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Sex after a heart attack: Is it safe?

For most patients, having a heart attack can be a frightening, life-changing experience.  Many heart attack survivors are reluctant to engage in any physical activity in the days and weeks following their event.  However, it is essential that patients begin to resume normal activity in order to manage risk factors and avoid developing a sedentary lifestyle.  Avoidance behaviors, while common in heart attack survivors, may lead to anxiety and depression, and can actually hamper recovery.

As a general rule, if you can climb one flight of steps without developing chest pain or shortness of breath, you are ready to resume sexual activity.   Most patients can resume intercourse within a week of a major cardiac event.  However, there are a few other factors to consider when developing a timetable for safely resuming sex.  

Some heart attack patients most undergo some type of procedure to restore blood flow to the heart.  The type of procedure used to restore blood flow will play a role in determining when it is safe to resume sexual activity.  

If a patient has a catheter-based stenting procedure (where a small metal tube is inserted into a heart artery through a puncture site in the groin or arm) sexual activity may be resumed as soon as the site heals—usually within a week or so.  If an open-heart procedure such as bypass surgery is required, the patient will need to wait 6-8 weeks in order to allow the wounds in the breastbone to heal properly.  

Some patients recovering from heart attacks may be on medicines that can worsen conditions like erectile dysfunction (ED).  In addition, many men with heart disease also have ED.  For men who wish to take medication for ED, it is essential to discuss all of your medicines with your physician.  If you are taking nitrates to treat chest pain, it is not safe to use medications for ED.  

While most patients worry about the safety of having sex after suffering a heart attack, the reality is that only 1 percent of all heart attacks occur during intercourse.  In fact, the risk for having a heart attack during sex is the same for men whether or not they have coronary artery disease at all.  

Having a sedentary lifestyle increases the risk slightly, but having sex regularly decreases the risk for heart attack likely due to an increase in exercise capacity.  In a study conducted by the American Heart Association, only 0.6 to 1.7 percent of heart attack-related deaths occurred during sex, and of these, nearly 75 percent were in men who were involved in extramarital sexual activities in unfamiliar surroundings with younger partners.  

Communication with both your partner and physician plays a key role in recovery and in understanding when it is safe to resume sexual activity.  It is imperative for doctors and patients to feel comfortable discussing sex after heart attack—don’t be embarrassed.  In addition, speaking with your significant other about your fears concerning sex after a cardiac event can be a good way to begin recovery.  

The bottom line is: It is safe to have sex after suffering a heart attack for the majority of patients.  If you develop chest pain or shortness of breath during sexual activity it is important to stop immediately and contact your doctor to discuss your symptoms further.  In addition, if you develop symptoms that do not go away after stopping intercourse, contact 911 immediately and seek evaluation in an emergency room.   

Dr. Kevin Campbell is an assistant professor of medicine in the division of cardiology at University of North Carolina at Chapel Hill. For more from Dr. Campbell, visit his website DrKevinCampbellMD.com.