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Sexual activity in patients with cardiovascular disease

William H Sauer, MD
Stephen E Kimmel, MD, MS
Section Editor
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Deputy Editors
Howard Libman, MD, FACP
Gordon M Saperia, MD, FACC


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.


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 [1]. 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 [2]. (See "Sexual dysfunction in women: Epidemiology, risk factors, and evaluation".)

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Literature review current through: Nov 2017. | This topic last updated: Jan 29, 2016.
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