Is sexual activity safe for the patients of heart failure?

If you are a patient of heart failure and you are worried whether it is safe to resume sexual activity after heart failure then you are at the right place. In this article, we will discuss various aspects of heart failure regarding sexual life and different ways to overcome the risks.
One thing you should keep in mind that immediately after a heart attack, your heart may become comparatively weaker for some period of time. It may not be able to tolerate the increase in cardiac load. It needs time and medicines to heal and normalize its activity but once your heart gains it's normal or near normal strength then you may resume sexual activity without any fear. We will discuss this in detail in subsequent paragraphs.

Effects of heart failure on sexual activity

Sexual stimulation activates both sympathetic and parasympathetic nervous systems. Sympathetic stimulation has a particular role in ejaculation and orgasm, while the parasympathetic system plays its role in arousal and plateau stages. The parasympathetic system decreases the heart rate and force of heart contraction. On the other hand stimulation of the sympathetic system increases the heart rate, the force of contraction of heart muscles and cardiac output. Thus under the sympathetic stimulation heart needs more oxygen, energy and blood flow in order to work harder and increase the cardiac output. Therefore, if your heart is weak, or you have ischemic heart disease and your arteries fail to increase the blood flow then you may feel chest pain, breathlessness, fatigue or in rare cases another episode of heart attack, during sexual activity (especially at time of orgasm because, at the time of ejaculation sympathetic system is activated). This is how sex affects the activity of heart and if you have suffered from a recent heart attack or any other kind of heart failure then you should wait and give your heart the required time to heal, take regular medications and when your heart function returns to normal (usually within a couple of weeks) and you start feeling better then you may resume sexual activity.

Is it safe to resume sexual activity after heart failure?

Yes, after your condition becomes stable and you start feeling better, you may resume sexual activity without any fear. A normal heart can generate maximum blood pressure of 300 mm of Hg and during orgasm, blood pressure reaches up to 163 mm of Hg. This value is far lower than the maximum capacity of a normal heart. After heart failure, the threshold of 300 mm of Hg decreases but still in most of the cases the heart remains strong enough to bear the load of 163 mm of Hg. Therefore it is recommended that once you feel better, you may resume your sexual life without any kind of fear. In fact, Sex is good exercise; it can help your heart to get its normal strength back.

Is there any risk of resuming sexual activity after heart failure?

Almost all the patients, who have suffered from heart failure, are afraid of resuming sexual activity. They think that if they resume sexual activity then they may get another heart attack or in the worst cases, they may die. According to AHA statistics, merely 0.6-1.7 % of patients of heart failure die during intimate sexual activity. 80-85% of which include males and in 75% of cases, the deaths occur during extramarital relationships, under unsuitable circumstances or after taking heavy meal or alcohol. By considering the above statistics we can say that deaths during sexual intercourse are very uncommon and most of the deceased die because of their own negligence. For example, it is recommended that a patient of heart failure should avoid sexual intercourse after taking a heavy meal or alcohol. Heavy meal redistributes blood supply to abdominal organs, stimulates the nervous system and various hormonal secretions which put more load on the heart during sexual activity. On the other hand, heavy drinking (beyond recommended limits) increases blood pressure, damages arteries and heart muscles. Therefore, those who don’t follow the recommendation, who aren’t careful or those who don’t have the necessary information, are obviously at a higher risk.

How long should you wait after a heart attack?

After the diagnosis of heart failure, usually there are no limitations but in the case of advanced cases. In the case of moderate to severe heart failure, you should wait. But it doesn’t mean that you have to wait for months. After adequate rest and medical therapy, heart condition becomes stable in most of the cases. Some physicians recommend passing a stress test before resuming sexual activity and others say that a patient can resume sexual activity when he feels fit for it. According to the American Heart Association (AHA) recommendations, a patient of heart failure should resume sexual activity after the complete evaluation by his physician. In general,
· After a heart attack patient should wait for 1-4 weeks before resuming sexual activity.
· If you have undergone cardiac stenting then you should wait for 1-2 weeks in order to allow the groin wound to heal properly.
· If your heart has received cardiac device implant or pacemaker, then you should wait for a week.
· After having a heart valve surgery or bypass you should wait for 4-8 weeks. This time period is required to allow your chest wound to heal properly. Once your chest wound is healed you may resume sexual activity.

Heart failure therapy and erectile dysfunction

If you are feeling the problem of erectile dysfunction then remember that you are not alone. Many patients of heart failure experience erectile dysfunction. The Massachusetts Male Ageing Study Suggested that 52% of men ageing between 40-70 years experience erectile dysfunction at some point in their lives. It means that the prevalence of erectile dysfunction is quite high in normal individuals as well. Heart failure itself is a risk factor of erectile dysfunction and the medicines such as beta blocker, which are prescribed for the management of myocardial infarction, also cause erectile dysfunction in 10-11% (max 25%) of cases. This erectile dysfunction is easily manageable. A study published in Myoclonic Proceedings suggested that most patients with chronic heart failure can safely resume sexual activity and can safely be treated with sildenafil for erectile dysfunction provided that they are not suffering from active ischemic heart disease and don’t require nitrates. If you can’t use sildenafil due to its side effects, then you may consider injections, vacuum pumps and in advanced cases surgical prosthesis. Thus, Heart failure induced erectile dysfunction isn’t a major problem and can be treated easily with one or the other way.

When is sexual intercourse not safe?

Sexual intercourse should be avoided if you are suffering from active ischemia, cardiac arrhythmias, worsening heart failure or symptomatic severe heart disease. In these cases, you should wait until your heart failure is optimally managed and your condition becomes stable.

Few more tips for practising safe sex in heart failure

When you plan to start sexual activity, don’t think too much about the risks, Sexual activity is good for the heart. As explained earlier the risk of getting another heart attack is extremely low. Avoid sexual activity after heavy meals and alcohol drink. Make sure that the temperature of the room is optimum. Man on bottom position is considered safer as compared to the man on top position but scientific studies don’t show a significant difference in the workload of the heart during both positions. Try to avoid putting your weight on your arms as it puts more pressure on the heart. Increase the duration of foreplay as it helps to build confidence and prepare the body for sexual intercourse. Enjoy your sexual life with full confidence.