The Heart and Sexuality: A Beautiful Connection!

Sex and love are good for our health
According to the WHO, sexual intercourse is a moderate-intensity activity, comparable to the energy expended climbing two flights of stairs in 10 seconds without stopping or to a brisk walk, with the added benefit of a significant emotional component. It offers all the benefits of physical activity: it stimulates the heart rate, boosts blood circulation, strengthens the heart, and also helps eliminate toxins.

“By increasing the production of certain antibodies, regular sexual activity also strengthens the immune system and makes the body more resistant to common infections,” adds Prof. Claire Mounier-Véhier, a cardiologist and vascular physician at Lille University Hospital and co-founder of Agir pour le Cœur des Femmes. It is also beneficial for mental health: the release of various pleasure-related hormones, endorphins, has a protective effect against stress and improves sleep quality.”

“Maintaining a regular sex life contributes to well-being and personal fulfillment,” insists Thierry Drilhon, business administrator and executive, and co-founder of Agir pour le Cœur des Femmes. “Sexual health is one of the criteria for quality of life and well-being.”

A recent study reveals that people who have sex fewer than 12 times a year have a higher risk of cardiovascular disease and all-cause mortality. As frequency increases, risks gradually decrease, reaching a minimum between 1 and 2 sexual encounters per week.

Being in love also has a positive impact on health, with a reduced risk of mortality. A meta-analysis of over 300,000 participants reveals that for happy couples, the reduction reaches 20% compared to unhappy couples.
“Love reduces cortisol levels and stabilizes blood pressure,” comments Thierry Drilhon. “The quality of married life influences health with an impact comparable to diet or exercise.” Single people, divorcees, or widows have a 42% increased risk of cardiovascular disease and a 55% increased risk of death from stroke.
Be warned: heartbreak has the opposite effect: by increasing stress, it raises cardiovascular risk.

Cardiovascular events have a major impact on sexuality
“For patients who have experienced the trauma of a heart attack or stroke, the fear of recurrence is often a major barrier to resuming an active sex life,” laments Prof. Claire Mounier-Véhier. A cardiovascular event can be a turning point in one’s sex life with a strong psychological impact. The fear of recurrence will have harmful consequences on libido, which can lead, depending on the case, to marital conflicts, feelings of worthlessness and vulnerability, excessive mothering of the partner with overprotection, fatigue, depression, isolation, sick leave… It is important to discuss this with your doctor, who will assess the actual risk, and to also address the topic with your partner.”

Should one fear cardiac arrest during sexual intercourse?
Cardiac arrest during sexual intercourse is a myth that needs to be debunked: it remains very rare. According to an American study published in 2017 in The Journal of the American College of Cardiology, out of more than 4,000 cardiac arrests analyzed, only 1% of cardiac arrests in men occurred during intercourse or within 15 minutes afterward. Among women, the figure drops to 0.1%.
The study also shows that patients with known, managed cardiovascular disease are no more likely than those without heart conditions to die from cardiac arrest during sex. Thus, in most cases, it is advisable to continue having regular sex and to benefit from its protective effect on the heart.

When should you resume sexual activity after a cardiovascular event?
If a pacemaker with leads in the heart chambers has been implanted, it is advisable to wait two weeks before resuming physical activity, including sexual activity, to allow the lead to properly integrate into the muscle. This period will be several weeks after an acute or complicated coronary syndrome, a sternotomy, or a bypass surgery, to allow for rehabilitation.

People with an implantable cardiac defibrillator may worry about receiving or delivering an electric shock to their partner during sexual intercourse. “This situation is extremely rare, and there is no greater risk of an electric shock during sexual activity than during any other physical activity,” reassures Prof. Mounier-Véhier.

However, there are red flags that must be strictly observed if one is at high risk according to the American Princeton IV consensus: uncontrolled high blood pressure, heart failure, uncontrolled atrial fibrillation, severe ventricular arrhythmias, or severe heart valve disease awaiting treatment.

Heart and Sex: A Topic That Remains a Social Taboo

“The topic of sexual activity after a cardiovascular event unfortunately remains too taboo: only 12% of women and 19% of men dare to bring it up during a consultation,” laments Prof. Claire Mounier-Véhier.
When the topic is brought up, patients are mostly given various types of restrictions: limiting sexual activity (35%), adopting a more passive role (26%), or keeping their heart rate low (23%). Yet these restrictions are not based on any scientific studies.”

Nevertheless, the doctor has a key role to play in reassuring patients once the situation is under control. The discussion with the doctor is the determining factor in resuming sexual activity one year after a myocardial infarction.

Screening for sexual dysfunction remains neglected in women
“Female sexual dysfunction is still poorly understood by healthcare professionals,” laments Prof. Claire Mounier-Véhier. Yet they are common and affect 4 out of 10 women of childbearing age and 6 out of 10 women during menopause. They can take various forms: decreased or absent desire, or even aversion in some cases; difficulties with sexual arousal or orgasm; clitoral erectile dysfunction; and vaginal pain and dryness.”

These disorders increase in the presence of risk factors (hypertension, diabetes, obesity, hypercholesterolemia, etc.) due to a direct impact on the function of the blood vessels involved in the functioning of the sexual organs and are also more common in women with coronary artery disease.

Women are often overlooked in the screening for sexual dysfunction due to a lack of awareness of the issue, limited time during consultations, embarrassment, and a lack of scientific data. Women receive less comprehensive counseling after a cardiovascular event, with little or no information provided. Furthermore, few women undergo rehabilitation, which is an ideal time to address the topic of sexuality.

Certain cardiovascular medications can cause or exacerbate sexual dysfunction: diuretics, certain beta-blockers, and certain centrally acting antihypertensives. For example, 42% of women with hypertension undergoing treatment experience a decrease in libido. However, we should not be too quick to blame the medications, but rather look for the many contributing factors: psychosocial issues, relationship problems…

“You should never stop your treatment because of sexual dysfunction; above all, you should talk to your doctor,” says Thierry Drilhon, “and keep in mind that love and affection are wonderful sources of well-being for the body, mind, and heart.”


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