What You Need to Know About Sex and Your Heart

05/01/2019 | 6 min. read

Dr. Stephen Sinatra

Dr. Stephen Sinatra

While we all know at least one joke about the “little blue pill,” the truth is there can be a very real connection between sexual dysfunction and cardiac risk. Thankfully, the last few decades have seen some major advances in new treatments for this problem and an unprecedented number of people are now seeking professional advice.

If your heart health impacts your love life, you might have options you haven't considered. So, don't give up on this important part of your life without reviewing some of the following options.

Step 1: Talk to Your Doctor

Express any concerns you have about your love life to your healthcare provider. Many folks are embarrassed to do so, but this aspect of your physical and emotional health is important for your physician to know. A basic physical examination and review of your medications is the usual starting point.

Some medications diminish sexual desire and performance. Beta blockers and other hypertension drugs are notorious in this regard, affecting both men and women. This is a real quality of life issue, so don't think that you "just have to live with it." There are solutions that can minimize—or better yet eliminate—these undesirable medication side effects.

If addressing your medications doesn’t resolve the issue, your physician can order tests to check for physical problems. For example, a circulation problem affecting your heart can suggest a blood flow problem to your genitals as well.

Once you have a professional medical evaluation to sort out the cause of specific concerns, such as erectile dysfunction, you can begin to get to the psychological roots of your problem. Both anxiety and depression can have profound impacts on your libido and may coexist with heart disease.

Step 2: Ascertain Your Risk

The research shows sex does raise your risk of having a heart attack—however, the risk is very small. In fact, regular sexual activity was no more dangerous than regular exercise. So, if you are doing both, you are most likely at low risk.

To quantify the risk, let's look back to the Framingham Heart Study from the early 1990s. If a healthy 50-year-old man exercises regularly, his risk of having a heart attack is only one-in-one million per hour of exercise. If the same man engages in sexual intercourse, his risk doubles to only two chances in a million per hour for a two-hour period following intercourse.

Now, take a man who has had a heart attack and been in cardiac rehab. His risk of having another heart attack during sexual activity is 10 chances in a million per hour. One reason his risk is still so low is that regular exercise has been shown to decrease the cardiac work required during sexual activity and reduces a person's chances of having a heart attack.

To find out if sexual activity is safe for you, an exercise stress test is usually your best bet. Folks with a good reason for concern about the safety of being sexually active are those with a sedentary lifestyle, unstable angina or advanced congestive heart failure. For these people, the risk of sudden, heavy exertion precipitating a heart attack is almost one in 1,000.

More Encouraging Findings

Research shows a protective benefit from sexual activity and implied cardiac risk for folks who aren't sexually active or fulfilled. Five- and 25-year studies looking at "all-cause mortality" found it to be lower in men who reported more frequent intercourse. In other research (over 10- and 29-year periods), women unable to achieve orgasm (for various reasons) and celibate priests were found to be more likely to have a heart attack.

It has been reported, however, that establishing a cause-and-effect relationship between sexual activity and cardiac risk has not been possible. When we look at population studies like this, we are inferring that there is such a relationship between the two variables being studied, but presently we can't prove more than a correlation.

For instance, people who are more sexually active may be different in other respects as well. And another problem was pointed out: "not every [heart attack] after sex is due to sex."

Researchers are now trying to rule out confounding variables and home in on the essential question: What is the relationship between sexual activity and heart attacks, and who is most at risk?

Moderate Your Risk

In a 1996 study, regular physical exercise—at least the equivalent of 6 METS (this is the equivalent of walking about 2.5 mph for five minutes on level ground)—modified the association between sex and heart attacks. So, right now, the number one reducer of cardiac risk from sexual activity is regular exercise. Other factors that can lower your risk include the time of day you choose.

It's been recognized that cardiovascular events follow a circadian rhythm and are also triggered by physical and emotional stresses. It's believed that your sympathetic nervous system is activated upon your assuming an upright position in the morning, so I advise folks to avoid sexual intercourse in the early morning hours (5–8 a.m.) to be on the safe side.

There is also evidence that coital position and extramarital sexual activity may alter your risk. One study showed that sudden death during sexual relations was 30 times more likely to occur when a man was with a woman other than his wife.

The Sinatra Solution for "Safe Sex"

When I had concerns about the safety of sexual activity in my patients—and yes, I have had a couple of patients in my 30-plus years of practice who did die during or just after sexual intercourse—I had them wait until I did a few tests first.

Who's at risk? Anyone who has angina, advanced coronary artery disease, congestive heart failure, arrhythmias, or compromised left ventricular function (meaning that their ejection fraction is below normal, and they are probably symptomatic with exertion).

What did I do? Before giving the green light to anyone with the above cardiac problems, I did a stress test to look at how their heart performs with an increase in physical activity.

If I was satisfied, I had them wear a Holter monitor to record the heart rate for 24 hours and asked that they engage in sexual relations while we can keep a record of the heart's activity.

If your doctor has given you the green light to resume sexual relations, here are some tips to do that safely:

  • Choose a time when you are rested and not under psychological stress.
  • Avoid placing any strain upon the chest muscles, particularly if you've just had surgery. Instead, try a side-lying position which puts less strain on the heart and chest.
  • Avoid intimacy one to two hours after meals. Digestion shunts blood to the gut, making less available to the heart.
  • Do not consume excessive amounts of alcohol.
  • Don't pressure yourself or your partner; the mental anxiety may put more of a strain on the heart than the physical activity.
  • Listen to your body. If what you're doing feels alright, chances are you'll be alright.

References:

  • "A Symposium: Sexual activity and cardiac risk: The Princeton Conference." Am J Cardiol 86 (2000): 1F-68F.
  • Muller, J. E., et al. "Triggering of Myocardial Infarction by Sexual Activity. Low Absolute Risk and Prevention by Regular Physical Exertion. Determinants of Myocardial Infarction Onset Study Investigators." JAMA275 (1996): 1405-9.
Dr. Stephen Sinatra

Meet Dr. Stephen Sinatra

Dr. Stephen Sinatra is a highly respected and sought-after cardiologist and nutritionist with more than 30 years of clinical practice, research, and study. His integrative approach to heart health focuses on reducing inflammation in the body and maximizing the heart's ability to produce and use energy.

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