Curr Cardiol Rep (2014) 16:445 DOI 10.1007/s11886-013-0445-4
ISCHEMIC HEART DISEASE (D MUKHERJEE, SECTION EDITOR)
Sexual Activity and Ischemic Heart Disease Richard A. Lange & Glenn N. Levine
Published online: 10 January 2014 # Springer Science+Business Media New York 2014
Abstract Human sexuality is an important aspect of health and quality of life. Many patients with ischemic heart disease – and their partners – are concerned that sexual activity could exacerbate their cardiac condition, possibly causing myocardial infarction or cardiac death. Patients with ischemic heart disease who wish to initiate or resume sexual activity should be evaluated with a thorough medical history and physical examination. Sexual activity is reasonable for individuals with no or mild angina and those who can exercise ≥3-5 METS without angina, excessive dyspnea, or ischemic ST segment changes. For the patient who is considered not be at low cardiovascular (CV) risk or in whom the CV risk is unknown, an exercise stress test is reasonable in order to determine his or her exercise capacity and to ascertain if symptoms or ischemia may occur. Regular exercise and cardiac rehabilitation can be effective in reducing the risk of CV complications associated with sexual activity for the patient with ischemic heart disease. Keywords Sexual activity . Coital angina . Coital MI . Ischemic heart disease
has been associated with health benefits and longevity [2, 3]. People in very good or excellent health are 1.5 to 1.8 times more likely to report an interest in sex than those in poorer health [3]. At age 55, men in very good or excellent health will on average have 5–7 more years of sexually active life compared to their peers in fair or poor health; for women in good or excellent health the corresponding number is 3–6 more years of sexually active life [3]. In patients with ischemic heart disease, decreased sexual function and activity are common and associated with anxiety and depression [4, 5]. Many patients with ischemic heart disease – and their partners – are concerned that sexual activity could exacerbate their cardiac condition, possibly causing myocardial infarction or cardiac death [6, 7]. Despite these concerns, most patients report that no physician has inquired about potential sexual problems [6, 8]. Health care providers are often uncomfortable addressing these issues because of lack of knowledge about the effects and safety of sexual activity in ischemic heart disease patients. This article presents the information relevant to sexual activity and ischemic heart disease in order to facilitate communication between health care professionals and individuals with coronary artery disease (CAD) regarding sexual activity.
Introduction Human sexuality is an important aspect of health and quality of life, even for many older individuals. More than half of people aged 57–85 years and about a third of those aged 75–85 years are sexually active [1]. Physical health is significantly correlated with sexual activity, and sexual activity This article is part of the Topical Collection on Ischemic Heart Disease R. A. Lange (*) Department of Medicine, University of Texas Health Science Center, 7703 Floyd Curl Dr., MC 7870, San Antonio, TX 78229-3900, USA e-mail: [email protected] G. N. Levine Department of Medicine, Baylor College of Medicine, Section of Cardiology (111B), Michael E. DeBakey Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA
Acute Cardiovascular Effects of Sexual Activity The neuroendocrine and cardiovascular (CV) responses to sexual arousal and coitus have been examined in numerous studies, most of which assessed physiologic responses in young males during vaginal intercourse with their wife [9–15]. From the limited data available, it appears that men and women have similar neuroendocrine, blood pressure and heart rate responses to sexual activity [10, 16]. In ten healthy men (mean age 33 years, range 25–43) who were studied during sexual stimulation and intercourse with their wife [9], heart rate rose by 4–8 beats per minute (bpm) (8–13 %) during foreplay, with a further increase from foreplay to stimulation of 11 bpm (16 %) for partner stimulation and 28 beats bpm
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(40 %) for man-on-top coitus. Peak values for heart rate, rate– pressure product (RPP) and oxygen uptake (VO2) were reached during the brief interval of orgasm (10 to 16 seconds) and then rapidly approached baseline levels during the resolution phase (20–120 seconds) (Fig. 1). In these male subjects, the hemodynamic effects of orgasm were modestly higher when coitus was performed with the man on top than when the woman was on top [17]; average heart rate, RPP and VO2 were highest during orgasm with man-on-top coitus (127±23 bpm, 21,200±6100 bpm mmHg bpm×mmHg and 3·3 METs [22 % of maximum], respectively). Not surprisingly, man-on-top coitus was associated with marked disparities in energy expenditures from one individual to another. For instance, VO2 during man-on-top orgasm ranged from 2·0 METs for one male volunteer to 5·4 METs for another. During sexual activity, systolic arterial pressure usually remains below 170 mmHg in normotensive individuals, and heart rate usually remains below 130 beats/min [9, 17, 18]; however, an occasional subject has an exaggerated hemodynamic response [14, 19]. In a study conducted in patients enrolled in an outpatient cardiac rehabilitation setting [19], average heart rate monitored during sexual activity was 118 bpm as compared with 113 bpm for daily activities (p=NS); however, in 11 % of these patients with stable CAD, the peak heart rate during intercourse ranged from 150 to 185 bpm, and some individuals experienced an exaggerated blood pressure response (systolic arterial blood pressure >200 mmHg). These studies conducted in young couples show that sexual intercourse generally involves only moderate physical activity (i.e., 3–4 METS) for a very short duration of time (i.e., several minutes) (Fig. 1). For comparison, the level of activity associated with sexual intercourse (3–4 METS) can be equated to climbing two flights of stairs, walking at 3 mph, bicycling at
ISCHEMIC HEART DISEASE (D MUKHERJEE, SECTION EDITOR)
Sexual Activity and Ischemic Heart Disease Richard A. Lange & Glenn N. Levine
Published online: 10 January 2014 # Springer Science+Business Media New York 2014
Abstract Human sexuality is an important aspect of health and quality of life. Many patients with ischemic heart disease – and their partners – are concerned that sexual activity could exacerbate their cardiac condition, possibly causing myocardial infarction or cardiac death. Patients with ischemic heart disease who wish to initiate or resume sexual activity should be evaluated with a thorough medical history and physical examination. Sexual activity is reasonable for individuals with no or mild angina and those who can exercise ≥3-5 METS without angina, excessive dyspnea, or ischemic ST segment changes. For the patient who is considered not be at low cardiovascular (CV) risk or in whom the CV risk is unknown, an exercise stress test is reasonable in order to determine his or her exercise capacity and to ascertain if symptoms or ischemia may occur. Regular exercise and cardiac rehabilitation can be effective in reducing the risk of CV complications associated with sexual activity for the patient with ischemic heart disease. Keywords Sexual activity . Coital angina . Coital MI . Ischemic heart disease
has been associated with health benefits and longevity [2, 3]. People in very good or excellent health are 1.5 to 1.8 times more likely to report an interest in sex than those in poorer health [3]. At age 55, men in very good or excellent health will on average have 5–7 more years of sexually active life compared to their peers in fair or poor health; for women in good or excellent health the corresponding number is 3–6 more years of sexually active life [3]. In patients with ischemic heart disease, decreased sexual function and activity are common and associated with anxiety and depression [4, 5]. Many patients with ischemic heart disease – and their partners – are concerned that sexual activity could exacerbate their cardiac condition, possibly causing myocardial infarction or cardiac death [6, 7]. Despite these concerns, most patients report that no physician has inquired about potential sexual problems [6, 8]. Health care providers are often uncomfortable addressing these issues because of lack of knowledge about the effects and safety of sexual activity in ischemic heart disease patients. This article presents the information relevant to sexual activity and ischemic heart disease in order to facilitate communication between health care professionals and individuals with coronary artery disease (CAD) regarding sexual activity.
Introduction Human sexuality is an important aspect of health and quality of life, even for many older individuals. More than half of people aged 57–85 years and about a third of those aged 75–85 years are sexually active [1]. Physical health is significantly correlated with sexual activity, and sexual activity This article is part of the Topical Collection on Ischemic Heart Disease R. A. Lange (*) Department of Medicine, University of Texas Health Science Center, 7703 Floyd Curl Dr., MC 7870, San Antonio, TX 78229-3900, USA e-mail: [email protected] G. N. Levine Department of Medicine, Baylor College of Medicine, Section of Cardiology (111B), Michael E. DeBakey Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA
Acute Cardiovascular Effects of Sexual Activity The neuroendocrine and cardiovascular (CV) responses to sexual arousal and coitus have been examined in numerous studies, most of which assessed physiologic responses in young males during vaginal intercourse with their wife [9–15]. From the limited data available, it appears that men and women have similar neuroendocrine, blood pressure and heart rate responses to sexual activity [10, 16]. In ten healthy men (mean age 33 years, range 25–43) who were studied during sexual stimulation and intercourse with their wife [9], heart rate rose by 4–8 beats per minute (bpm) (8–13 %) during foreplay, with a further increase from foreplay to stimulation of 11 bpm (16 %) for partner stimulation and 28 beats bpm
445, Page 2 of 9
(40 %) for man-on-top coitus. Peak values for heart rate, rate– pressure product (RPP) and oxygen uptake (VO2) were reached during the brief interval of orgasm (10 to 16 seconds) and then rapidly approached baseline levels during the resolution phase (20–120 seconds) (Fig. 1). In these male subjects, the hemodynamic effects of orgasm were modestly higher when coitus was performed with the man on top than when the woman was on top [17]; average heart rate, RPP and VO2 were highest during orgasm with man-on-top coitus (127±23 bpm, 21,200±6100 bpm mmHg bpm×mmHg and 3·3 METs [22 % of maximum], respectively). Not surprisingly, man-on-top coitus was associated with marked disparities in energy expenditures from one individual to another. For instance, VO2 during man-on-top orgasm ranged from 2·0 METs for one male volunteer to 5·4 METs for another. During sexual activity, systolic arterial pressure usually remains below 170 mmHg in normotensive individuals, and heart rate usually remains below 130 beats/min [9, 17, 18]; however, an occasional subject has an exaggerated hemodynamic response [14, 19]. In a study conducted in patients enrolled in an outpatient cardiac rehabilitation setting [19], average heart rate monitored during sexual activity was 118 bpm as compared with 113 bpm for daily activities (p=NS); however, in 11 % of these patients with stable CAD, the peak heart rate during intercourse ranged from 150 to 185 bpm, and some individuals experienced an exaggerated blood pressure response (systolic arterial blood pressure >200 mmHg). These studies conducted in young couples show that sexual intercourse generally involves only moderate physical activity (i.e., 3–4 METS) for a very short duration of time (i.e., several minutes) (Fig. 1). For comparison, the level of activity associated with sexual intercourse (3–4 METS) can be equated to climbing two flights of stairs, walking at 3 mph, bicycling at
