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Relationships: Sexual intimacy

Returning to sexual intimacy

Many people have anxiety or fears about having sex after a heart attack or heart surgery. They are scared that sex will be too much for their heart. Keep in mind that sexual activity (full intercourse) only uses the same amount of energy as climbing two flights of stairs (15 steps). The effects on the heart of masturbation or manual/oral stimulation are similar to that of intercourse.

Talk to your cardiologist about when you can safely have sex again. For most people, that is two to eight weeks after your heart attack or heart surgery. People with persistent unstable angina, shortness of breath or tiredness after climbing two sets of stairs should wait until they are doing better. In the meantime, work on your intimacy by having physical contact with your partner such as cuddling or holding hands.

Typical barriers to returning to sexual intimacy

Some people may be less active, develop temporary problems with their interest in sex or erectile dysfunction (problems getting or keeping an erection) while they learn to live with their new coronary artery disease. These difficulties can be caused by medical conditions (coronary artery disease, type 2 diabetes, prostate problems, hypertension), medication side effects, mental health conditions (depression, anxiety) or problems in the couple relationship.

A healthy sex life has many benefits. It can lower stress, make you feel better about yourself and deepen your relationship with your partner. Here are some tips for getting your sex life back:

  • Understand that things will not be perfect at first. You might need to lower your expectations. Go slowly – at your own pace.
  • Share your fears, needs, desires and wishes with your partner about having sex again. A lot of patients feel the closeness they have with their partner after their heart disease helps to improve the quality of their relationship and their sex life.
  • Set up a healthy routine for eating, resting, sleeping, exercising and managing stress. This helps you feel good about your body, builds your confidence and looks after your heart health.
  • Give quality time to your relationship with your partner.
  • Plan to have sex when you are rested and not under stress. Choose a relaxing place where you will not be interrupted. Foreplay in a relaxed setting lets your heart rate and blood pressure increase gradually.
  • Do not have sex in a very hot or cold place, after a heavy meal and after drinking a lot of alcohol. Sex in these situations can cause more stress for your heart. Wait two to three hours after eating before you have sex.
  • Take your time. Stop if you have chest pain. Contact your cardiologist or family doctor as soon as possible.
Erectile Dysfunction

Some medications used to treat coronary artery disease or hypertension can cause a drop in your sex drive and difficulty with erections or orgasms. Never stop taking your cardiac medication because you have side effects that affect your sex life. Talk to your cardiologist to find out if your medication can be changed. Medication that treats erectile dysfunction: e.g., Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra) can cause dangerous drops in blood pressure if taken within 48 hours of any form of nitrates (e.g. nitroglycerine tablets (ISMN or Imdur), patches or sprays). If you have cardiac symptoms for which you would normally use nitrates and you used medication to treat erectile dysfunction within 48 hours, do not take your nitrates and go immediately to the emergency room of your local hospital to get treatment. Talk to your healthcare team about any worries you may have about this.

Do not take herbal medications to treat erectile dysfunction, as they may affect your heart medication.

Talk with your healthcare team about any problems you have about the return to your sex life. They will be able to tell you the causes of your difficulties, and might be able to offer you treatments or send you to appropriate medical specialists, psychological or sexology services.

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