Sexual activity ‘safe’ for most heart disease patients
MedWire News: Patients with stable cardiovascular disease (CVD) can safely engage in sexual activity, according to an American Heart Association scientific statement.
"Sexual activity is a major quality of life issue for men and women with CVD and their partners," commented lead author Glenn Levine (Baylor College of Medicine, Houston, Texas, USA) in a press statement. "Unfortunately, discussions about sexual activity rarely take place in the clinical context."
The statement, published in Circulation, was developed by experts in CVD, exercise physiology, and sexual counseling. They state that although sexual activity is associated with an increased risk for CVD, the absolute rate of events is "miniscule" because exposure to sexual activity is of short duration and comprises a very small percentage of the total time at risk for myocardial ischemia.
However, patients with severe heart disease who have symptoms when participating in minimal activity or at rest should not be sexually active until their symptoms have been stabilized using appropriate treatment.
The authors say that after a diagnosis of CVD has been made, it is "reasonable" for patients to be evaluated by their physician or healthcare provider before resuming sexual activity.
In addition, among people who have experienced myocardial infarction or heart failure, cardiac rehabilitation and regular physical activity "can be useful" to reduce the risk for CV complications related to sexual activity.
The statement suggests that women with CVD are counseled on the safety and advisability of contraceptive methods and pregnancy based on their patient profile.
Postmenopausal women with CVD who find sexual intercourse painful can be "safely treated" with topical or vaginally inserted estrogen.
The authors point out that CVD drugs that can improve symptoms and survival should not be withheld due to concerns about the potential impact on sexual function.
Patients who experience sexual dysfunction should be assessed to see if it is being caused by underlying vascular or cardiac disease, anxiety, depression or other factors, they say.
Levine et al also state that it is "generally safe" for men with stable CVD without angina to be prescribed drugs for the treatment of erectile dysfunction. However, nitrates should not be administered to patients within 24-48 hours of using an erectile dysfunction drug such as sildenafil, vardenafil, or tadalafil.
Finally, they recommend patient and spouse/partner counseling by healthcare providers, suggesting that it helps resume sexual activity after a cardiac event, new CVD diagnosis, or implantable cardioverter-defibrillator implantation.
"Sexual activity is an important component of patient and partner quality of life, and it is reasonable for most patients with CVD to engage in sexual activity," say Levine and team.
They conclude: "Future studies of interventions to improve sexual activity in the context of CVD, including sexual counseling, should address sexual concerns and activity of both men and women, young and old, and both patients and partners."
MedWire (http://www.medwire-news.md/) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Piriya Mahendra