Fear, Confusion Among Women Resuming Sexual Activity Post-MI

July 25, 2013

CHICAGO, Illinois— Frank discussions about the resumption of sexual activity for women who have had an MI are simply not that common and the discussions that are taking place are vague or confusing, according to a new report[1]. These post-MI patients, many of whom expressed fear or apprehension about resuming sexual activity, would like direct advice from their physician, specifically such as when they can start again and how much exertion is safe for their heart.

"The predominant feeling of fear is described on both sides, both among the women and their partners," lead author Emily Abramsohn (University of Chicago, IL) told heartwire . "These were fears of having another heart attack or dying during sex. One woman even had to convince her husband that she wasn't going to die in bed. But women also expressed a motivation to return to sex as a way to get back to their normal life and not be stigmatized as a heart patient. We heard that a lot."

Of the women interviewed, most started having sex again within four weeks of the MI despite their fears. At six months, only one individual was not sexually active.

qOne woman even had to convince her husband that she wasn't going to die in bed.

The study is published July 24, 2013 in the Journal of the American Heart Association. Abramsohn, along with senior author Dr Stacy Lindau (University of Chicago), interviewed 17 women with monogamous sexual partners in the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) registry. The women were interviewed to gain a better understating of the recovery of sexual function following an acute MI and to improve sexual outcomes in women after the clinical event.

Recommendations Not Being Discussed

The American Heart Association (AHA) and American College of Cardiology recommend that physicians counsel patients about their ability to resume sexual activity after MI. The European Society of Cardiology (ESC) also makes recommendations about resuming sexual activity.

The AHA states, for example, that in stable patients without complications sex can be resumed within 10 days of the MI. In a paper published in 2012, and reported by heartwire at the time, the AHA said sexual activity is safe for the majority of heart disease patients and that doctors--as well as patients and their partners--should endeavor to bring up the subject of sex in discussions. According to the AHA, only unstable heart disease patients and those with severe symptoms should not partake. These patients should be assessed and stabilized with appropriate treatment before engaging in sexual activity.

"While there are recommendations outlined by the AHA and other similar guidelines by the ESC, the findings of this study demonstrate that the few women who talk to their doctors about sexual activity after their heart attack find the sexual counseling vague or confusing," said Abramsohn.

To heartwire , Abramsohn noted that physicians might be reluctant to bring up sex with their patient because they might not have anywhere to send a patient if there is a problem. At the University of Chicago, for example, there is the clinical Program in Integrative Sexual Medicine for Women and Girls with Cancer. This program focuses on the identification and treatment of sexual dysfunction in women with cancer. Such resources might not be available to cardiologists and their patients, or the physician might not be aware of cardiac rehabilitation programs that may have resources to address sexual activity and/or dysfunction.

 
They were concerned about the safety of returning to sex, such as exertion levels their heart could handle.
 

Abramsohn noted that in a previously published paper--a qualitative analysis of the TRIUMPH data--one of the predictors of the loss of sexual activity following MI was a lack of counseling by the physician. In that paper, loss of sexual activity was defined as less frequent or no sex in women who were previously sexually active. In the current analysis, the 17 women surveyed felt that the cardiologist was the most appropriate member of the medical team to advise patients about resuming sexual activity.

"We asked women what information they would like to have about sexual activity and when in the continuum of care they would like to receive the information," said Abramsohn. "A lot of women felt that the subject should be broached by the cardiologist because he or she knows their heart the best. They were concerned about the safety of returning to sex, such as exertion levels their heart could handle. While it may be difficult for cardiologists to provide specific information, just broaching the subject will demonstrate to their patients that it's important to them, too."

All of the authors reported no related conflicts of interest.

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