Sex After MI: Few Are Counseled, Most Want to Learn

Pam Harrison

December 17, 2014

BOSTON, MA — Few patients report receiving counseling regarding the resumption of sexual activity after an acute MI even when it occurs between the ages of 18 and 55, new research indicates[1].

Of those who do receive counseling, restrictions are commonly given that are not supported by evidence or guidelines, according to the study, published online December 15, 2014 in Circulation.

"This is the first study where we've looked specifically at the 18-to-55-year-old group, where about one-fifth of all heart attacks occur. We expected that rates of counseling would be higher for younger people, that there would just be a general bias toward physicians being more open to discuss this issue with younger people," lead author Dr Stacy Tessler Lindau (University of Chicago, IL) told heartwire .

"But we actually found rates of counseling were lower, if anything, than they were in our prior study that included older adults, and what concerns us is that people are resuming their sexual activity with little information or in some cases misinformation about what's safe and what to look for. That can cause fear and worry and other problems."

The prospective longitudinal Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study was carried out at 127 hospitals in the US and in Spain. It was designed in part to evaluate gender differences in baseline sexual activity, function, and patient experience with physician counseling about sexual activity after an acute MI.

Half the Cohort Younger Than 48 Years

For this analysis, investigators used baseline and 1-month data collected from 2349 women and 1152 men who had experienced an acute MI. The median age of the cohort was 48 years.

Of those who reported sexual activity prior to the MI, 54% of women and 63% of men had resumed sexual activity by 1 month after the MI.

Of interest, 9% of patients who were not sexually active in the year prior to their MI had initiated sexual activity in the month following their attack.

However, only 12% of women and 19% of men overall, not all of them sexually active, had some discussion with a physician about sex in the month after their MI.

Among those who reported having a discussion with their physician regarding sexual activity, 68% were given restrictions to limit sex, take a more passive role during sex, or to keep their heart rate down. Those with poorer physical function were somewhat more likely to receive restrictive recommendations than those in better physical condition.

Rates and frequency of sexual activity were, however, substantially lower in the first month after the MI compared with the prior 12 months, the authors report.

Sexual Behavior 1 Month After AMI: VIRGO Study Participants
Frequency of sex
US
Spain
Women (%) Men (%) Women (%) Men (%)
3-6 times/wk 12 16 7 16
1-2 times/wk 37 46 45 54
2-3 times/mo or less 49 36 47 30

The vast majority of patients agreed that it is appropriate for a physician to discuss sexual health with them and indicated that they felt comfortable discussing this issue with a physician. However, in the US, most patients who had such a discussion reported that they initiated it, whereas in Spain, most discussions were initiated by the physician (P<0.001).

In adjusted analyses, female gender, older age, and sexual inactivity at baseline were all statistically significantly associated with no counseling by physicians about resuming sex after an MI.

Despite restrictions given by physicians, two-thirds of patients who received them indicated that they were "completely satisfied" with the recommendations received.

"I still believe that the power dynamic between doctor and patient puts the doctor in the position of responsibility in terms of raising the topic of sexual function," Lindau emphasized.

"Having said that, I also believe that if patients have a concern about this issue, it is squarely within the realm of medical care to attend to this concern. Even the guidelines in the US and Europe and elsewhere say this is an important issue to address, and I believe that if patients ask, physicians will have an informative and caring response."

Lindau reported receiving National Institutes of Health grant support for this study. Disclosures for the coauthors are listed in the article.

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