Is There Sex After Heart Disease?

Is There Sex After Heart Disease?
Doctors have good news for heart patients hoping to resume sexual activity.
By Karen Springen

Reviewed by Louise Chang, MD

Four years ago, Emmetsburg, Iowa, insurance agent Jim Wirtz, now 65, had triple bypass surgery. Just 10 days later, he was back at the office. Three weeks after that, he received a clean bill of health from his doctors, who said he could do any physical activity -- except shovel heavy snow.

Wirtz took their advice, and he and his wife resumed having intercourse. "Stay in the game, whether it's sex or work," he says. "My own philosophy is, you just better live."

Wirtz is doing what doctors say most heart disease patients can and should do: having sex after heart disease. "We encourage people to stay physically and sexually active," says Vincent Bufalino, MD, a cardiologist and spokesman for the American Heart Association and president and CEO of Midwest Heart Specialists. "They tend to be happier folks."

That's good news for the 80 million Americans with one or more forms of cardiovascular disease, including the 7.9 million who will suffer from a new or recurrent heart attack this year.

There are, of course, some caveats to resuming sex after heart disease. Here's what else people need to know:
Stress Tests

It's important to remember that sex is a workout. So doctors typically tell patients to abstain from sex after heart disease until they can withstand the cardiac workout.

"The concern is if somebody has absolutely no physical activity and then with sexual activity is more physically active than any other time," says Peter Schlegel, MD, chairman of urology at New York-Presbyterian/Weill Cornell Medical Center.

But patients who can handle the stairs or walk six minutes on the treadmill should be OK. "They shouldn't have any fear," Bufalino says. "I tell them if you can pass your stress test, you are more than comfortable to do anything you want -- have intercourse, play tennis, or go for a light jog around the block. We shouldn't have intercourse be one of the things we stay away from."
Sex After a Heart Attack or Bypass Surgery

Not surprisingly, some patients, or their partners, are afraid that sex will trigger a heart attack.

"After a heart attack or any kind of heart disease, they're frightened about whether or not they can have a sexual life," says Wei Jiang, MD, an internist and psychiatrist at Duke Health Systems at Duke University.

But the reality is that most patients can have a sexual life. Although you can't jump into sex the day after a heart attack or surgery, most people can resume sexual relations three to six weeks afterward, as long as they are free of chest pain or other complications.

Sex also gives heart disease patients a good incentive to change their lifestyles. "What's bad for the heart is bad for the penis," says Harry Fisch, MD, a urologist at Columbia University, and author of Size Matters. And what's good for the heart -- exercising, maintaining an ideal body weight, not smoking -- is good for the bedroom. "Everything that is healthy for your heart is healthy for your erection," Schlegel says.

If concerns persist, "You may want to seek out a psychologist to speak with about some of your fears," says Susan Czajkowski, PhD, program director for the NHLBI's division of prevention and population sciences. "The goal really is to get people back to as close as possible their normal set of activities and feeling good about themselves and feeling pleasure… Quality of life is important."
Erectile Dysfunction

Although heart disease is a risk factor for erectile function, erectile dysfunction can be an early warning sign of cardiovascular disease. The reason: the tiny arteries that go into the penis are about half the diameter of the ones that go into the heart, so they "clog up" first, says Craig Niederberger, MD, a urologist at the University of Illinois at Chicago. "The penis is like a red flag…You generally get about three years between symptoms of erectile dysfunction and symptoms of heart disease. Every man with ED should be considered a man with potential heart disease."

People with heart disease also likely have other risk factors for ED such as hypertension, diabetes, smoking, and obesity.
Medications

Beta-blockers, used for irregular heart beats after open heart surgery and to lower blood pressure, are the biggest culprit that can interfere with sex after heart disease. They lower blood pressure -- and the "hemodynamic fill of the penis," says Paul Turek, MD, a retired professor of urology at the University of California at San Francisco and director of the Turek Clinic in San Francisco. "Think of it as a hose. If you lower the pressure, you're effectively … turning off the hose. The inflow is lower."

Doctors also can try to adjust the drug's dosage over time, which can also help, or switch patients to a different medication.

An erectile dysfunction drug may help, but some men may not be able to take ED drugs because of other medications.
Using ED Drugs

Viagra, Levitra, and Cialis are OK -- with some exceptions. Phosphodiesterase inhibitors (Viagra, Cialis, and Levitra) do not increase heart attack or death rates and are considered safe for most men wishing to have sex after heart disease. One exception is in men taking nitrates (usually for angina, the sense of tightness in the chest), because the combination of the two drugs can cause a large and sudden decreases in blood pressure.

Another caveat: "the pill enables them to perform activities that will tax the heart the way it hasn't been before," Turek says. Many men feel timid and hesitate to ask about these types of medications, Niederberger says. He reassures them by explaining that the erection problem is related to the heart problem and that "sexual activity is a healthy thing to do." Sometimes a man will say, "my wife is afraid for me to take it," Niederberger says.

If ED drugs don't work, doctors may offer alternatives such as injections (which patients give themselves five or 10 minutes before intercourse and which last 15 to 60 minutes), vacuum-erection devices (a plastic cylinder that draws blood into the penis, and then a ring is placed at the base of the penis) or surgery (a prosthesis can be surgically implanted).
Depression and Psychological Issues

Men and women may suffer from depression after a heart attack, which can cause a lack of interest in sex, Jiang says. But some antidepressants may also affect sexual desire and function.

"We are truly in a dilemma," Jiang says. And not surprisingly, men with erectile dysfunction typically feel depressed, which decreases the desire to have sex after heart disease.

Therapy to deal with psychological issues can also help with sexual problems.
Lifestyle Changes Can Help

Men who take steps to live healthier can help their hearts and their sex lives. Sex also gives heart disease patients a good incentive to change their lifestyles.

Exercise increases blood flow everywhere, including to the penis, Fisch says. He recommends walking 10,000 steps a day, or 30 minutes of moderate exercise every day.

Losing weight helps patients lower their blood pressure and their cholesterol levels. Smoking constricts and damages the arteries, including those going into the penis. Heavy drinking can lower libido and lead to erectile dysfunction.

The bottom line on sex and heart disease? Patients need to talk to their doctors about their individual cases because someone who has bypass surgery is different from someone who has a mild heart attack. "They should have very open and honest conversations with their physicians," Czajkowski says. Ideally, she says, bring in a significant other.

Patients with any fear of having sex after heart disease might want to remember that intercourse is psychologically -- and apparently physically -- healthy and can have a "protective effect" on men's health.