Heart and sexuality: advice for patients at risk?

Numerous studies, mainly focusing on male sexuality, show that 15% of treated hypertensives have to cope with major erectile dysfunction, and that 40% of 40-year-old coronary patients and 67% of 70-year-old coronary patients also suffer from it.
Not to mention a very high percentage (75-90%) of heart failure patients. However, there has recently been a real awakening of awareness among learned societies, and women's sexuality is now clearly addressed. So there are ways of "rehabilitating" them and restoring their confidence.
A cardiovascular accident can have a devastating impact on a patient's sex life, marking a real turning point in his or her activity. For both men and women. It can be a real post-traumatic shock, curbing the libido and leading to marital conflicts, feelings of devaluation and fragility, excessive mothering by the partner, a reactionary depressive syndrome or even a real fear of recurrence.
What's more, certain cardiovascular treatments can have undesirable effects on sexuality, such as diuretics (hydrochlorothiazide, spironolactone), certain beta-blockers (propanolol) or central antihypertensives (alphamethyldopa, clonidine).

Women are less well advised and under-screened.
There's no denying it, there are few studies on sexuality associated with cardiovascular risk in women. This is all the more true given that women suffering from sexual problems are more likely to talk to their gynecologist than to their cardiologist.
As a result, they will receive little or no information after the acute event about resuming sexual activity. And they will often be considered more fragile by their partner.
It is also vital to be able to reassure the patient. To do this, the doctor needs to be familiar with the hemodynamic constraints of the sexual act, bearing in mind that today less than one in two patients (men and/or women) receives informed advice on the subject.
According to an American study of over 4,000 cardiac arrests analyzed, only 1% of male cardiac arrests occur during the act or 15 minutes afterwards. In women, the figure drops to 0.1%. The study also shows that patients with known CV disease who are under care are no more likely than non-cardiac patients to die of cardiac arrest during sex. The American Heart Association stresses several points. Sexual activity is a moderate-intensity physical activity, equivalent to walking up two flights of stairs without stopping. Like any physical activity, it increases the risk of a cardiac event at the time it is performed, but this risk decreases within 2 hours for both men and women. The AHA also stresses the importance of regular exercise, which is beneficial to health. But it also warns that smoking before and after exercise (for up to two hours afterwards) is a de facto risk factor.

What are the risk factors during sex?
Keeping your usual partner and postural habits helps to avoid risks. But a new partner, an extramarital relationship, a younger partner and of course drug use (cocaine, poppers, amphetamines...) increase them.
If you've had a pacemaker fitted with leads in the heart chambers, it's also advisable to wait a week before resuming any physical activity, including sexual activity. As after acute coronary syndrome, sternotomy and bypass surgery, it is advisable to wait several weeks before engaging in sexual activity. In fact, these patients are advised to wait until after their 20 cardiovascular rehabilitation sessions.
There are also red lights that must be observed if you present a high risk according to the Princeton IV consensus: uncontrolled hypertension, heart failure, uncontrolled atrial fibrillation or severe ventricular rhythm disorders, heart valve disease awaiting treatment.
On the other hand, GERS (the Société Française de Cardiologie's cardiovascular rehabilitation working group) points out that sexual health is one of the WHO's quality-of-life criteria, and that sexual activity represents a moderate physical effort that should not be restricted if the patient can achieve 60 watts on a bicycle or climb two flights of stairs (in 10 seconds) with good tolerance.

A healthy lifestyle will be an effective treatment.
To remedy all these problems, it is obviously advisable to adopt a healthier lifestyle: lose weight, eat less salty food, reduce alcohol consumption, stop smoking and control hypertension.
It is important never to stop taking medication for sexual problems without consulting a doctor. And never hesitate to consult a health professional. Once again, the percentage of men and women who broach the subject in consultation - under 20% - is far too low.



Princeton IV consensus guidelines: PDE5 inhibitors and cardiac health.
Kloner RA, Burnett AL, Miner M, Blaha MJ, Ganz P, Goldstein I, Kim NN, Kohler T, Lue T, McVary KT, Mulhall JP, Parish SJ, Sadeghi-Nejad H, Sadovsky R, Sharlip ID, Rosen RC. J Sex Med. 2024 Jan 30;21(2):90-116.