Heart Health & Intimacy: Navigating Sexual Wellness After a Heart Attack

Watan-A heart attack often triggers a mix of emotions, including sadness, anxiety, and fear. However, as the initial shock fades, most people desire to return to their normal lives.

Amid all the advice on how to recover and protect heart health in the future, one topic is rarely discussed: sex.

On this subject, Dr. Emily Lau, a cardiologist at Massachusetts General Hospital, affiliated with Harvard University, explained: “My patients rarely ask questions about sex. I admit that I also do not usually bring up the topic.”

However, cardiovascular diseases and their treatments can certainly affect sexual function. Additionally, some medications used to treat common sexual problems may not be safe for individuals with heart disease.

Effects of Heart Disease

The buildup of plaque in the arteries (atherosclerosis) is the root cause of most heart attacks. Atherosclerosis can affect arteries throughout the body, including those that supply blood to the genitals. As a result, men may struggle with erectile dysfunction, while women may experience inadequate blood flow necessary for vaginal arousal and lubrication.

Moreover, high blood pressure can cause sexual dysfunction by damaging the inner lining of the arteries, contributing to atherosclerosis.

Additionally, common blood pressure medications can sometimes lower libido or make it harder to achieve orgasm in both men and women. According to Dr. Lau, among the different classes of drugs used to treat high blood pressure, beta blockers and thiazide diuretics are more likely to cause sexual side effects.

On the other hand, ACE inhibitors, angiotensin-receptor blockers, and calcium-channel blockers are less likely to have sexual side effects.

Medication Precautions

For most men with heart disease, medications used to treat erectile dysfunction, including sildenafil (Viagra), tadalafil (Cialis), and vardenafil, are safe—except in one critical case. Men who take nitrates, which are commonly prescribed for chest pain (angina), should not take erectile dysfunction medications.

Since both erectile dysfunction drugs and nitrates work by relaxing and dilating blood vessels, taking them together can cause a dangerous drop in blood pressure.

For women, menopause symptoms such as hot flashes, night sweats, and vaginal dryness can interfere with sexual activity. Dr. Lau stated: “Estrogen products can help alleviate these symptoms. However, women with heart disease should avoid systemic estrogen therapy.”

She explained that systemic estrogen treatments, including estrogen pills and skin patches, increase the risk of blood clots. However, estrogen products applied directly to the vagina (such as creams, suppositories, and rings) can relieve dryness and discomfort during sex and are safe for women with heart disease. “Women can safely use these topical products for as long as they need,” Dr. Lau added.

Sexual Health After a Heart Attack

Some couples avoid intimacy after a heart attack out of fear of triggering another one. However, for most people, sex is safe and is comparable to other light-to-moderate activities, such as brisk walking or climbing two flights of stairs, according to Dr. Lau.

If you undergo cardiac rehabilitation—which ideally starts about a month after a heart attack, as strongly recommended by cardiologists—you will likely take an exercise stress test. A normal result can provide reassurance about resuming physical activities, including sex.

After any procedure involving a catheter inserted into the heart through a blood vessel in the upper thigh, you should wait until the puncture site fully heals before resuming sex. After open-heart surgery, sexual activity should be postponed until the breastbone heals, which typically takes six to eight weeks. For several months afterward, avoid positions that put pressure on your chest.

If you’re concerned about your ability to engage in sex after a heart attack, here are some tips for restoring intimacy:

• Choose a time when you feel comfortable and relaxed, such as in the morning or after a nap.
• Pick a familiar, comfortable place where you won’t be interrupted.
• Don’t feel pressured to engage in vigorous sex immediately—hugging and foreplay may be a more comfortable way to start.
• Talk to your partner about any concerns, and be understanding of each other’s feelings.