SEX IN THE SETTING OF HEART DISEASE
- 1 in 4 women dies of heart disease each year in the United States
- As women age, they are more likely to develop heart disease
- More women die from heart attacks than men
- Cardiovascular disease includes coronary artery disease and stroke
Coronary Artery Disease (CAD): still considered a "male" disease even though women are at a greater risk for illness and death related to it.
In general, women with CAD have worse sexual relationships and more depressive symptoms than men with CAD.
Depression causes greater incidence of CAD in women (therefore, depression is both a risk factor for and consequence of CAD)
Erectile dysfunction in men and difficulty with genital arousal in women can be symptoms of cardiovascular disease.
Many of the same risk factors for cardiovascular disease are also thought to be responsible for female sexual dysfunction, especially in postmenopausal women.
Cardiovascular disease may be associated with decreased blood flow to the vagina, which may lead to sexual dysfunction:
- Delayed or decreased engorgement
- Decreased lubrication
- Decreased or absent orgasm
- Pain with sexual intercourse
The side effects of cardiovascular disease can cause sexual dysfunction in women:
- Stress/depression = lowered libido
- Performance anxiety= lowered libido
- Need to change sexual positioning = change in arousal and orgasm
- Impact of medication = lowered libido and arousal
Majority of patients with cardiovascular disease are not asked about their sexual function by their doctors
Many women who have CAD believe that sexual activity could harm their cardiac condition
Women with CAD have fewer sexual episodes a month than women without CAD
COMMON MISCONCEPTION: "SEX CAUSES HEART ATTACKS"
Truth: Severe complications of CAD in men and women is low during sexual activity
Truth: Sexual activity was the likely contributor to the onset of a heart attack in less than 1% of cases in patients with CAD
Truth: In CAD patients, risk of heart attack or death = 20 chances per million
Truth: Sex causes only a modest increase in heart rate and blood pressure
Cardiac rehabilitation often fails to address issues related to female sexual dysfunction
Women are traditionally underrepresented in research evaluating sexual dysfunction in the setting of cardiovascular disease. Recommendations for treatment of sexual dysfunction in women with heart disease comes from studies done in men
RECOMMENDATIONS FOR INITIATING SEXUAL ACTIVITY AFTER A HEART ATTACK:
Most situational depression following a cardiac event resolves after 3-6 months as does anxiety and fear of sexual performance
Women should be referred to mental health practitioners if their depressive symptoms do not resolve
Women need to adjust their sexual expectations after a cardiac event, such as a heart attack
Women with heart disease should modify their heart attack risk by:
- Medications to reduce heart rate and blood pressure
- Discuss the possible sexual side effects of medications commonly used for this risk reduction with a physician (beta-blockers)
- Regular exercise reduces risk of heart attack caused by sexual activity
In general, sexual activity after heart attack may be resumed once the patient is given the o.k. to resume physical activity. This generally occurs after 2-3 weeks.
Sex is considered moderate exertion. It is similar to taking a brisk walk, carrying 20 pounds of groceries a short distance, or a round of golf
GENERAL TREATMENT RECOMMENDATIONS FOR WOMEN WITH CARDIOVASCULAR DISEASE AND SEXUAL DYSFUNCTION:
Women with low risk cardiovascular disease: may resume sexual activity soon after a heart attack and should receive treatment for sexual dysfunction
Women with moderate risk cardiovascular disease: should receive stress testing prior to treatment of sexual dysfunction and/or resuming sexual activity after a heart attack
Women with high risk cardiovascular disease: heart disease must be stabilized prior to treating sexual dysfunction or engaging in sexual intercourse.
Recommendations for patients:
- Patients should make a list of their intimacy concerns and bring them to their clinician's attention
- Make use of alternate sexual positioning
- Patients should engage in sexual activity when they are relaxed
- Wait one to three hours after a meal to engage in sexual intercourse
- Ease back into sexual activity slowly after a cardiac event
About Dr. Leah Millheiser
Dr. Millheiser oversees the Female Sexual Medicine Program, which is available to women of all ages in the discreet surroundings of our Stanford Hospital office. This clinic provides treatment for the following disorders: decreased libido; decreased arousal; anorgasmia; dyspareunia and vaginismus. We take a multidisciplinary approach to female sexual medicine, working in conjunction with a licensed sex therapist, pelvic floor physical therapist, as well as alternative health practitioners.