by Dr. D. P. Atukorale
Misinformation about sex and heart disease abounds among Sri Lankan heart patients. These myths do nothing but create needless fears which slow the patients recovery.

Although some Sri Lankan physicians and surgeons find sexual matters difficult to discuss with their patients, this area is a major concern for most heart patients. Physicians should try to overcome their reticence and offer information in an objective and non-threatening fashion that will allay fears and anxiety. Resumption of sexual activity may be very important during the stressful readjustment period after a heart attack and after by-pass surgery.

Most patients are capable of physical exertion required (5 METS at orgasm) which is about the equivalent of climbing a flight of stairs briskly (Nemec et al, Am, Heart J. 1976;92:274-277) on the other hand, angina during the intercourse is a possibility and can be devastating to a heart patient. Therefore it may be advisable for some patients to use a nitroglycerin (GTN) tablet 15-20 minutes prior to sexual activity, particularly before the first attempt after discharge from the hospital.

It is generally safe for an uncomplicated heart attack or by-pass surgery patient to have sex with his or her partner four to six weeks after leaving hospital. It is dangerous for heart attack and by- pass patients to have extra-marital sex as large quantities of catacholam-ines secreted by the adrenals can cause dangerous arrhythmias (palpitations) which can rarely cause ventricular fibrillation (cardiac arrest). It is the duty of the cardiologists who are doing cardiac rehabilitation, to discuss about their marital problems as part of cardiac rehabilitation.

Myths about sex after heart attack and by-pass surgery

There is a myth among heart patients that desire and intensity for sexual activity is the same in men and women as they age. This is not correct. In men there is a decline at a slow but steady rate after the age of 60 when it remains same indefinitely. In females sexual drive peaks about the age of 27 to 30 and remains steady until menopause when it drops slightly. After menopause a woman is capable of sexual pleasure, in some cases even greater pleasure because of the lack of concern about unwanted pregnancy.

Another myth among heart patients is that sex after a heart attack is a frequent cause of death. In reality, this rarely happens and if so in an extramarital situation. As mentioned earlier, extramarital sex is more stressful than sex with the spouse for various reasons. The associated effects of too much of food and alcohol intake add to the overall stress and also extra-marital sex takes place in unfamiliar surroundings.

There is another myth among some Sri-Lankans that alcohol is a powerful stimulant for sex. In some cases small amounts of alcohol may help to reduce tension, fears and guilt which may result in increased sexual performance and pleasure. But alcohol is a powerful depressant and may inhibit sexual function even more that it impairs speech, muscle coordination and judgement. The long-term effects of alcohol are so damaging that an alcoholic who becomes impotent may not recover potency even after he stops drinking in spite of using modern drugs which are believed to stimulate sexual function which are dangerous for heart attack patients.

Another common myth is that decline in sex drive and function after a heart attack is due to heart’s inability to respond to the physical demand of sex. In reality except for a few people with severe heart disease and heart failure, the major impact on sex drive and function after a heart attack is psychological rather than physical. The demands of sexual intercourse are mild and are comparable to climbing a flight of stairs briskly.

Some heart attack patients believe that when angina occurs during sex, it is a warning sign to the patient to completely abstain from sex thereafter. But the truth is that angina during sex is rarely severe enough to cause the patient to stop facing sexual relations. If the patient develops chest pain during sexual intercourse, patient’s family physician will recommend a tablet of nitroglycerin (GTN) under the tongue 15-20 minutes before sexual activity to improve the heart function and to prevent development of chest pain.

Conclusion

When a couple feels comfortable and secure enough about their sex life, things begin to improve in other areas of their lives as well. Heart disease may alter a person’s life in ways he or she might not have wished, but it also may give the person time to reflect on relationship to assess beliefs and values, reaffirm or redesign what is most important and if necessary reorder his or her priorities. If the person takes advantage of this opportunity he or she will find that it is possible to have even happier associations with family, friends and co-workers and to return to full and satisfying life.

Heart patients should keep off doctors, relatives and friends who want to make you a cardiac involved. You must consider a heart attack as a signal that there is something a miss with your pattern of living and as an opportunity to make the necessary changes in your way of life.