Sexual Health Concerns in Patients With Cardiovascular Disease
Sexual health concerns are common in patients with all types of cardiac disease, including patients with coronary artery disease, patients after a heart attack, those with implantable cardioverter-defibrillators, and patients with chronic heart failure.1–5 In fact, approximately 60% to 90% of patients with chronic heart failure acknowledge sexual dysfunction.2 Heart patients often experience changes in their ability to engage in and enjoy a broad range of sexual activities, which can result in less frequent and less satisfying sexual experiences. Sexual health is an important quality-of-life concern for patients and their partners, and healthcare providers can often help if they are aware of the problem.
For men, the most frequently reported sexual problems include reduced sexual desire and difficulty achieving and maintaining an erection.2 Cardiovascular disease and its treatment may also affect a man’s ability to achieve orgasm. Women are more likely to experience decreased sexual desire, problems with orgasm, vaginal dryness, and pain during intercourse.1 See Table 1 for a list of common sexual problems in cardiac patients.
Unfortunately, sexual problems are often not reported and go untreated, and they may negatively affect your physical recovery, emotional well- being, and intimate partner relationships. Moreover, studies suggest that a majority of patients and their partners have questions or concerns about their sexual health.6 Often, these concerns go unexpressed and remain untreated during routine cardiac care. Therefore, the purpose of this patient page is to describe common sexual difficulties, to identify strategies to improve your sexual health, to discuss steps to effectively communicate concerns to healthcare providers and partners, and to provide answers to frequently asked questions about sexual health concerns.
Factors That Contribute to Sexual Problems in Cardiac Patients
Cardiovascular disease increases your risk for developing sexual problems. Cardiovascular disease and its treatments change the way blood circulates throughout the body and may reduce the amount of blood supplied by the heart to distant areas of your body, including the genital region. Reduced blood flow can lead to erectile dysfunction in men and sexual arousal difficulties in women. Symptoms of cardiovascular disease such as chest pain, shortness of breath, and fatigue may also interfere with sexual performance and enjoyment of sexual activities. Additional factors such as having multiple chronic health conditions (ie, diabetes, COPD, cancer) and side effects of certain medications may also disrupt sexual activity.
Additional Factors That Can Disrupt Sexual Health
Fear that it is not safe to be sexually active
Emotional distress, depression, and anxiety are common in patients coping with cardiovascular disease and are associated with increased risk for sexual problems.7 In addition, concerns about whether sexual activity is safe after a cardiac event can lead to avoidance of physical affection and intimacy. Relationship problems and health behaviors such as smoking, inadequate sleep, alcohol abuse, and physical inactivity can also interfere with sexual performance and lead to sexual problems.8,9
Strategies to Improve Your Sexual Health
Communication With Healthcare Providers
Research has shown that 61% of patients want to discuss sexual health concerns with their medical providers,2 yet fewer than 15% have had those discussions with their physician.8 Patients and their partners can find it difficult to discuss issues related to sex and intimacy. However, your healthcare providers view sexuality as an important part of your life and are used to talking about these issues. You may need to initiate this conversation with your cardiologist or another member of your medical team.
How to Start the Discussion With Providers
“I read somewhere that my heart condition could get in the way of intimacy.”
“I want to be intimate with my partner, but I am worried that it will make my heart beat too fast.”
“My partner is concerned that sex is not safe for my heart.”
Communication With Your Partner About Sexual Concerns
Many patients are fearful or anxious about resuming sex or have concerns about sexual performance after a cardiac event. Physical changes in appearance, surgical scars, and body image concerns are also common and may interfere with sexual activity. For patients in a partnered relationship, open and honest communication with your partner about your concerns is an essential first step toward resuming intimacy. Understanding each other’s sexual interests and concerns will allow you and your partner to develop a plan of action that meets both of your needs for intimacy, emotional connectedness, and physical affection.
Returning to intimacy can be a slow process, but you need to start somewhere. Approach this problem as a couple, and try to keep an open mind to new ideas and experiences. Start by spending time with your partner in ways that focus on physical affection without the expectation of sex. This will help create a romantic mood that leads to a greater sense of emotional closeness and relationship satisfaction. If your partner is anxious about resuming sex, listen to his or her concerns and start off slowly by just holding hands, cuddling, or kissing. As you and your partner become increasingly comfortable with resuming sexual activity, you can gradually incorporate more intimate activities into your relationship.
Seeking new romantic relationships after a cardiac event can be particularly stressful for patients who are less than 50 years old or single. Fear or anxiety about dating, initiating sex with a new partner, and sexual performance concerns are common. Before initiating a new sexual relationship, it is important for you to have an open and honest conversation with your partner about any potential challenges or sexual concerns. For example, if you have physical limitations, you should discuss them with your partner, and together you should develop a list of possible solutions or positions that maximize performance and promote mutual satisfaction with the sexual encounter.
Manage Health Behaviors That Interfere With Sexual Activity
Table 2 is a list of common health behaviors that interfere with sexual activity and suggested strategies to improve your sexual health.
A number of treatment options are available if you or your partner experiences sexual difficulties as a result of cardiovascular disease. Table 3 describes the advantages and disadvantages of each treatment. Talk to your doctors about your sexual health concerns. You may want to bring your partner to that appointment for emotional support or to provide additional information to your doctors if needed. Your heart condition, health history, and medications may affect which treatments can be prescribed.
Your cardiologist may refer you to a doctor who specializes in treatment for sexual dysfunction. Sexual problems can also be a symptom of emotional distress or depression. These symptoms are common and can often be treated with 2 to 3 counseling sessions with a psychologist or mental health provider. Long-term struggles with depression might require additional treatment. Keep in mind that you may need to try 1 or more strategies before you find what works best for you and your partner.
The reality of heart disease is that it can disrupt your quality of life and daily activities in a number of ways, including your sex life. Sexuality and intimacy concerns are common and important to patients with cardiovascular disease and their partners. If you or your partner experiences sexual difficulties and are interested in treatment, talk to your healthcare providers about your sexual health concerns. Having this discussion with your providers to address frequently asked questions (Table 4) will allow you to receive accurate information, suggestions, or professional recommendations to help you overcome these issues.
Dr Sears serves as a consultant to Medtronic and has received research grants from Medtronic. Dr Sears also has received speaker honoraria from Medtronic, Boston Scientific, St. Jude Medical, Biotronik, and Spectranetics. The other authors report no conflicts.
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.
- © 2014 American Heart Association, Inc.
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