Safe Sex & Heart Dis

Sex Is Safe for Many Patients With Heart Disease

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Your patients will be happy to hear the latest advice from the American Heart Association (AHA)!

According to a newly released AHA scientific statement,[1] most men and women with stable cardiovascular disease can safely engage in sexual activity. The statement goes on to say that sexual activity is “reasonable” for patients with coronary artery disease who have no or mild angina and for patients with compensated and/or mild heart failure.

Published online in Circulation: Journal of the American Heart Association, the statement contains comprehensive recommendations by experts from various fields including heart disease, exercise physiology, sexual counseling, and urology.

The guidelines were created in part because many patients are uncomfortable talking about sexual activity with their healthcare providers. For many patients, sexual activity is an important quality-of-life measure and they should not have to live with an uncertainty or fear that prevents them from enjoying sexual relations.

Decreased sexual activity and function—common in men and women with cardiovascular diseases—is often related to anxiety about the level of activity required for lovemaking. However, the absolute rate of cardiovascular events during sexual activity, such as heart attacks or chest pain caused by heart disease, is miniscule because sexual activity is usually for a short time. In fact, the authors state that sexual activity is the cause of less than 1% of all heart attacks. The statement also states that sexual activity with one’s usual partner is roughly equivalent to mild or moderate physical activity at 3 to 5 metabolic equivalents—roughly equal to the amount of energy generated per hour by moderate bike riding, tennis doubles, or moderate weight lifting.[2]

Certain patients, such as those with severe heart disease who have symptoms while at rest, should put off sex until their condition has stabilized. But if patients can walk briskly or climb two flights of stairs without experiencing chest pain, abnormal heart rhythms, or shortness of breath, they’re almost certainly ready to start having sex again, the guidelines say.

The one caveat? Married men having affairs—often with younger women in unfamiliar settings that include excessive food and alcohol—may be at higher risk. These circumstances can add to stress that may increase the risks, evidence from a handful of studies suggests.

The recommendations include

  • After a diagnosis of cardiovascular disease, it is reasonable for patients to be evaluated by their physician or healthcare provider before resuming sexual activity.
  • Cardiac rehabilitation and regular physical activity can reduce the risk of cardiovascular complications related to sexual activity in people who have had heart failure or a heart attack.
  • Women with cardiovascular disease should be counseled on the safety and advisability of contraceptive methods and pregnancy based on their patient profile.
  • Patients with severe heart disease who have symptoms with minimal activity or while at rest should not be sexually active until their cardiovascular disease symptoms are stabilized with appropriate treatment.
  • Patients should be assessed to see if their sexual dysfunction is related to underlying vascular or cardiac disease, anxiety, depression, or other factors.
  • Drugs that can improve cardiovascular symptoms or survival should not be withheld due to concerns that such drugs may impact sexual function.
  • Drugs to treat erectile dysfunction are generally safe for men who have stable cardiovascular disease. These drugs should not be used in patients receiving nitrate therapy for chest pains due to coronary artery disease (blockages in the arteries that supply the heart with blood), and nitrates should not be administered to patients within 24 to 48 hours of using an erectile dysfunction drug (depending on the drug used).
  • It is reasonable for postmenopausal women with cardiovascular disease to use estrogen that’s topically or vaginally inserted for the treatment of painful intercourse.
    The scientific statement has been endorsed by several other medical societies, including the American Urological Association, American Association of Cardiovascular and Pulmonary Rehabilitation, International Society of Sexual Medicine, and the American College of Cardiology Foundation.

Jill Shuman, MS, ELS
Published January 31, 2012



  1. Levine GN, Steinke EE, Bakaeen FG, et al. Sexual activity and cardiovascular disease: a scientific statement from the American Heart Association [published online ahead of print January 19, 2012]. Circulation. doi:10.1161/CIR.0b013e3182447787.
  2. Centers for Disease Control and Prevention (CDC). General physical activities defined by level of intensity. Available at: Accessed January20, 2012.