Despite the fact that we all know at least one Viagra joke, the truth is that connection between sexual dysfunction and significant cardiac risk is very serious in its impact on both physical and emotional health. Thankfully, the last few decades have seen some major advances in new treatments for this problem. And an unprecedented number of people are now seeking professional advice.
If your love life is in the tank, you might have options that you haven't considered. Don't give up on this important part of your life without reviewing some of the following options.
Step 1: Talk to Your Doctor
Your first step should be to express any concerns that you might have about your love life to your health care provider. Many folks are embarrassed to do so, but this aspect of your physical and emotional health is important for your physician to know—and he or she may forget to ask you about it. A basic physical examination and review of your medications is the usual starting point.
You probably realize that drugs can diminish sexual desire and performance. For instance, beta blockers and other hypertension drugs are notorious in this regard, and they affect both men and women. This is a real quality of life issue, so don't think that you "just have to live with it."
There are solutions that can minimize or eliminate these undesirable side effects. And if controlling or ruling out the drug effects doesn't completely restore normal function, your physician can then order tests to check for physical problems. For instance, a circulation problem that affects your heart might imply blood flow problems to your genitals, as well.
Once you have a professional medical evaluation to sort out the cause of specific concerns, such as erectile dysfunction, you can begin to get to the psychological roots of your problem. Anxiety and depression can have a profound impact on your libido, and may coexist with cardiac disease.
Step 2: Ascertain Your Risk
After interpreting the existing research to determine whether sexual activity is beneficial or increases the risk of a cardiac event, the consensus is that sex does raise your risk of having a heart attack. However, the risk increase is very small. In fact, regular sexual activity was no more dangerous than regular exercise. So, if you are doing both, you are most likely at low risk.
To quantify the risk, let's look back to the Framingham Heart Study from the early 1990s. If a healthy 50-year-old man (there really weren't enough women represented in this study, so we can't use the numbers for women) exercises regularly, his risk of having a heart attack is only one chance in one million, per hour of exercise. If the same guy engages in sexual intercourse, his risk doubles to only two chances in a million per hour for a two-hour period following intercourse.
Now, take a guy who's had a heart attack and has been in cardiac rehab. His risk of having another heart attack during sexual activity is 10 chances in a million per hour. One reason his risk is still so low is that regular exercise has been shown to decrease the cardiac work required during sexual activity, and also reduces a person's chances of having a heart attack.
To find out if sexual activity is safe for you, exercise stress testing is your best bet. Folks with good reason for concern about the safety of being sexually active are those with a sedentary lifestyle, unstable angina (chest discomfort at rest and/or with minimal exertion), or advanced congestive heart failure. For these people, the risk of sudden, heavy exertion precipitating a heart attack is almost 1 in 1,000.
More Encouraging Findings
Recent research shows a protective benefit from sexual activity, and implied cardiac risk for folks who aren't sexually active or fulfilled.
Five- and 25-year studies looking at "all-cause mortality" found it to be lower in men who reported more frequent intercourse. In other research (over 10- and 29-year periods), women unable to achieve orgasm (for various reasons) and celibate priests were found to be more likely to have a heart attack.
It has been reported, however, that establishing a cause-and-effect relationship between sexual activity and cardiac risk has not been possible. When we look at population studies like this, we are inferring that there is such a relationship between the two variables being studied, but presently we can't prove more than a correlation.
For instance, people who are more sexually active may be different in other respects as well. And another problem was pointed out: "not every [heart attack] after sex is due to sex."
Researchers are now trying to rule out confounding variables and home in on the essential question: What is the relationship between sexual activity and heart attacks, and who is most at risk?
Moderate Your Risk
In a 1996 study, regular physical exercise—at least the equivalent of 6 METS (this is the equivalent of walking about 2.5 mph for five minutes on level ground)—modified the association between sex and heart attacks. So, right now, the number-one reducer of cardiac risk from sexual activity is regular exercise. Other factors that can lower your risk include the time of day you choose.
It's been recognized that cardiovascular events follow a circadian rhythm, and are also triggered by physical and emotional stresses. It's believed that your sympathetic nervous system is activated upon your assuming an upright position in the morning, so I advise folks to avoid sexual intercourse in the early morning hours (5–8 a.m.) to be on the safe side.
There is also evidence that coital position and extramarital sexual activity may alter your risk. One study showed that sudden death during sexual relations was 30 times more likely to occur when a man was with a woman other than his wife.
The Sinatra Solution for "Safe Sex"
When I have concerns about the safety of sexual activity in my patients—and yes, I have had a couple of patients in 25 years of practice who did die during or just after sexual intercourse—I have them wait until I do a few tests first.
- Who's at risk? Anyone that I see who has angina, advanced coronary artery disease, congestive heart failure, arrhythmias, or compromised left ventricular function (meaning that their ejection fraction is below normal, and they are probably symptomatic with exertion).
- What do I do? Before giving the green light to anyone with the above cardiac problems, I do a stress test to look at how their heart performs with an increase in physical activity.
If I am satisfied, I have them wear a Holter monitor to record the heart rate for 24 hours, and ask that they engage in sexual relations while we can keep a record of the heart's activity. I always recommend that folks choose a time when they are rested and not under psychological stress to head for the bedroom, as well as using physical positions that are comfortable.
If you have any of the heart conditions that I have mentioned, and especially if you are symptomatic during sexual activity, then ask your doctor to do these screening tests for you. If you are avoiding sexual relations out of fear that your heart may be compromised, taking these tests is a good way to accurately assess the risk.
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