In recent years, much has changed in the approach to the sexuality of cardiac patients. Professionals have started to recognise sexual activity as an important area of patients' lives. Patients themselves have opened up and are more likely to ask directly for recommendations on these issues. Finally, recommendations for returning to sex after a myocardial infarction have also changed, from being very conservative and escalating the patient's fears, to being much more permissive (casual). Indeed, it turns out that in the vast majority of cardiac patients, sex is allowed and even recommended.
Aheart attack is associated with a terrible fear for one's life. It is not uncommon for a heart attack and the subsequent treatment to prompt lifestyle modifications, re-evaluations and a great deal of anxiety about what daily life will be like in the future. It is not without reason that psychologists are mandatorily employed in cardiology departments.
One important, but still considered shameful, area of activity is sexual activity. Because it is still often considered a taboo subject, patients and doctors may be reluctant to talk about it. Sex is associated with great physical exertion, which gives rise to various fears about returning to sex after a heart attack. These fears are shared not only by those involved who have experienced a heart attack themselves, but also by their partners.
This text aims to deal with some of these fears and to provide existing recommendations in this area.
What does counselling look like?
Research shows that the frequency of intercourse after a heart attack decreases if the patient has not received counselling in this area. Probably for cultural reasons, women seem to be more disadvantaged in this regard. Professionals have been shown to broach the subject less frequently with women than with men. Similarly, older age and previous sexual inactivity were factors associated with less frequent receipt of sex counselling in this group of patients.
Meanwhile, both young adults and older people often consider sex to be an important area of life. Other studies indicate that patients expect initiative from the doctor in addressing such a sensitive area as human sexuality, as they fear that asking questions directly may embarrass the doctor or be perceived as a symptom of a disorder. Providing counselling in this area would ideally fit in with the idea of a holistic approach to the patient. On the other hand, there are guidelines developed by professionals on these issues.
In Poland, books are being written on a field such as cardiosexology. It can therefore be expected that there are centres in Poland where post-heart attack patients receive advice on sexuality. If this is not the case, it is worth asking your doctor or psychologist directly to explain your concerns. In case of doubt, a simple physical capacity test verifies the safety of possible sexual activity.
Stair climbing test
Contrary to beliefs that having sex involves high energy expenditure and puts a strain on the cardiovascular system, this is not true. Researchers have found that sexual activity is, in terms of energy expenditure, the equivalent of walking about 1.5 kilometres on a flat surface in 20 minutes or quickly climbing two flights of stairs in 20 seconds. If an exercise test is available, sexual activity can be calculated as the equivalent of 4 minutes on a treadmill according to the Bruce protocol. If your physical capacity allows you to perform these activities, it may also be considered safe to return to sex. There is also no need to take a more passive role during intercourse or to reduce the frequency of intercourse.
photo: panthermedia
Risk of death during sex
The alleged need to limit effort during sex is an unnecessary stressor not only for the person who has experienced a heart attack themselves, but also for their sexual partner, who may feel guilty about expressing their own sexual needs or feel anxious during the sexual act itself ("What if it kills her/him?").
Although the French call orgasm a little death, this has nothing to do with increasing the risk of death during sexual activity. Sex, like any physical activity, is accompanied by adaptive changes on the part of the cardiovascular system. The heart rate normally accelerates to about 115-130 beats per minute and blood pressure increases by about 40 mmHg. The changes described are within the tolerance limits of a healthy body. A greater increase in these parameters, and therefore a strain on the heart muscle, can be expected when having sex under the stress of a new sexual partner ("Will I prove myself?", "Will I please?") or a new location.
Erectile dysfunction as a warning sign
Sexual dysfunction is common in cardiac patients. The best researched issue in this area is erectile dysfunction. Given that myocardial infarction is nothing more than the effects of myocardial hypoxia resulting from vascular obstruction, it seems reasonable to be concerned about the occurrence in this group of patients of other conditions with similar risk factors, such as stroke. What is much less often remembered is that the mechanism of erection formation also depends on the smooth interaction of the nervous and vascular systems. The diameter of the vessels in the penile corpora cavernosa is considerably smaller than the coronary vessels supplying the heart, so erectile dysfunction may be the first indicator of the need to visit a cardiologist for a check-up and to make lifestyle modifications. Erectile dysfunction precedes the onset of pain in the precordial region by an average of three years.
