Sexual Activity and Heart Disease
Cardiovascular disease can involve:
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
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
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.
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.,
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;
The articles, on the Cardiac Health Foundation of Canada website, are presented with the understanding that the Foundation is providing information only and not rendering medical advise. Please check with your family physician, specialist or health care professional before implementing any of the ideas expressed in these articles.