Too often, worries over the safety of sexual activity are not addressed
MONDAY, July 29, 2013 (HealthDay News) -- Many people who survive a heart attack have unspoken anxieties over whether it is safe to resume sexual activity. Now, experts in cardiology say doctors need to be more proactive in counseling patients who find themselves wrestling with the issue.
The recommendation comes in a joint statement released July 29 by the American Heart Association and the European Society of Cardiology. It also arrives after the release last week of a study that found that many women, especially, worry about resuming sex after a heart attack.
"Patients are anxious and often afraid sex will trigger another cardiac event -- but the topic sometimes gets passed over because of embarrassment or discomfort," statement lead author Elaine Steinke, a professor of nursing at Wichita State University in Kansas, said in a joint AHA/ESC news release.
Task force co-chair Tiny Jaarsma, a professor at Linkoping University in Sweden, said that many factors get in the way of frank talks about the issue. "Some health care professionals may believe the patient does not want this information, but we have found it is easier for the health care provider to start the discussion than for the patient to bring up these issues," she said.
"Time constraints or just plain embarrassment should not be an excuse for avoiding these topics that are essential to the cardiac patient's mental and physical health," Jaarsma added.
According to the new recommendations, doctors should:
- Routinely check all patients after a cardiac event and during follow-up visits to see if he or she is healthy enough to resume sexual activity.
- Provide counseling that's in tune with the patient's specific needs and medical condition.
- Discuss recommended positions, how to be intimate without having sexual intercourse and when to resume sexual activity, and counsel all patients regardless of gender, age and sexual orientation.
Exercise stress testing is recommended for some patients to determine if the heart is strong enough to resume sexual activity, and physical activities such as brisk walking may be suggested for some heart patients before resuming sexual activity, according to the statement.
In addition, the experts noted that patients may be advised that the stress of extramarital sex could pose a health risk for people with heart disease.
A study released July 24 in the Journal of the American Heart Association found that many female survivors of heart attack worry about whether resuming sex is safe. The study, which involved in-depth interviews with 17 such patients, found that while most rekindled their sex lives within a month of the attack, many also remained fearful about how sex could affect their hearts.
Few had discussed the issue with their doctor and when the issue was raised it was the woman, not her doctor, who typically brought it up.
That situation needs to change, a study author told HealthDay. "If the doctor brings it up, at least the woman will know it's important to them as well, and that she can talk to her doctor about it," said Emily Abramsohn, a researcher at the University of Chicago.
Many fears around the cardiac dangers of sex may be unfounded, experts say. Many studies have shown that for most heart attack survivors, sex is a low-risk activity. Less than 1 percent of all heart attacks are triggered during sex, according to the American Heart Association.
The new recommendations also focus on the role of heart medications. While heart drugs can affect sex drive and function in both men and women, patients should talk to their health care provider before stopping any medications, the new guidelines say. Health care providers can help figure out if sexual problems are being caused by the drug or an underlying condition, such as depression.
Psychological issues are key, one other expert said.
Sex involves emotional and mental well-being, too, said Dr. Suzanne Steinbaum, a cardiologist and director of women and heart disease at Lenox Hill Hospital in New York City. People may have concerns about it even if they feel physically fit. Depression, for instance, is common after a heart attack, and that might affect sexual functioning.
"We need to address the emotional and psychosocial issues, too," Steinbaum said.
So what can heart attack survivors do? "Know that you're not alone in having fears surrounding sexual activity," Abramsohn said. "And if you are concerned, bring it up with your doctor."
If you do that but still "feel you're not being heard," Steinbaum said, you can ask for a referral to someone who works with heart patients -- a social worker, psychologist or cardiac rehab nurse, for example.
The U.S. National Library of Medicine has more about heart disease and sex (http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000540.htm ).
SOURCES: American Heart Association/European Society of Cardiology, news release, July 29, 2013; Emily Abramsohn, M.P.H., Program in Integrative Sexual Medicine for Women and Girls With Cancer, University of Chicago; Suzanne Steinbaum, D.O., director, women and heart disease, Lenox Hill Hospital, New York City; July 24, 2013, Journal of the American Heart Association, online