By Julian Booker, MD
Okay. First things first. If you have heart trouble, CONSULT YOUR PHYSICIAN before proceeding with sexual activity. You should complete a thorough history and physical exam to determine that you are indeed low risk.
Now that we have that out of the way, we will review the American Heart Association’s consensus statement on sexual intercourse in persons with coronary artery disease. I cannot tell you how many times I have heard, “Doc, I just had a heart attack. When can I start having sex?” The women ask just as much as the men. Fortunately, the recommendations are the same
Before we go too far, we should probably address what your risks of having a heart attack during sex are in general. A meta-analysis was performed looking at men and women in their 50s and 60s in an attempt to define their risk of heart attack. It turns out that their risk of heart attack was more than double compared to times where they were not exerting themselves. Whether you have already had a heart attack did not appear to affect your risk. Interestingly, sedentary people had an even higher risk. This sounds very scary but what does this mean in real numbers. For people with a prior history of myocardial infarction, the chance of reinfarction or sudden cardiac death is about 20 to 30 chances per million per hour.
Sexual intercourse is felt to be safe in as little as one week following an uncomplicated heart attack. An uncomplicated heart attack can reasonably be defined as asymptomatic at mild to moderate physical activity (about 3-5 metabolic equivalents of exercise or about 2-3 flights of stairs), if you have undergone complete coronary revascularization with either stents or surgery, or you subsequently had a stress test that identified you as low risk. If you are unsure if you have cardiac symptoms, it may be a good idea for you to undergo an exercise stress test to determine your risk.
If you have coronary artery disease but have not had a recent heart attack then symptoms are going to be the primary determinant of how to proceed. If you have no angina or mild angina with mild to moderate exertion, again remember 2-3 flights of stairs, it can be considered safe to engage in sexual intercourse. If your symptoms are more severe or they occur at a lower exercise threshold, it is probably safest to have a stress test to make sure all is well. If you are having angina that is progressing either in frequency or severity, you should limit all stressful activity, including sex, and contact your physician as soon as possible.
For those of you that recently underwent complete coronary revascularization in the form of stents or bypass surgery, your recommendations are more directed towards the procedure rather than your coronary risk, again assuming that you are now asymptomatic. Cardiac catheterization through the femoral artery is probably safe within several days. If your catheterization was performed through your wrist (radial artery), then you are probably safe even sooner. For those that underwent coronary artery bypass, particularly through a mid-line incision through your sternum, you have a bit of a longer wait. For most, the sternum is reasonable healed within 8 weeks so sexual activity should probably be delayed at least 6-8 weeks.
I cannot emphasize enough that these recommendations are assuming a straight forward, uncomplicated case and are not intended to be an exhaustive review. The final decision should be made between you and your physician.
I am including some bonus recommendations to help you through this transition
- If you are suffering from erectile dysfunction, do not discontinue potentially lifesaving heart medications before meeting with your physician. Many of these medications may have alternates that will provide you with the benefits that you need while not unnecessarily adding to your risk.
- Do not take nitroglycerin within 24 hours of sildenafil or vardenafil or within 48 hours of tadalafil. It can cause you blood pressure to fall dangerously low and even kill you. No sex is worth that.
- If you have difficulty walking two flights of stairs for any reason other than painful joints, it is critical that you get clearance from you physician before sexual intercourse.
- Regular exercise can lower your chances of having a heart attack.
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