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Cardiovascular Disease: Sexual Problems and Their Management
(05/04/2004) by Annette Owens
Cardiovascular disease can involve:
1) Atherosclerosis
Atherosclerosis is a narrowing of small blood vessels. Changes may be
confined to blood vessels in the heart, reducing the blood supply for the
pumping heart. This is called "ischemic heart disease." If the heart’s
pumping action is increased during exercise or stress, the blood supply
through the coronary arteries may not be sufficient, and pain (angina)
occurs. If one or several of the coronary arteries become blocked off
completely, myocardial infarction (heart attack) occurs.
Atherosclerotic changes of small blood vessels can also occur in the legs,
causing pain during walking or exercise ("intermittent claudication"). If
blood flow to the penis is affected, problems with erections may occur.
2) High blood pressure
3) Breathing problems
If the heart has trouble pumping blood through the body and the lungs,
breathing may be affected. The effects of this condition and other chronic
lung diseases on sexual wellness are covered in a separate section (Lung
Disease).
General suggestions related to sexual problems and their management
If you have hypertension (high blood pressure) you may fear that sexual
activity will increase your blood pressure to dangerously high levels.
Unless sex occurs with a new partner in unusual or unfamiliar surroundings
or involves a high level of physical activity, it should be tolerated as
well as any other kind of moderate physical activity of a non-sexual kind.
See your doctor regularly in order to keep your blood-pressure under
control and discuss possible side effects of your medication. Depending on
which medicine you are taking, possible side effects include decreased
lubrication in women and diminished erections in men. Do not stop taking
your medicine if side effects occur. Your doctor may be able to improve the
timing, lower your dose and/or combine several medications in order to
reduce the side effects you are experiencing.
Women with decreased vaginal lubrication can use water-soluble lubricants
(K-Y jelly, Astroglide, etc.), sold over the counter in most pharmacies.
Erectile dysfunction can have psychological and/or physical causes.
Sometimes, erectile problems are resolved after the medication has been
adjusted. Sexual counseling or sex therapy may be helpful. Various treatment
options for physical erectile insufficiency exist.
Remember that erectile dysfunction does not prevent you from being sexually
active and giving towards the one you love. This may be a good time to
explore alternative ways of being loving and intimate with your partner
without having firm erections.
If you feel a reduced interest in sex, remember that you still can have a
loving relationship with your partner without sexual activity. There are
many ways of expressing your love and fondness without having sex, including
cuddling and kissing each other.
If you feel very tired, try to plan intimate time with your partner at
times when you are most rested.
Angina (pain) during sexual activity should be judged in the same way as
angina during exercise. Coronary dilators can be used before intercourse.
Activity should not continue if ischemic symptoms persist. In this case, you
should slow down or take a short rest until the pain has resolved
completely.
If you have experienced a myocardial infarction (heart attack), you and
your spouse may fear that sex will put too much stress on your heart.
Research has shown that patients after a MI benefit from enrolling into a
cardiovascular rehabilitation program. The low risk of triggering a MI
during sexual activity is nearly unchanged whether you have a history of
heart disease or not. Regular exercise can even reduce the risk further
(Muller et al. 1996).
Use the positions during intercourse that feel most comfortable and
relaxing. The stress on your heart differs little whether you are on top, or
on bottom. If the male is on top it may require less muscle activity if he
is prone on his elbows, rather than extending his arms to support his upper
body. A side-by-side position, or use of a low wide chair may be
comfortable. Some of these positions are well illustrated in the reference
book by Sipski & Alexander.
When is it safe to return to sexual activity ?
If you have had a coronary artery bypass grafting (CABG) it is recommended
that you wait at least four weeks before resuming sexual activity. This will
allow the sternum to heal and prevent pain from the incision.
It is strongly recommended that you enroll in a cardiac rehabilitation
program. The results of an exercise stress test are good predictors for how
well your heart tolerates physical stress, including sexual activity.
Fertility & pregnancy
If you are in the reproductive age and have cardiac problems, your doctor
may advise you against certain oral contraceptives because of potential
blood-pressure increases. Alternative methods for birth control include
diaphragm, intrauterine device, cervical cap, condoms, and sterilization.
Women with heart disease (congenital or acquired) can have normal
pregnancies. If you have had a heart valve replacement, your doctor can
advise you about the risks of using anticoagulants during pregnancy. Some
women may need more instrumental help (including caesarian section) during
labor and delivery. Sometimes the birth weight of babies born to mothers
with heart problems are in the lower range.
Avoid sexual activity:
after substantial intakes of food or alcohol
when fatigued
when under time pressure
during emotional outbursts
when under emotional stress
under temperature extremes.
Be sure to report to your doctor if the following symptoms should occur:
persistent angina during intercourse
rapid heart rate or difficulty breathing that persists for 7 to 10 minutes
after orgasm
feelings of extreme fatigue after orgasm
development or persistence of other sexual difficulties.
Local support
The Charlottesville Sexual Health & Wellness Clinic offers individual and
group session where people with cardiovascular problems and/or their
partners can discuss their concerns related to sexual wellness. If you live
in the Charlottesville area and are interested in participating, please
submit your contact information using group@cvillewellness.com.
Other Support Groups
The American Heart Association in collaboration with The Senior Center:
Wednesday 7:30pm - 9:00pm, The Senior Center, 1180 Pepsi Place, off
Greenbrier Drive. Parking is free and convenient. Guest speakers every 3rd
Wednesday. For further information, please call
The American Heart Association, Charlottesville/Albemarle Division, 3025
Berkmar Drive, Charlottesville, VA 22901, (804) 973 5072, or
Ben Word, Jr., MD (804) 977 9097
References
Bancroft, J. (1989) Human sexuality and its problems. Churchill Livingstone,
ISBN: 0-443-03455-9
Milsten, R. & Slowinski, J. (1999) The sexual male. Problems and solutions.
Norton, ISBN: 0-393-04740-7
Muller, J.E. et al. (1996) Triggering myocardial infarction by sexual
activity. Low absolute risk and prevention by regular physical exertion.
Journal of the American Medical Association; 275: 1405-1409
Schover, L.R. & Jensen, S.B. (1988) Sexuality and chronic illness. A
comprehensive approach. The Guilford Press, ISBN: 0-89862-715-X
Sipski, M.L. & Alexander, C.J. (1997) Sexual function in people with
disability and chronic illness. Aspen Publishers, Inc., ISBN: 0-8342-0886-5
The Sensuous Heart: Sex after a Heart Attack or Heart Surgery Suzanne Cambre This cartoon-style booklet explains the emotional and physical needs of persons who have had heart attacks or heart surgery. It answers questions about frequency of sexual activity; suggests comfortable positions; and covers the effects of alcohol, prescribed drugs, stimulants, and illegal drugs. 1990, 21 pp., $5.75 plus $1.50 postage and handling. Pritchett and Hull Associates, 3440 Oakcliff Road NE, Suite 110, Atlanta, GA 30340-3079; 800-241-4925.
Sexual Concerns When Illness or Disability Strikes Carol Sandowski This book discusses the possible effects of various medical conditions (arthritis, diabetes, spinal cord injury, alcoholism) on sexual functioning, relationships, self-esteem, and communication. The author explores treatments for sexual dysfunction. 1989, 281 pp., $56.75 plus $5.50 postage and handling. Charles C. Thomas Publisher, 2600 South First Street, Springfield, IL 62794-9265; 217-789-8980, 800-258-8980.
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