How Heart Disease Affects Intimacy, Sexual Health, and Wellbeing

Allison E. Gaffey – Yale University, VA Connecticut Health System; S. Raquel Ramos – Yale University; Kara Nishimuta – University of Kansas Medical Center

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Problems with sexual intimacy are very common, especially among those with heart conditions. These difficulties may affect up to 90% of men and women with cardiac conditions, including adults with various hypertension, coronary artery disease, heart failure, implantable devices, and patients who had heart attacks.

Sexual difficulties can be a major quality-of-life issue for you and your partner. While your healthcare provider may not start a conversation about this topic, it is helpful to be informed so you can start a discussion about this common experience.

For people with cardiac conditions, sexual difficulties may include:

• Decreased sexual desire
• Difficulty achieving orgasm
• Vaginal dryness
• Vaginal pain during intercourse
• Difficulty achieving and maintaining erection

Can I have sex after a heart attack or other cardiac event?

Understandably, many patients and their partners have concerns about returning to safe sexual activity after a cardiac event. While it might feel uncomfortable to talk about these concerns with your cardiologist, your providers are aware of these intimacy issues and there are ways they can help, such as counseling about safely returning to sexual activity or prescribing medications.

After a cardiac event or surgery, you may not be able to return to sexual activity right away. However, there are many ways to be intimate, including:

1. Physical Intimacy (non-sexual): Hugging, cuddling, holding hands, kissing, or simply being physically close.
2. Emotional Intimacy: Sharing feelings, fears, hopes, or expressing gratitude and love with those you care about.
3. Experiential Intimacy: Sharing experiences, such as a meal, playing cards, or going for a walk. If you cannot engage in activities you typically enjoy now, try planning a future activity with someone you love.
4. Intellectual Intimacy: Sharing ideas, opinions, and life perspectives, learning something new, and discussing different topics can all be intellectually intimate. Maybe you have been wanting to learn to cook a new type of food or watch an interesting movie. Try sharing this experience with a loved one and discussing it afterward!
5. Spiritual Intimacy: If you’re spiritual or religious, this type of intimacy can promote closeness with those you care about. This can include talking about your beliefs, praying or worship, engaging in important rituals, attending services or ceremonies, or connecting with your spiritual community in some way.

Physical and Psychological Factors Affecting Sexual Health and Satisfaction

• Emotional distress, personal health, and health behaviors like smoking, alcohol, and diet
• Relationship problems or previous sexual experiences
• Medications or medication side effects
• Your partner’s health
• Cultural, family, or media influences
• Self-esteem or concerns about your body image
• Worry or fear that sex is unsafe

Strategies and Treatment Options

• Talk with your healthcare providers.
  • Be assertive! Bring up the topic at the beginning of the visit. If you don’t get your questions answered by the first provider, ask other providers until you get your questions answered.
  • How to start the discussion: “I read that my heart condition could get in the way of intimacy.” or “I’m worried that sex isn’t safe for my heart.”
• Talk with your partner.
  • Talk about your feelings
  • Participate in common activities
  • Make alone time and go slowly
  • Experiment with alternative types of intimacy and sexual techniques
  • Have fun and don’t put too much pressure on each other
• For erectile dysfunction, medications are easy to use and work quickly.
• Sexual aids can be used alone or with a partner.
• Moisturizers and lubricants can reduce discomfort and do not require a prescription.
• Therapy or counseling can help with communication, body image, and individual or couples’ concerns. Therapy can also address behaviors, emotions, and stress that cause sexual difficulties.

Sex Positivity and Communication

Intimacy can take many forms, but health conditions like heart disease can create challenges to sexual intimacy. During these times, it is important to remain Sex Positive. In its broadest definition, Sex Positivity means having non-judgmental openness and attitudes about sexual expression or sexuality.

For people with heart conditions, it could mean re-thinking your beliefs about sexual intimacy and feeling good. Sexual intimacy and pleasure are not limited to specific acts. Being sex positive removes the stigma and shame from sexual intimacy and pleasure and allows a consensual exploration of new ways to achieve similar feelings of intimacy or pleasure without shame or stigma due to having a heart condition.

Sex Positivity Benefits Include:

• Confidence: Understand that you’re in control of your sexuality and intimacy not your heart condition. Re-imagining intimacy within the bounds or your abilities can be liberating.
• Mental well-being: “Feel good” hormones released in your brain during intimacy can reduce depression and anxiety.
• Healing: Removing any doubt, body shame, or feelings of low self-worth that are influenced by negative feelings from the impact of heart disease and social pressures. Unlearning negative messaging about heart disease and intimacy.
• Strengthen Communication Skills: Communication is necessary to achieve any of the 5 types of intimacy (physical, emotional, experiential, intellectual, and spiritual). In time, you will become more comfortable verbalizing your needs and expressing yourself.

Learn More:

• Sex and Heart Disease  
• All About Sex Positivity
• What does “sex positive” mean?  
• Sex and Good Communication

"How Heart Disease Affects Intimacy, Sexual Health, and Wellbeing" is fifth in a series of articles on how heart health and mental health are related. 

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