Sexual Health for Patients With an Implantable Cardioverter Defibrillator
Studies examining the quality of life of implantable cardioverter defibrillator (ICD) patients have consistently demonstrated that ICD patient quality of life is at least equal to, if not better than, that of patients treated with medications alone.1 Quality of life may be related in part to the patient's ability to resume “pre-ICD” activities; however, sexual activity is rarely included as part of the patient education process. Sexual functioning has not been well studied in ICD patients, but preliminary research has suggested that patients commonly express concerns about fear of ICD shock during sex, varying interest and pattern of sexual activity, and a desire for more information and sexual counseling.2 The purpose of this Cardiology Patient Page is to identify typical issues related to sexual functioning in ICD patients and offer possible strategies for effective management.
Barriers to Healthy Sexual Functioning in ICD Patients
Despite limited research regarding the social functioning of ICD patients, our collective clinical experience suggests that common barriers exist when it comes to addressing their sexual health. The following sections detail specific barriers to healthy sexual functioning for ICD patients and proposed strategies for overcoming those barriers.
Communication Between Patients and Healthcare Providers
Although some people may believe that sex, love, and intimacy are subjects not to be discussed with others, sexual activity is highly relevant to your health and well-being and is an absolutely appropriate topic of discussion with your doctor. Unfortunately, research has shown a lack of adequate communication about sex between cardiovascular patients and their healthcare providers. Despite estimates that >75% of patients with cardiovascular disease experience some type of difficulty with sexual functioning,3 a lack of communication between patients and doctors persists.
Research has shown that 98% of patients reported that they believed their cardiologists should discuss sexual functioning with them; however, only 15% of patients have ever had such a discussion with their doctors.4 Although ICD patients clearly desire improved communication about sex, these discussions rarely occur.
Develop an effective communication strategy with your doctor or healthcare professional regarding your sexual concerns, because this is a vital component of health and well-being. Spouses or intimate partners should also be involved in these conversations. Bring written questions or concerns to provide to your physician. Be proactive about this component of your health! The Table contains some frequently asked questions and answers that you may wish to discuss further with your doctor or healthcare professional.
Your comfort with sexual activity or your desire for sex may have changed after implantation of an ICD. For many patients, a decrease or temporary stop in sexual activity is normal. Even if this occurs, it is important to continue to maintain a level of closeness and intimacy with your partner. As you consider returning to sexual activity with your partner, you may want to discuss what you are comfortable with at this time. If the idea of intercourse is too much for you to start with, other forms of intimacy may be a good start, such as holding hands, hugging, kissing, or finding your own ways of being close. A lack of sex will not damage a relationship, but a lack of intimacy and open discussion certainly could.
When you feel ready to move forward, you should set aside some special time for you and your partner, free from distractions. Taking things slowly at first may help. This can take time, patience, and effort from both of you. Although many may think exclusively of sex when discussing intimacy, there is actually more to intimacy than just intercourse. You and your partner may want to explore other activities to help you feel sexually satisfied. Intimacy is a continuing process, not just a single event.
Confirm your readiness for sexual activity with your doctor.
Talk with your partner about activities that both of you feel comfortable engaging in ahead of time.
Plan for sexual activity when you are likely to be more relaxed and have sufficient time to rest both before and after sex.
Moderate your food intake and alcohol intake before sex. If you are a woman, it is particularly important for you to drink water both before and after engaging in sexual intercourse.
Allow yourself to pace yourself back into sexual activity if necessary.
Fear of Shock During Sexual Activity
Fear of the cardiac risk associated with sexual activity is a common concern in ICD patients.2 A large number of patients do not return to normal sexual activity after a cardiac event, possibly owing to fear of triggering additional cardiac problems.5 However, the physical demand of sexual intercourse has been described as being within the range of moderate physical activities and is often achieved or exceeded during a normal workday.6 A study of 1774 patients who had experienced an acute myocardial infarction7 showed that sexual activity was a likely contributor in fewer than 1% of cases. In fact, regular physical exertion, such as that associated with sexual activity, was associated with a decreased risk of cardiac events in patients!
Similar to other cardiovascular patients, ICD patients often experience fear about the perceived strain of sexual activity on the heart and the subsequent potential for ICD shock. However, the absolute risk caused by sexual activity is considered to be extremely low, because sex for most patients represents only a moderate stress on the heart.
Sex is a common concern, but most sexual activity is safe and is considered a gentle form of exercise. You and your doctors should explore issues related to fear of shock and establish a shock plan8 in the event that shock were to occur during sex. Feeling safe to return to sexual activity, having confidence in your device for protection, and decreasing any fear of shock during normal sexual activity can ensure a comfortable return to sexual activity.
Returning to Life After a Cardiac Event
Although you may be familiar with coping strategies to deal with difficulties, stress can still become too overwhelming to handle on your own. This can certainly be true after experiencing a cardiac event. Resuming sexual activity may represent yet another stress you may face; something that feels like “just one more thing” to deal with. Despite all of your efforts, there are times when stress like this cannot be handled by one person any longer.
Unfortunately, some patients who experience a cardiac event never return to sexual activity.5 Abstaining from sexual activity should not be a consequence of a cardiac event. There is no research to date that has suggested that ICD patients should not engage in sex. Even if you feel you are not physically able to engage in sexual intercourse, you should not let this stop you from engaging in other intimate activities. Even the most stressful problems, such as resuming sexual or intimate activity, can be carefully worked through with the help of a professional. Achieving a satisfying and fulfilling sexual relationship can represent both a physical and psychological achievement for you and your partner.
Keep in mind that there are times when you may need the support of a professional. It is important to be able to recognize the warning signs that may alert you that it's time to call for “backup.” The following are general signs that you need to consult a professional for help with your concerns:
Feeling sad or depressed on most days of the week
Not enjoying activities that were once pleasurable, such as sex or intimacy, or having a lack of interest in things that used to be fun
Avoiding activities, people, intimacy, or situations
Thoughts of hurting or killing yourself, or feelings of hopelessness
Feeling nervous, jittery, or tense, or being unable to get worries out of your mind.
Patient with ICDs may face unique challenges, including changes in sexual functioning or concerns about the safety of sexual activity. Communication with healthcare providers is essential in striving for optimal health and well-being. Improving communication with partners can promote healthy intimate relationships and ensure comfortable and satisfying sexual functioning. Resuming sexual activity may be a key component of returning to life after a cardiac event and taking control of the pursuit of optimal health.
Dr L.D. Vazquez has received speaker honoraria from Medtronic. Dr Sears serves as a consultant to Medtronic and has had or currently has research grants from Medtronic and St. Jude Medical and has received speaker honoraria from Medtronic, Boston Scientific, St. Jude Medical, and Biotronik. J.B. Shea serves as a consultant to Medtronic, Boston Scientific, St. Jude Medical, and Sanofi-Aventis and has received speaker honoraria from Medtronic, Boston Scientific, and St. Jude Medical. Dr P.M. Vazquez has no conflicts of interest to disclose.
The information contained in this Circulation Cardiology Patient Page is not a substitute for medical advice, and the American Heart Association recommends consultation with your doctor or healthcare professional.
- © 2010 American Heart Association, Inc.