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Sex After Heart Attack

Yes, you can have sex after a heart attack. Great sex. You just need to start slowly. Here are answers to questions you may be too embarrassed to ask your cardiologist.

Discussing your sex life with the cardiologist after you or your partner has had a heart attack may feel as awkward as buying condoms for the first time. However, it's normal and common for couples to have questions and concerns about resuming intimacy. We asked top specialists what their patients need to know.

Am I at Risk for Another Heart Attack if I Have Sex?

You should be fine. In fact, the more you exercise-including having sex-the better your odds. So get moving! First, seek your doctor's guidelines, but they are rarely prohibitive, says Shirley Zussman, Ed.D., a New York City sex and marital therapist and coauthor of the newsletter Sex Over 40. "It helps people to feel more confident that they can resume a normal life."

She urges couples not to cling to their previous sex lives. "Instead, be open to a new one," she says. "A heart attack can even lead to a revival of a sexual relationship. It helps us to realize that we're all very vulnerable and life is precious."

How Soon can I Resume Sexual Intercourse?

If you can comfortably walk a quarter-mile or climb two flights of stairs, you can have sex again. For most people, that's within a few days of a heart attack. After a severe coronary, you might have to wait two weeks.

"You sort of have to test yourself on the sidewalk before you test yourself in the bedroom," says Gerald W. Neuberg, M.D., cardiologist and director of the Intensive Care Unit at New York-Presbyterian Hospital/Allen Pavilion. "Sex is physically therapeutic. Like other regular physical activity, it's heart-healthy-good for your circulation, metabolism, and reducing future heart-disease risk."

Can Sex Cause a Heart Attack?

While research shows that sex can indeed trigger heart attacks in some people, especially men, the odds of literally succumbing to passion are very low. Sexual activity is a contributing factor in less than 1 percent of heart attacks, according to a 1996 study by Harvard Medical School researchers.

Although heart attacks during sex are rare, no one wants to be among the unlucky few who die while getting lucky. So if you have cardiovascular disease (CVD), or even if it runs in your family, it's important to ask your doctor what type of sexual activity is safe. If you've just had a heart attack, for instance, you should wait three to four weeks before having intercourse, according to current guidelines.

And if you have heart failure, your doctor may recommend that you avoid lying on your back during sex, because fluid is more likely to pool in your lungs in that position.

Heart health step-by-step

The physical danger posed by sexual activity is probably the least of your problems, however. There are plenty of other ways for heart disease to curtail your sex life. Everything from incision pain following bypass surgery to the emotional stress of living with a heart condition can get in the way of intimacy.

Sexual activity and heart conditions can interact in complicated ways, which can be difficult to tease apart. To make matters worse, heart patients (and their partners) are often uncomfortable discussing their sex lives with their doctors and vice versa.

So what's a heart patient to do? Prepare a list of intimacy questions in advance of your next checkup, then review the list with your doctor in the same way you would review a list of medications or orders for exercise. 

Is my sexual dysfunction related to my heart?

The link between cardiovascular disease and sexual dysfunction is well established, at least in men. Researchers have known for years that erectile dysfunction (ED) is disproportionately common among men with CVD (and even among those with risk factors for CVD, such as diabetes and high blood pressure). While erectile dysfunction can result from a number of factors, including psychological ones, the majority of cases can be traced to vascular problems.

The shared mechanism linking ED and CVD is believed to originate in the endothelium, the thin layer of cells that lines blood vessels. Risk factors such as high cholesterol, high blood pressure, and cigarette smoking prevent cells in the endothelium from releasing nitric oxide. This compromises the ability of blood vessels to dilate, which can lead to both atherosclerosis and erectile dysfunction.

Atherosclerosis, the hardening and narrowing of the arteries that causes coronary heart disease, can affect the arteries that pump blood into the penis just as readily as those that surround the heart. But endothelial problems can also prevent the so-called smooth muscle in the penis from relaxing properly. In either case, erections become harder to sustain.

For a long time it was thought that ED was strictly a side effect of CVD and atherosclerosis, but experts now believe that ED may actually precede heart problems. A 2005 study in the Journal of the American Medical Association described ED as a "harbinger" of cardiovascular events.

The study, which analyzed more than 4,000 men without symptoms of CVD or ED, found that the men who subsequently experienced ED were nearly 50 percent more likely than those who did not to experience a cardiovascular event within seven years.

It's important to know that just looking fine doesn't necessarily mean you have a healthy heart.  Both the patient and their partner should talk to their doctor about any sexual dysfunction, because it could signal a cardiac problem.

In women, the relationship between CVD and sexual dysfunction is less clear. Although sexual dissatisfaction in women has been linked to peripheral arterial disease, the mechanisms of female sexual function are thought to be less intertwined with the cardiovascular system.

Do my heart meds have any sexual side effects?

If your heart doesn't cause you problems in the bedroom, the medicine you take to keep it healthy might. Several medications commonly prescribed to heart patients can have sexual side effects in both men and women, including ED and loss of libido.

Two kinds of cholesterol-lowering drugs, fibrates and statins, have been linked with ED, but it is mainly blood-pressure medications that are believed to contribute to sexual dysfunction.

Beta-blockers, calcium channel blockers, angiotensin-II receptor antagonists, and diuretics are all associated with ED.  Although some experts have argued that hypertension itself is responsible for ED, a 2007 study in the International Journal of Impotence Research found that men taking angiotensin-II receptor antagonists were twice as likely to experience ED than men whose hypertension was untreated. Another study of nearly 1,400 men determined that taking hypertension drugs (diuretics, beta-blockers, methyldopa, or clonidine) increased the odds of experiencing ED by 2.5 times.

Blood-pressure medications are also known to cause sexual dysfunction in women, although the phenomenon hasn't been studied as extensively as it has in men. One reason for the disparity may be that the most common symptoms in women -- loss of libido, inadequate lubrication -- are more subtle than ED.

When Liz S., 48, first started taking a beta-blocker, she saw her sex drive shrink significantly.  "I went from being a really vibrant woman to someone who could just live without it," she says. "When my husband initiated anything, my attitude became, 'Oh no, do we have to do this?'"

She was too embarrassed to bring up the issue with her doctor. "Initially I thought my lack of sex drive pertained to all of the stress I was under, not to my heart medications," says Liz, who was on the beta-blocker Toprol-XL (metoprolol) before suffering a heart aneurysm.  "None of my doctors explained that it could be a side effect of what I was on."

It wasn't until she switched insurance companies and got a call from one of the nurses on staff that she finally got to the root of her problem: "She asked a couple of questions that acted as a trigger for me to evaluate my sex drive and realize what was wrong."