Sexual activity in patients with cardiovascular disease
- William H Sauer, MD
William H Sauer, MD
- Associate Professor of Medicine
- University of Colorado School of Medicine
- Stephen E Kimmel, MD, MS
Stephen E Kimmel, MD, MS
- Associate Professor of Medicine and Epidemiology
- University of Pennsylvania
- Section Editor
- Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
- Section Editor — Coronary Heart Disease
- Professor of Cardiovascular Science
- Director, Cardiovascular and Cell Sciences Research Institute
- St. George's, University of London
- Deputy Editors
- Howard Libman, MD
Howard Libman, MD
- Deputy Editor — Primary Care (Adult)
- Professor of Medicine, Emeritus
- Harvard Medical School
- Gordon M Saperia, MD, FACC
Gordon M Saperia, MD, FACC
- Senior Deputy Editor — UpToDate
- Deputy Editor — Cardiovascular Medicine
- Assistant Professor of Medicine
- Tufts University School of Medicine
Sexual activity is an important component of quality of life and thus is of great concern for both patients with heart disease and their physicians. Cardiac patients are often fearful of triggering myocardial infarction (MI) during intercourse and may therefore have sex less frequently. Another component of this problem is that patients seeking medical attention for sexual dysfunction often have concomitant cardiovascular disease.
Several aspects of the sex-MI relationship will be discussed here, including the cardiovascular effects of sexual activity, the association between sex and MI, modulating factors that may decrease the risk of MI following sexual activity, and the treatment options for cardiac patients with sexual dysfunction. The risk in patients with other cardiovascular diseases will also be mentioned.
CARDIOVASCULAR EFFECTS OF SEXUAL ACTIVITY
Sexual activity, including arousal, erection, ejaculation, orgasm, refractory period, and resolution, is in part dependent upon changes in the autonomic nervous system.
●Sexual arousal and penile erection in men results from stimulation of parasympathetic nerves in the penis, reduced activity of sympathetic pathways, and the release of nitric oxide from the endothelium . The importance of nitric oxide constitutes the rationale for the use of sildenafil in men with sexual dysfunction. (See 'Sildenafil' below and "Overview of male sexual dysfunction", section on 'Role of blood flow and nitric oxide'.)
●Early sexual arousal in women appears to result from sympathetic nervous system activation . (See "Sexual dysfunction in women: Epidemiology, risk factors, and evaluation".)
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- CARDIOVASCULAR EFFECTS OF SEXUAL ACTIVITY
- Hemodynamic stress
- Response in stable angina
- RISK OF MI AFTER SEX
- Modulation of risk
- - Regular exercise
- - Medical therapy
- RISK OF SEXUAL ACTIVITY
- Risk assignment
- - Low risk
- - Intermediate or indeterminate risk
- - High risk
- SEXUAL DYSFUNCTION POST-MI
- TREATMENT OF SEXUAL DYSFUNCTION
- General principles
- PDE-5 inhibitors
- - Sildenafil
- - Vardenafil and tadalafil
- - Adverse interaction with nitrates
- - Antihypertensive drugs
- - Does sildenafil promote MI?
- - Other potential problems
- Other therapies
- SEXUAL COUNSELING
- RECOMMENDATIONS OF OTHERS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS