Sex post-heart attack: it's time to talk

Fewer than one in four Australian health professionals talk to heart attack survivors about sexual activity and intimacy, yet more than eight in 10 health professionals believe these conversations should take place, new findings reveal.

The Heart Foundation is urging health professionals and patients to put any embarrassment aside and talk about sexual activity and intimacy. Heart Foundation Queensland Health Director Rachelle Foreman said that resuming sexual activity and, just as importantly, emotional intimacy are important for quality of life for patients and their partners.

New analysis of the survey¹, which was conducted by the Heart Foundation, University of Sunshine Coast and True Relationships and Reproductive Health, shows that health professionals were more comfortable discussing sexual activity and intimacy with women than with men.

Only just over half reported being comfortable discussing sexual activity and intimacy with people from all cultures and backgrounds, according to the 2017 survey of 251 health professionals across Australia.

The survey followed a Heart Foundation patient study and a review of current research. “Heart attack survivors are worried about having another heart attack, performance and over-exertion,” Foreman said.

“Depression, fatigue, a lack of cardiac fitness, pain or discomfort, and sexual dysfunction, including low libido, can also play a role.

“Two out of three heart attack survivors² tell us that having a heart attack had affected their sexual activity, yet only one in four had spoken with a health professional about it. That’s what prompted us to ask health professionals for their perspective, so that we could provide better information for both patients and health professionals.”

National Heart Foundation Chief Medical Advisor Professor Garry Jennings AO said the new survey results showed that while most health professionals recognised the importance of talking to patients about sex and intimacy, many lacked the time, confidence, protocols or resources to do so.

“This isn’t something we generally talk about openly with others, and health professionals are not exempt from feeling uncomfortable about it — in fact, many of those directly managing people with heart attack have not had a lot of training on sex and intimacy advice. What they can do is try to put themselves in the position of the patient and listen — both to what is said and what is not said about these important aspects of life,” he said.

The professionals surveyed felt that GPs and cardiac rehabilitation specialists were best placed to discuss sex and intimacy with patients, followed by cardiologists (re sexual activity) and counsellors (re intimacy).

“Everyone needs to play a part,” Professor Jennings said. “If it’s not covered by health professionals during recovery, it can play on patients’ minds and cause misconceptions and unnecessary anxiety. It is stressful enough to have survived a heart attack and to resume normal life without the added burden of not knowing whether, and when, to resume intimate relations.”

Health professionals can reassure patients and their partners that the risk of a heart attack during sex is relatively low — less than 1% of heart attacks occur during sexual activity. Professor Jennings says it is reasonable to have sex as early as one week after a cardiac event, such as a heart attack or angiogram/stent insertion, and six to eight weeks after coronary bypass surgery, when the wound has completely healed.

As with any physical activity, it is important to feel comfortable and to progressively increase your level of participation. “Studies show that the exertion of having sex with one’s usual partner is comparable to climbing two flights of stairs or walking briskly for a short time. Why not start by taking a walk together? It will give you a chance to talk and rebuild intimacy while testing your fitness following a cardiac event.

“A discussion around returning to, or increasing the level of, physical activity can also be a natural segue for both the patient and health professional to introduce the topic of resuming sexual activity into conversation.”

Health professionals should also discuss all medicines with their patient, as some medications used after a cardiac event can cause sexual difficulties, and medications for erectile dysfunction should be used with caution in men with heart disease.

Further information may be found on The Heart Foundation website.

1. Sexual activity and intimacy after a heart attack by Kara Lilly and Jane Taylor from the University of Sunshine Coast, Claire Moran from True Relationships and Reproductive Health, Rachelle Foreman and Bill Stavreski from the Heart Foundation.

2. Heart Foundation Heart Attack Survivors’ Survey, 2014.

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