Sexual activity is a normal human instinct, which protects men and women against feelings of isolation. It offers them an opportunity to be free of mental stress and tension by gestures such as touching, hugging, caressing and fantasy. Intercourse is the ultimate expression of sexuality.
Heart patients and their spouses frequently perceive sexual intimacy as stressful or even life threatening. Their fears and doubts are often not clarified by physicians and other health care providers, who may also feel inhibited while discussing sexual matters with their patients. Majority of the patients, therefore receive little or no instructions about resuming sex after a heart attack or heart surgery. Those who are instructed frequently don’t receive adequate information. Often the spouse is excluded from counselling. Without proper guidance, both patient and spouse rely on their own knowledge, myths and misconception to cope up with their unfounded fears of sexual inadequacy, impotence and death during intercourse.
Sexual problems in heart disease
Male heart patients frequently report a reduction in frequency and satisfaction of intercourse after heart attack or heart surgery. Sexual desire may decrease, leading to inhibition of feelings and failure of erection. Some men also experience premature ejaculation. Yet, such problems do occur in as many as 40% of happily married normal couples too. A strong emotional relationship between spouses lessens the occurrence of sexual dissatisfaction after a heart attack. Relatively few studies have been carried out regarding sexual activities of female patients with heart disease.
Psychological basis of sexual problems
Two primary psychological reactions interfere with resumption of normal sex after a heart attack:
- Anxiety: Anxiety results from fear of angina or recurrence of heart attack during sexual intercourse. These fears are frequently based on ignorance about physical demands of sexual activity, when to resume sex and ways to prevent to treat the symptoms. Another contributory factor is patient’s perceived change in body image, leading to a feeling of being less of a man or a woman.
- Depression: After a heart attack, many people experience a moderate to severe depression. It prevents the patient from resuming normal; emotional ties with the spouse and may also lead to a decrease in libido. Occasionally, it may cause impotence.
Forced dependency in hospital setting during a heart attack or surgery may lead to erosion of feeling of self worth and sexual attractiveness for a while. During this time, the spouse can provide much needed support. In reality, many spouses themselves undergo considerable psychological trauma during this period. They wish to reassure their spouse of their love and affection, yet feat the worst. This naturally comes in way of resuming normal sex. Lack of communication or covert communication only helps to reinforce the anxiety of both the partners. The matters may be complicated when the spouse also begins to grudge his/her continued responsibility.
Physical effort of sexual intercourse with spouse is comparable to climbing a flight of stairs or walking briskly. Therefore, most of the people should be able to return to their previous level of sexual activity after recovering from a heart attack or CABG. Here are some practical tips to regain a normal sex life.
When sexual intercourse is not advisable
- Communication with your spouse This is the first and most important step in resuming a normal relationship. Heart attack or major heart surgery is a stressful experience for both the partners. Recuperation after home coming is the right time to pick up the threads of life once again. An open discussion about apprehensions and anticipations may be more important than the act of sexual intercourse itself at this stage.
- Getting started Cuddling for a while without worrying about performance is desirable. Hugging, touching and caressing without penetrative sex and orgasm require very little energy. These may be resumed soon after reaching home. An affectionate gesture this time is good way to express your love before moving on to sexual intercourse.
- Time to resume sexual intercourse Sexual intercourse is like any other physical activity. A general rule of the thumb is that sex may be resumed when it is possible to climb 1 0r 2 flights to stairs with angina or breathlessness. This generally means 4-6 weeks following an uncomplicated heart attack, and a little later after heart surgery.
- The environment Sexual intercourse should be resumed in familiar surroundings, in a relaxed and restful environment. Room temperature should be comfortable. Extreme temperatures place more stress on the heart.
- Don’t skip the foreplay While it is never a good idea to cut short the foreplay, it is especially important during convalescence. Besides enhancing enjoyment, foreplay also allows a gradual rise in heart rate, preparing for sex in the same way as warm up stretching exercises prepare for aerobic training.
- Desirable positions Whatever the position adopted during sexual intercourse, it should be comfortable and permit free breathing. It was previously thought that when the patient was in bottom or lies side to side rather than the top, the rise in blood pressure during intercourse is less. Little isometric effort is involved in these positions. What should be avoided is supporting the body on hands, when on top.
- Things to avoid Digestion of food increases heart rate for a while. Therefore, sexual intercourse should be avoided for 2 hours after a heavy meal to minimise strain on heart. Sex should be avoided when either of the partners is extremely tired, tense, angry or under time pressure.
If sexual intercourse precipitates severe angina or breathlessness on more than 1 occasion, or when even modest physical exertion precipitates irregular or missed heart beats or ECG changes, it is desirable to resume sexual intercourse after optimization of medical therapy. Causes of sexual problems in heart disease
- Preexisting sexual problem
- Concomitant stroke during acute heart ailment or heart surgery
- Atherosclerosis of aorta or its branches supplying blood to penis
- Physical deconditioning
- Alcohol and tobacco abuse
- Some therapeutic drugs
Sometimes sexual problems encountered in heart disease are caused or aggravated by certain medicines. Some medicines known to cause sexual difficulties are spironolactone, beta blockers, thiazide diuretics, statins, anti-depressants and sedatives and anti-anxiety drugs. Personal physician is the best guide to assess whether particular medicine is responsible for sexual problems. If identifies with reasonable certainty, the offending medicine may be withdrawn. When a medicine is absolutely essential, sex may be scheduled when blood levels of the problem medication are low, that is, about 6-8 hours after dose of the medicine. Conclusion
Sexual intercourse after a heart attack is not a risky Endeavour. To the contrary, it is normal, also to be desirable and healthy provided it is undertaken with a familiar partner. If someone can walk on a treadmill, climb 2 flights of stairs at a good pace without breathlessness, palpitations or chest pain, his physical condition is good enough to resume normal sex.