Most people can resume activities six to eight weeks after surgery: researchers
Heart attack survivors who can climb two flights of stairs briskly are likely ready to resume sex, but furtive encounters with extramarital partners could be fatal for men recovering from a cardiac "event." So warns the first scientific consensus statement to provide detailed advice on how to resume sex after a heart attack, bypass surgery or other heart condition - a document designed to help doctors overcome their own discomfort discussing sex with heart patients. "Patients want to know, 'When can I return to sexual activity?' " said lead author Elaine Steinke, professor of nursing at Wichita State University in Kansas.
The document applies to patients who have had a heart attack, an implantable heart device, a heart transplant, coronary artery bypass graft surgery, heart failure, stroke or other cardiovascular diseases, as well as to their partners. Published Monday in two journals, Circulation and European Heart Journal, the document covers everything from recommended positions and the strategic use of pillows to sexual activities less physically strenuous than intercourse. Anxiety, fear and body image issues from surgical scars can all affect intimacy and sexual functioning in people with heart disease, Steinke said.
Heart patients and their partners are often terrified that sex will trigger another heart attack, Steinke said, even though the data suggest that the risk is low - by some estimates less than one per cent. "I think that's something we need to communicate to cardiac patients and their partners," she said. "The risk isn't really all that high."
Where things get riskier is with extramarital sex, or sex with an unfamiliar partner. "Sexual activity with an extramarital partner could pose a health risk for those with cardiac disease," reads the consensus document from the American Heart Association and the European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions.
The stress of illicit sex may increase blood pressure and heart rate significantly, they warned, "resulting in sudden death or cardiovascular events." Even so, the risks appear to be very low - "far less than that associated with anger and unaccustomed physical exercise." Exercise stress testing can be performed to determine if the person's heart is strong enough to resume sex, the authors said. Sex requires the energy output equivalent to walking a treadmill at three to four miles per hour, or climbing two flights of stairs at a brisk pace.
Sex can usually be resumed six to eight weeks after cardiac bypass surgery, Steinke said, and one to two weeks after an uncomplicated heart attack. Pillows can be used to support incision areas; a mild pain reliever can also help. Most heart attack patients are able to resume sex within about four weeks of the attack, though some take longer, up to a year.
Many people with implantable defibrillators worry about the device firing during sex. One study found that the percentage of patients receiving a shock during sex was 13 per cent. Patients should follow the same course of action if "shocked" during sex as they would with any shock, including reporting it to their doctor. Steinke said heart patients can start with activities such as hugging, kissing and fondling to gauge their tolerance for sex, building up to intercourse. Warning signs, such as chest pain, shortness of breath, rapid or irregular heart rate or dizziness should be reported to doctors. Chest pain during sex that doesn't go away within 15 minutes, or five minutes after the use of nitroglycerine, should be treated as an emergency.
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