Post-MI Sex Common in Younger Patients, But Not Trouble-Free

Patrice Wendling

September 20, 2016

CHICAGO, IL — Although most younger patients are sexually active 1 year after an acute MI [AMI], one in 15 women and one in 20 men never resume one of life's greatest pleasures, a new report finds[1].

Among 2802 patients aged 18 to 55 years, 85.2% of men and 72.6% of women were sexually active 1 year after an MI (P<0.001).

In the subset who were active at baseline, more than half had resumed sex by 1 month and more than 90% had done so by 1 year.

Further, sex was rated as important to some degree by 92% of all men and 73% of all women and "extremely" or "very" important by 45% and 24%, respectively.

In the year after AMI, however, 59.4% of women and 45.7% of men reported at least one new sexual problem (P<0.001). Most commonly this was lack of interest (39.6%) and trouble with lubrication (22.3%) among women, while men struggled with erectile difficulties (21.7%) and lack of interest (18.8%).

"Despite a high prevalence of sexual-function problems, particularly among women, few participants reported having any conversation with a physician about resuming sex after an AMI," Dr Stacy Tessler Lindau (University of Chicago, IL) and colleagues reported recently in JAMA Cardiology.

The investigators previously reported from the same VIRGO study that communication with a physician is a significant indicator of the probability of sexual activity after an AMI.

In the present analysis of data from the US and Spain, 90% of participants reported that it's appropriate for physicians to discuss sexual concerns and more than 85% felt comfortable doing so.

Interestingly, Spanish men and women were more likely to report having such conversations with their physician (41.3%, 23.8%) and that a physician initiated the discussion.

"With these findings in mind, it is concerning that most US patients (81% of women and 71% of men) had no discussion about sex with a physician following their AMI," Dr Kevin Weinfurt (Duke Clinical Research Institute, Durham, NC) writes in an accompanying editorial[2].

He observes that if not addressed, sexual problems may erode the patient's relationship with his or her partner and that these relationships can influence the patient's health outcomes.

In adjusted analyses, patients who had not communicated with their physician about sex in the first month after AMI were significantly more likely to delay resuming sex (adjusted odds ratio [AOR] 1.51; 95% CI 1.11–2.05).

Having diabetes (AOR 1.90; 95% CI 1.15–3.13) and higher stress levels (AOR 1.36; 95% CI 1.01–1.83), however, more strongly predicted the probability of never resuming sexual activity.

"Attention to modifiable risk factors and improved physician counseling may be important levers for improving sexual function outcomes for young women and men after AMI," Lindau et al conclude.

Weinfurt writes that "the findings from VIRGO fill a gap in our ability to let younger patients know what to expect" regarding the likelihood of sex and sexual problems after AMI and that the study "serves as a model for making the assessment of sexual function a normal part of clinical research in cardiology and other therapeutic areas."

Lindau reported no relevant financial relationships; disclosures for the coauthors are listed in the article. Weinfurt reported no relevant financial relationships.

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