Cardiac rehabilitation sexual advice information

Suffering from a cardiac event can have an overwhelming effect on a person’s emotional wellbeing. Therefore, it is normal to feel anxious and to have fears about resuming day-to-day activities.

Sex is an important part of life for many. Resuming sexual activity after a cardiac event is a common worry for both patients and their partners. Discussing your sex life with the cardiologist or GP after you have had a heart attack or cardiac event may feel awkward and a topic you wish to avoid.

One of the most common fears that patients experience is that sexual activity may contribute to a further acute coronary event. The facts and advice in this information leaflet should answer any questions and concerns you may have about resuming sexual activity post cardiac event.

Risk with sexual activity

The American Heart Association (AHA) suggests that for the majority of Coronary Heart Disease (CAD) patients, sex is safe. Coital Angina is Angina that occurs during or after sexual activity. This is very rare in patients that do not have Angina during strenuous physical exertion but can be more common in those with severe Coronary Artery disease who experience Angina with minimal physical activity.

Regular exercise and physical activity are good for the heart. Sedentary individuals have a higher relative risk of coital MI when compared to physically active individuals. Like any form of physical activity, having sex can make your heart work harder, by increasing your heart rate and blood pressure.

In order to reduce your risk of a cardiac event, you should consider gradually increasing the intensity of your activity slowly, allowing your body time to adjust to the demands of the activity.

Many people believe that sexual activity might be too strenuous, however if you have recovered from a cardiac problem with no complications, you are no more likely to trigger another heart attack through sexual activity than someone who has no prior known CAD.

How strenuous is sexual activity?

Sexual activity is equivalent to mild to moderate physical activity in the range of 3-5METS (metabolic equivalents). If you can achieve an equivalent energy expenditure then the risk for ischemia during sexual activity is very low (see table 1 below).

This is dependent on how active a role you play and why it is important to take on a more passive role than your partner initially.

MET (metabolic equivalent)

In order to monitor the intensity of an activity or exercise, individuals are routinely monitored using MET. The metabolic equivalent of a task (MET) is a physiological measure expressing the energy cost of physical activities. It is defined as the ratio of metabolic rate and therefore the rate of energy consumption during a specific physical activity.

Table 1: MET level of sexual intercourse compared to daily chores/physical activity.

As shown in Table 1, sexual activity is roughly equivalent to performing other daily activities. However, it is advised that vigorous sexual activity should be avoided initially, particularly with an unfamiliar partner.

When to resume sexual activity

The British Heart Foundation’s recommendation is that you are able to resume sexual activity as soon as you are feeling well enough. It is also advised that once you are fit enough to walk briskly up two flights of stairs without getting out of breath or having chest pains you can return to sexual activity.

The below table outlines guidelines for various Cardiovascular conditions:

This is only a guideline and it is recommended that the patient resumes sexual activity when he/she feels ready, both physically and psychologically.

Therefore, if you recover well after your heart attack, you can have sex again when you feel ready to do so. It is usual to lose your confidence and feel anxious when returning to sexual activity initially but be assured these feelings will ease as you regain confidence with your partner.

Tips for returning to sexual activity

• Choose a relaxing atmosphere to recommence sexual activity. Keep the room at a comfortable temperature
• Foreplay allows the body to gradually warm up and helps individuals to relax. Starting with foreplay may be helpful to increase confidence and reduce anxieties
• Having a passive role to begin with will demand less energy and allow rebuilding of confidence
• It is important for you to use a position that you are used to and are comfortable with. An unfamiliar position may cause stress and anxiety, and may potentially cause chest pain.

What to do if you get symptoms during sexual activity?

If you start to develop symptoms such as chest pain, shortness of breath, fatigue, dizziness, or palpitations gradually stop your activity. In a seated position administer your glyceryl trinitrate (GTN) spray (see exception below) as advised by your physician. If your GTN spray doesn’t ease your symptoms following the recommended dosages, call 999. Do not hesitate to ask a member of your cardiac rehabilitation team or GP if you are unsure about using your GTN.

Caution when taking or using nitrate medication

If you are taking oral “nitrate” medication regularly such as “Isosorbide Mononitrate” you must avoid certain medicines for erectile dysfunction such as “Sildenafil, Tadalafil or Vardenafil”, as when they are taken together with nitrates your blood pressure could fall to dangerously low levels increasing the risk of a heart attack.

If you are taking “Sildenafil, Tadalafil or Vardenafil” and experience chest pain during sexual activity, call 999 and do NOT use GTN – Glyceryl Trinitrate (spray or sublingual tablets). GTN should be avoided for 24hrs after Sildenafil or Vardenafil and 48 hours after Tadalafil.

Ask the Cardiac Rehabilitation nurse or pharmacist for more information.

When to avoid sexual activity

• Within three hours of a large meal

The heart is required to meet with the demands of the digestive system, therefore placing additional stress on the heart.

• Alcohol consumption

Alcohol reduces coronary circulation and also has a negative effect on sexual function.

• Anal Intercourse

Should be avoided initially as stimulates the vagus nerve which may slow down heart rate and cause chest pain through its associated reduction in coronary stimulation. It can also lead to an irregular heart rhythm.

Sex drive and erectile dysfunction

Both men and women can have changes that lead to sexual problems. Men can have problems getting or maintaining an erection is known as erectile dysfunction (ED) or impotence, and rates of sexual dysfunction are similar in women. A loss of sex drive can also be common, and both can be caused by emotional stress, or occasionally as a side effect of taking medication such as beta-blockers. Having diabetes can also affect your sex drive.

ED and sexual dysfunction can also be presenting signs of heart disease and may appear one to three years prior to angina. It is very important to speak to your GP who can check what is causing your problems and can advise you on treatment options if required.

If you are unsure about resuming sexual activity or would like further information about the contents within this leaflet, please contact a member of the cardiac rehabilitation team on 01223 216985 Monday - Friday between the hours of 08:00 to 16:00.

Privacy & Dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.