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Sexual Dysfunction After Heart Attack

Causes and Treatment Options for Sexual Dysfunction After Heart Attack

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Updated December 12, 2009

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

The specter of having a heart attack during sex, while incredibly rare, is still a common one in popular culture. Less frequently talked about are sexual difficulties that can happen after a heart attack. I was curious about how common it is to experience sexual dysfunction after a heart attack so I turned to an article from UpToDate, an electronic reference used by many physicians and patients looking for in-depth medical information.:

“Sexual dysfunction is common in patients with cardiovascular disease because of concern about risk; side effects of medications (diuretics, beta blockers, lipid-lowering drugs); the coexistence of shared risk factors, such as lipid abnormalities, diabetes, smoking, and hypertension; and the presence of psychologic factors. Sexual dysfunction after an MI (most often erectile dysfunction in men) is estimated to occur in one-half to three-quarters of patients; although less common, sexual dysfunction is also seen after bypass surgery. Both men and women have less sexual activity and less satisfaction with sexual activity after an MI.”

Causes of Sexual Dysfunction After Heart Attack

Sexual dysfunction after a heart attack my be the result of several factors, some of which may be unrelated to the heart attack itself.

Physical factors. There are too many physical causes of sexual dysfunction to list here. The health and strength of your heart, your circulation, neurological and urological systems can all be a factor in sexual dysfunction, as can many illnesses and diseases. This is why, even if it feels embarrassing, talking with your doctor and having a complete examination by a doctor is a good place to start an investigation into the causes of sexual dysfunction.

Psychological factors. How we think and feel can impact our enjoyment of sex and our physical response to sex. Being afraid of sex triggering a heart attack, dwelling on your own mortality, and depression after a heart attack can all lead to sexual dysfunction. Bodily changes can also lead to changes in your sexual and gender identity (what it means to feel like a man or a woman). These are not minor issues and can all impact our sexual functioning.

Relationship factors.Your relationship health and the health of your sexual relationship prior to a heart attack may also impact sexual functioning post heart attack. If you only consider sex to be intercourse, for example, you may find sex during recovery and beyond frustrating or unsatisfying, which can become a vicious cycle of sexual dissatisfaction and dysfunction.

Medications.Many medications have sexual side effects which can cause sexual dysfunction. Some medications used in the treatment of heart disease, for example anti-hypertensive medications, also known as beta-blockers are to impact sexual desire and also erectile functioning. Other medications which you may be taking for unrelated conditions might also be contributing to sexual dysfunction. If you’re experiencing sexual dysfunction start by asking the doctor who is prescribing the medication about known side effects and whether there are other drugs available.

Treatments for Sexual Dysfunction

Treatment for sexual dysfunction has to begin with you. You have to talk to your partner about it and then talk with your doctor. The treatment method will depend both on the dysfunction, but also on your doctor’s assessment of your cardiac risk.

Education.The first and least invasive treatment for sexual dysfunction is educating yourself. If you’re afraid that sex will trigger another heart attack it’s not surprising that you may lack an interest or find your body isn’t responding in the usual way. You can’t force your mind to feel pleasure, and you can’t will yourself to “just relax”. Understanding exactly what’s happened to your or your partner’s body as a result of the heart attack, and understanding how sex impacts the heart are good places to start. You may also want to learn more about sexual activities and broaden the range of sex play you have.

Counseling/Therapy. The heart attack may or may not be causing sexual dysfunction, but either way it can be a good reason to deal with sexual problems in your relationship. Sexuality touches every part of our lives, and when we get stuck it can be very difficult to find our way out on our own. Talking with a counselor or therapist, including one who specializes in sex therapy, can be well worth it. Sex therapy is often brief (6-8 sessions) and may involve getting exercises and homework for each partner and as a couple. A therapist might also recommend the use of non-medical devices, or refer you to a physician if they believe that you would benefit from medical treatment.

Medication. The most common medication used to treat sexual dysfunction are the PDE-5 inhibitors, better known by their brand names Viagra, Levitra, and Cialis. It can be dangerous for some men to take these drugs and if you have a cardiac condition you need to discuss this with a doctor who knows about your condition. For many men with heart disease who are experiencing erectile dysfunction these drugs may provide a safe way to have erections. For some men there maybe safer and less invasive treatments (see above). Men with heart disease should avoid so-called “natural sexual enhancers” like the kind found in health food stores and online. Most of these products are unregulated and they may contain ingredients that have cardiovascular side effects (one known example is yohimbe, which is touted as a libido booster and may also cause high blood pressure and tachycardia).

Want to learn more? See UpToDate's topic "Sexual activity in patients with heart disease" for additional in-depth medical information.

Source:

Sauer, W.H. & Kimmel, S.E. “Sexual activity in patients with heart disease.” UpToDate. Accessed: November 2009.

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