With all of the hoopla surrounding the bestseller Fifty Shades of Grey, you’d think everyone was talking about sex these days. But you’d be wrong. In fact, the very people who should be talking about sex are avoiding the subject.
Turns out, heart attack patients are notoriously reticent to talk about resuming intimate relations after they return home. It is often mentioned at the last minute, as the patient is heading out the door, when it should be given much more attention.
Now, it its first-ever scientific statement on the matter, “Let’s talk about sex: After a heart attack,” the American Heart Association (AHA) has said that “following a heart attack, risk of death or a repeat heart attack is actually low.” They go on to encourage a meaningful discussion between patients and their physicians regarding heart health and sex.
Get In the Right Frame of Mind
There are many factors that can affect the cardiac patient. Key among these are mental and emotional challenges such as anxiety, depression and even fear. There are also physical issues, including decreased function and low libido, both of which are even more affected by medications like diuretics, antidepressants, and prescriptions for chest pain and arrhythmia.
On the emotional front, TV and the movies may be partially to blame for the fear around sex and heart health. How many times have we seen the scene played out where a man dies in the throes of passion with his (often younger) lover?
The reality is, while sexual activity can be associated with a cardiac event, the risk is less than 1 percent. In fact, anger is three times more likely to trigger a heart attack than making love.
As for the anxiety, much of this comes from a lack of knowledge and education. Take the time to talk to your physician about your concerns, or even reach out to a sexual counselor. Research shows that sexual counseling gives you the information you need to resume sexual activity, improve desire, gain confidence and limit fear.
On the physical front, there is a connection between heart health and decreased sexual function, namely erectile dysfunction (ED). In fact, if you have ED, the likelihood of having a heart attack or stroke doubles.
This is due, in part, to endothelial dysfunction, in which your blood vessels don’t fully dilate. Men with this “other ED” frequently also have an increased risk of atherosclerosis, or hardening of the arteries, as well as high cholesterol and high blood pressure. By treating these risk factors, you can often reduce the risk of both atherosclerosis and endothelial dysfunction, and, in turn, erectile dysfunction.
And this condition isn’t limited to men. Women with endothelial dysfunction can have sexual limitations as well, namely inadequate vaginal lubrication. Fortunately, estrogen creams can help postmenopausal women in particular.
As for men, that little blue pill can help with erectile dysfunction, so long as they are not taking nitroglycerin tablets or other forms of nitrates for angina or chest pain. The combination of these medications can result in extremely low blood pressure.
More importantly, though, focus on implementing a healthy lifestyle. This includes not smoking, losing weight if needed, limiting alcohol, avoiding trans and saturated fats, limiting high-glycemic carbs, and increasing your intake of fruits, vegetables, whole grains and lean proteins.
Get Back in the Bedroom
As you get ready to head back into the bedroom, consider the following. The energy used during sex is equivalent to that expended during a brisk half-mile walk or climbing two flights of stairs. If you are comfortable with those activities, then resuming sex should be a breeze.
According the AHA’s guidelines, patients with stable heart disease can head back into the bedroom after a week if they haven’t experienced heart failure, shock, severe arrhythmia, or severe residual chest pain following their heart attack. Additionally, the guidelines indicate that the patient must also have “good functional capacity,” meaning they can engage in mild to moderate exercise for about 20 minutes.
Once your physician has seen you after a week and given you the go-ahead, you can go ahead. Start with cuddling, caressing, handholding, and other forms of physical intimacy. Then, when you are ready, dim the lights, shut the door, and enjoy safe sex.
 Stephens S. Let’s talk about sex: After a heart attack. Heart Insight. 2012 May;pp. 8-11.