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Physicians advised to counsel patients about sex after cardiac event
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A joint consensus statement from the American Heart Association and the European Society of Cardiology Council on Cardiovascular Nursing and Allied Professionals offers the first guidelines on physician counseling of patients about sexual activity after a cardiac event.
The statement is the first to provide “how to” information about resuming sexual activities. Past recommendations have focused on when to resume sex, risks with sex and managing medications. The document contains general recommendations for counseling patients with all forms of CVD, and specific recommendations for counseling patients with CAD, angina or MI; patients with CABG, cardiac transplantation or a left ventricular assist device; patients with HF; patients who have received an implantable cardioverter defibrillator; patients with congenital heart disease; and patients with stroke.
Elaine E. Steinke
“Patients are anxious and often afraid sex will trigger another cardiac event — but the topic sometimes gets passed over because of embarrassment or discomfort,” Elaine E. Steinke, APRN, PhD, chairwoman of the writing group and professor of nursing at Wichita State University, Wichita, Kan., said in a press release.
Topics to address
In most cases, sexual counseling by the physician should be enough to address a patient’s concern about resuming sexual activity, according to the statement.
“Both physical and psychological concerns of cardiac patients and their partners can be addressed through sexual counseling by health care professionals, with only a few patients needing referral and more intensive follow-up by a specially trained sex counselor,” Steinke and colleagues wrote. “It is important that providers assess sexual problems and concerns in a timely manner and address any issues through sexual counseling and medical management where indicated.”
Evidence-based recommendations for physician–patient discussion include:
- Assess all patients to determine whether they are healthy enough to return to sexual activity after a cardiac event and during follow-up.
- Provide individualized and structured counseling based on each patient’s specific medical condition and needs.
- Discuss the best time to return to sexual activity.
- Discuss which positions might be best suited for the patient.
- Offer suggestions for intimacy other than sexual intercourse.
- Counsel all patients on this topic without regard to age, sex or sexual orientation.
- Encourage patients to report any symptoms they experience with sexual activity and to seek medical assistance for chest pain that does not subside.
- Recommend regular exercise, as it has been shown to reduce risk for CV events triggered by sexual activity.
Fear of resuming sex
The call for physicians to take the lead in sexual counseling mirrors the findings of a recent qualitative study of sexual outcomes in women with MI.
The Journal of the American Heart Association study included 17 women (mean age, 60 years) who were married or in a long-term relationship. Researchers surveyed the women about their sexual activity before and after MI. The women’s responses revealed that many expressed fear of resuming sex after MI and wanted more information from their physician on the subject.
“Sexual problems and concerns were prevalent, including patient and/or partner fear of ‘causing another heart attack,’” Emily M. Abramsohn, MPH, of the University of Chicago, and colleagues wrote.
In addition, the researchers found that most women wanted to resume sexual activity with their partner and return to a “normal” life, but few received counseling about the safety of resuming activity. Among those surveyed who did receive counseling, most initiated the discussion with their physician and were disappointed with the quality of information received. Nonetheless, most of the participants resumed having sex within 4 weeks after their MI.
For more information:
Abramsohn EM. J Am Heart Assoc. 2013;doi:10.1161/JAHA.113.000199.
Steinke EE. Circulation. 2013;doi:10.1161/CIR.0b013e31829c2e53.
Disclosure: One researcher reports financial ties with Medtronic and UnitedHealth. The other researchers, members of the writing group and reviewers of the joint consensus statement report no relevant financial disclosures.
Perspective
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Glenn N. Levine, MD, FACC, FAHA
Sexual activity is an important component of quality of life. In a recent scientific statement by the AHA, issues regarding sexual activity in patients with CVD were addressed, and numerous recommendations were given regarding the evaluation of patients with CVD before resumption of sexual activity, as well as when and under what circumstances it was reasonable to resume sexual activities. In most patients with stable CVD, it was deemed reasonable for such patients to engage in sexual activity. However, it was also noted that both patients and their partners have anxiety and concern regarding the resumption of sexual activity, and that most patients are not counseled on issues regarding resumption of sexual activity.
These issues regarding counseling of patients with CVD and their partners are now addressed in a comprehensive consensus document from the AHA and the ESC, authored by a multidisciplinary writing group of nurses with expertise in sexual activity, sexual counseling and CV nursing. Numerous practical recommendations are made and numerous additional recommendations are given for patients with specific CV conditions, such as those who have undergone open-heart surgery, those with HF, those who have been treated with an ICD and those with congenital heart disease.
This consensus document should serve as a valuable educational tool and resource to all health care professionals who are involved in the care of patients with CVD. The document reminds us that we must treat the patient, not just the disease.
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