Cardiac Disorders

Barriers:

  • Surgical procedures may affect ability to engage in sex (See Sternal Precautions)
  • Unless cleared by physician, clients cannot engage in anal sex due to stimulation of the vagus nerve (Steinke et al., 2013)
  • Females may have difficulty with vaginal lubrication
  • Males may have erectile dysfunction
  • Decreased cardiovascular endurance

Determining Risk:

DeBusk et al. (2002) divided patients with cardiac conditions into categories based on the risk that sexual activity poses. While each patient should be considered on a case-by-case basis, these guidelines provide some general recommendations. Final determinations should be made by a physician.

Low risk patients

  • Characteristics
    • Asymptomatic with less than 3 major risk factors for coronary artery disease
    • Hypertension, controlled
    • Past uncomplicated myocardial infarction
      • At least 6-8 weeks post
    • Mild valvular disease
      • Mitral valve disease
    • Mild angina that has been evaluated and treated
    • Congestive heart failure: Class I
      • Can engage in ordinary physical activity without symptoms
    • Post-revascularization
      • Includes coronary artery bypass grafting and percutaneous coronary intervention
      • Patients are considered low-risk if they have adequate coronary revascularization and no significant ischemia.
  • Recommendation: Low risk patients are typically safe to resume sex.

Intermediate risk patients

  • Characteristics
    • More than 3 major risk factors for coronary artery disease
    • Recent myocardial infarction
      • 2-6 weeks post
    • Moderate angina
    • Congestive heart failure: Class II
      • Slight limitations in daily activities
      • Walking causes shortness of breath
    • Artherosclerosis
    • History of stroke or transient ischemic attack
    • Left ventricular dysfunction
      • Ejection fraction less than 40%
  • Recommendation: Intermediate risk patients require further evaluation by a cardiologist to determine safety to return to sex

High risk patients

  • Characteristics
    • Unstable, refractory angina
      • New onset
      • Severe
      • Refractory: treatment is ineffective
      • Occurs at rest
    • Hypertension, uncontrolled
    • Congestive heart failure: Class III or IV
      • Class III: Marked limitations
      • Class IV: dyspnea at rest
    • Recent myocardial infarction
      • Less than 2 weeks
    • Moderate/severe aortic stenosis
    • Hypertrophic obstructive cardiomyopathy
      • Syncope and sudden death with exertion
    • Arrythmia
      • Patient may not be at higher risk if they have a pacemaker
  • Recommendation: High risk patients should be medically stabilized prior to engaging in sex.

Strategies:

  • Education on warning signs of cardiac distress, including chest pain, dyspnea, irregular or rapid heart rate, dizziness, insomnia after sex, or fatigue the day after sex (Steinke et al., 2013)
  • When resuming sexual activity, suggest that client does so with a familiar partner in a familiar setting to decrease cardiovascular distress.
  • It may also be beneficial to begin with less intensive activities, such as fondling and kissing, and then progress to mutual masturbation and oral sex. If the client can tolerate these activities without warning signs, then they may be ready to progress to more intensive sexual activities.
  • Women with cardiovascular disease may benefit from use of external lubrication to compensate for vaginal dryness
  • Education on the importance of maintaining a regular exercise
  • No specific positions are best, so clients are free to use whichever positions are most comfortable for them
  • Educate client on the level of exertion necessary to engage in sexual activity. Sexual activity requires 3-5 metabolic equivalents of task (METs), which is the equivalent to climbing 2 flights of stairs at a brisk pace. If a client is able to climb up 2 flights of stairs without adverse effects, then they most likely can engage in sexual activity without adverse effects.

References

DeBusk, R., Drory, Y., Goldstein, I., Jackson, G., Kaul, S., Kimmel, S. E., . . . Zusman, R. (2000). Management of sexual dysfunction in patients with cardiovascular disease: Recommendations of the Princeton consensus panel. American Journal of Cardiology, 86(2), 175-181. Retrieved from https://doi.org/10.1016/S0002-9149(00)00896-1

Steinke, E. E., Jaarsma, T., Barnason, S. A., Byrne, M., Doherty, S., Dougherty, C. M., . . . Moser, D. K. (2013). Sexual counselling for individuals with cardiovascular disease and their partners: A consensus document from the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions. European Heart Journal, 34(41), 3217-3235. Retrieved from https://doi.org/10.1093/eurheartj/eht270