A flood of questions arose following my earlier article on sex and the
heart, making it necessary to address unanswered issues related to those with
underlying heart disease. While the past focus was on the risk of getting a
stroke or a heart attack with sex, my current focus will be on managing sex for
those with heart disease.
Heart attack and sex
While data from multiple research
trials shows that heart attacks are more likely to occur during sexual activity
than at rest, for those who have sex more frequently or who are physically fit,
this likelihood is less compared to someone who is desk-bound or a potato
couch.
When your doctor tells you that
you have significant narrowing of one of your heart arteries, this doesn't
spell the end of your sex life. If you are able to walk briskly for 10 minutes
without developing chest pain or becoming excessively short of breath, sex with
your regular partner will usually not be a problem.
Should the blockage be severe and
involve the origin of the left heart arteries (left main artery) or the initial
segment of the key artery supplying the main pumping chamber of the heart
(proximal left anterior descending artery), a proper discussion with the doctor
is necessary as a heart attack involving these arteries is associated with a
high risk of sudden death. For these individuals, the risk remains relatively
low if chest pain is absent during brisk walking.
Sex after a heart attack
After an uncomplicated heart
attack, sexual activity can be resumed if the individual can walk briskly
without symptoms. If, however, chest pain or shortness of breath occurs with
minimal exertion, sex should be avoided till the heart condition is stabilised.
Generally , the risk of death from sex after a heart attack remains small. For
those who have suffered a heart attack previously, an hour of physical sexual
engagement can increase the risk of a recurrent heart attack or death from 10
chances in 1 million to up to 30 chances in 1 million.
Sudden death during sex
Data from one Japanese and two
German published papers showed that sudden death during sexual intercourse
(coital death) accounted for 0.6 to 1.7 per cent of all sudden deaths. Coital
death occurred predominantly in males (about 80 to 90 per cent were males),
mostly during extramarital sex (75 per cent of deaths) with a younger partner
away from home, sometimes spiced with liberal alcohol intake.
Surgery for heart disease
Inserting a stent to open a
blocked heart artery does not mean that sex is definitely safe. If all the
blocked heart arteries have been opened during the procedure, regular sexual
activity can be resumed after a week. If there is residual significant blockage
of the heart arteries, one can only engage in sex with low risk if a stress
treadmill test shows minimal or no abnormal findings.
For those who have undergone
heart bypass surgery or open heart surgery for valve disease, once the breast
bone surgical wound has healed well and they are able resume routine activities
in daily life, sexual activity can resume.
On average, this may take six to
eight weeks. However, such individuals will need to adopt positions during sex
that will not put undue stress on the surgical wound. A 2007 publication in
Heart Lung by Clark reported that those who recovered successfully from heart
bypass surgery expressed satisfaction in their sex lives.
Can weak hearts withstand the stress of sex?
No matter how weak the heart pump
is, the perennial question "Can I have sex?" always crops up. Those
whose hearts are swollen and weakened as a result of a heart attack or viral
damage may sometimes develop heart failure with resultant water in the lungs
and shortness of breath.
Heart failure patients have
decreased appetite, decreased energy and reduced sexual interest. For those who
still retain their appetite for sex and are able to do most routine activities
of daily living with minimal or no symptoms, sexual activity can continue. If
huffing and puffing interferes with the enjoyment of sex, the person will find
greater sexual satisfaction by being a passive partner, lying on the back or
partially propped up with pillows.
Abnormal heart rhythms
Sex is rarely contra-indicated
for those with irregular heart rhythms or those who have a pacemaker or
automatic implantable cardiac defibrillator (AICD), as long as they are not
impeded in their daily routine as a result of their underlying medical
condition. Exceptions may include those with AICD who have received multiple
shocks, in which case it is prudent to stabilise the condition prior to
resuming regular sexual activity.
Even then, there is no evidence
that when the AICD discharges an electrical impulse, the other partner will
suffer an electrical shock while in the throes of intimacy.
Overcoming difficulty in enjoying sex
Those with heart conditions may
suffer erectile dysfunction to varying degrees and, invariably, the question
will pop up "Is it safe for me to take a pill? ". The
"pill" refers to phospdodiesterase 5 inhibitors (PDE5 inhibitors),
which includes sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis)
- all drugs which enhance erectile function.
They are generally safe to use
for those with stable heart disease except that Levitra is to be avoided in the
case of those with an electrical disorder of the heart called prolonged QT
interval. Care must be exercised in certain situations.
As these drugs may cause mild
reduction of blood pressure, caution must be exercised when the patient has low
blood pressure or is taking alpha-blocking drugs as this may further reduce the
blood pressure resulting in symptoms.
The same applies to those who are
already on nitrate drugs, where PDE5 inhibitors should be avoided as
concomitant use may reduce blood pressure significantly. Therefore, nitrates
should be avoided for 24 hours after consumption of Viagra or Levitra, and for
48 hours after consumption of Cialis.
There are two conditions which
are associated with reduction in blood flow from the left heart chamber to the
aorta, where there is concern about the safety of using PDE5 inhibitors; one is
a result of mechanical obstruction caused by thickening of the heart muscle
(hypertrophic cardiomyopathy) and the other is severe narrowing of the valve
opening into the aorta (severe aortic stenosis). While there is no data on
this, there is concern that the use of PDE5 inhibitors may aggravate these
medical condition.
Most women who have an underlying
heart disease are post-menopausal and the main impediments to sex are vaginal
dryness and pain during sex. Topical application of the female hormone,
estrogen, in the vagina and at the vulva may relieve these symptoms and have
not been demonstrated to increase cardiovascular risk.
Finally, the commonest reason for
failure to enjoy sex in those with heart disease is the anxiety of both the
patient and the partner concerning the risk of aggravating the underlying heart
condition by having sex. Having a good understanding of enjoying sex safely by
those with heart disease and their spouses will go a long way in helping them
maintain a healthy and intimate sex life.
Dr Michael Lim
The Business Times
No comments:
Post a Comment