Let’s talk about sex and heart disease
Heart and stroke patients and their partners should receive individually tailored counselling from healthcare professionals about resuming sexual activity. This is now recommended in a consensus document issued by the America Heart Association and the European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions.
Patients are often afraid that sex will trigger another cardiac event. Due to embarrassment or discomfort, the topic may not be discussed with their doctors. This is the first scientific statement offering detailed guidance for patients. This includes information about ‘how to’ resume sexual activities after having had a heart attack, heart transplant, stroke, or having other heart conditions, including having an implanted heart device. Previous recommendations focused on when to resume sex, risks associated with sex and managing medications.
The statement recommends that healthcare providers routinely assess all patients after a cardiac event and at follow-up visits to determine if the patient is healthy enough to resume sexual activities. Healthcare providers should give individualised, structured counselling based on specific needs and the medical conditions. Furthermore, among other recommendations, patients should be advised on recommended positions, how to be intimate without having sexual intercourse and when to resume sexual activity. All patients should be counselled, regardless of gender, age and sexual orientation.
Exercise stress testing is recommended for some patients, through which can be assessed if the heart is strong enough to resume sexual activity. Brisk walking is suggested for some heart patients, before resuming sexual activity. The authors note that the stress of extramarital sexual activity may put people with heart disease at risk.
Since heart medication can affect sex drive and function in both men and women, medication use should be discussed before a patient considers stopping to take a drug. A healthcare provider can assess whether sexual problems are caused by a drug.
The recommendations are based on evidence-based research on sex counselling. Classes of the magnitude of the treatment effect are distinguished, along with an indication of the level of certainty about that effect. General recommendations are given for sexual activity and cardiovascular disease, as well as for specific CV conditions.
It is often easier for the healthcare professional than for the patient to start a conversation about sex. Since these topics are essential to the patient’s mental and physical health, healthcare providers are urged to counsel heart and stroke patients on how to resume a healthy sex life. All health care providers, thus including cardiologists, primary care practitioners, nurses, nurse practitioners and physical therapists, should be ready and willing to address these topics. Additional training on sex counselling in cardiovascular disease may be necessary.
Press release American Heart Association and European Society of Cardiology
Steinke EE, et al "Sexual counseling for individuals with cardiovascular disease and their partners: A consensus document from the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP)"
Find this article online at Eur Heart J (2013) doi: 10.1093/eurheartj/eht270, or at
Circulation 2013; DOI: 10.1161/CIR.0b013e31829c2e53