wall pain can sometimes be a problem.  It might be useful to experiment and find a position that is comfortable for both of you.  There is no reason to avoid normal sexual activities following a bypass operation.  The main problem may be pain from the muscles in the chest.  If there are any problems do not avoid the subject, ask for help from your own doctor.  Hairs on men's chests are prickly when they regrow and their partners may find this uncomfortable.  A small soft pillow placed over the chest between partners can help.

Following angioplasty you can typically resume sex within 2 to 3 days, depending on whether your groin is bruised or painful.  Again, it may be useful to try alternative positions to become comfortable.

Sexual activity doesn't usually present a problem and is not harmful for patients with heart failure.  As in all forms of exercise, breathlessness might limit what you can manage, so take advice if this occurs.

back to top

Loss of libido

An individual's desire or interest in sex can often be affected by their emotional well-being.  Understandably, anxiety and depression are common following cardiac illness. 

Anxiety and depression may alter your ability to enjoy sexual relations.  For example, many people are fearful of having sex, or think that being excited will increase the chances of a heart attack or sudden death.  As previously mentioned this is a common myth.  Sex is no more dangerous than any other form of mild exercise.  Avoiding having sex because of fears or concerns regarding what might happen will only make it more difficult to resume normal levels of activity.  A useful strategy is to gradually increase the extent of your intimate contact with your partner.  At first, it may be that just touching, holding and caressing without intercourse will help you slowly return to a full sex life.  As time progresses you may feel more confident about engaging in full intercourse.

Depression is very common following cardiac illness.  Frequently, your emotional well-being will improve relatively quickly.  However, some people may continue to feel depressed several months after their heart attack or surgery.  One common characteristic of depression is a diminished interest in and/or enjoyment of sex.  If this is a problem you should speak to a health professional or your GP.  Medication can be very safe and effective in treating emotional problems.

Your sex drive may also be altered by your medication.  If this has happened, you should mention it to your cardiologist rather than accept it, they may be able to change your medication.  It is important you do not suddenly stop taking your medication as this can be dangerous.

back to top

Commencing new sexual relationships

We have discussed the stress placed on the heart when resuming sexual relations.  But what about starting a new sexual relationship?  Evidence suggests that the degree of stress placed on the heart increases under some circumstances.  Causal sex is thought to be more stressful to your heart.  This may be because the situation is more exciting or creates more tension.  Long-standing relationships, where people are comfortable with each other, should present no problem, but a casual encounter can lead to a greater heart rate rise.  This is not harmful to a normal heart, but if coronary disease is present, problems may occur.  An interesting statistic suggests that, of those who die or have a heart attack during sex, 80% are having extramarital sex.

A new relationship developing after heart disease has been diagnosed in one or both partners should not present problems providing it has none of the dangers of a causal encounter.  Relationships based on trust, understanding and love are not causal, and as they develop, no undue stress is placed on the heart.

back to top

The impact of medication on sex life

A common consequence of heart disease and its treatment is male impotence.  This can be a common side effect of some medications including beta blockers, the diuretics, and, more rarely, the statins.  If you have a problem developing or sustaining an erection, you should consult your doctor.  Do not stop taking your medication.  It may be possible to change your medication or dosage.  Your doctor may suggest additional medication for impotence.  Viagra is now a well-recognised medication to improve this problem, helping approximately 8 out of 10 men who take it.  Do not buy Viagra on the Internet and use it without getting medical advice.  Viagra is safe if used sensibly, but should not be taken if you also take nitrate tablets or certain other drugs.  There is no increased risk of a heart attack from Viagra. 

back to top

Sex after cardiac illness: some common sense guidelines

  • Improve and maintain good physical condition.
  • Take medicine as prescribed by the doctor.
  • Share your concerns and fears about having sex with your partner. 
  • Both partners need to feel ready to restart an active sex life.
  • Discuss your concerns with a health professional from your rehabilitation program, who can help you and your partner decide if your concerns are warranted and give you suggestions for resuming your sex life. 
  • Alternatively, if you are not sure whether you are ready for sex, ask your doctor to give you an exercise test to check your physical capacity.
  • Choose a time when you are rested, relaxed and free from the stressful feelings brought on by the day's schedules and responsibilities.
  • Select familiar, peaceful setting that is free from interruptions.
  • Don't make love if you are tired at the end of the day.  Wait until the morning when you are refreshed and relaxed
  • Avoid sex within two hours of a bath or a heavy meal.  Taking a shower and eating a light salad will be better
  • Avoid caffeine, smoking or alcohol before or after sex.  Alcohol may raise expectations that you cannot fulfill and it certainly does not enhance your sex life.
  • If you get angina, use your nitrate tablets before lovemaking

back to top