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Physician counseling on sexual activity uncommon after acute MI
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In a new study, few patients with acute MI received counseling from health care providers regarding sexual activity, despite the majority of patients indicating that such a discussion would be appropriate.
Among patients who did receive counseling, many were given recommendations to restrict sexual activity that were unsupported by evidence or treatment guidelines.
The prospective, longitudinal VIRGO study incorporated data from 2,349 women and 1,152 men aged 18 to 55 years (median, 48 years). All had acute MI and were treated at 127 hospitals in the United States and Spain. Partner status, sexual activity and attitudes about sex were assessed at baseline and 1 month following acute MI, along with whether patients had discussed sexual activity with a physician.
In the month following MI, rates and frequency of sexual activity were reduced regardless of age or geographic location. Most patients who were sexually active before acute MI, including 54% of women and 63% of men, had resumed sexual activity within 1 month.
Nearly all patients (89% women, 94% men) reported that they considered it appropriate to discuss sexual health with their physician, and most (84% women, 91% men) said they felt comfortable discussing sexual issues with a physician. However, within 1 month of MI, only 12% of women and 19% of men reported discussing their sexual activity with their physician.
Among these patients, health care providers recommended restrictions on sexual activity in 68% of cases, including limiting sexual activity (35%), taking a passive role (26%) and maintaining a lower heart rate (23%). The researchers noted that these recommendations “were inconsistent and only weakly related to patient characteristics.” They also noted that “neither strong evidence nor clinical guidelines support the specific kinds of sexual activity restrictions patients received.”
Risk-adjusted analyses indicated significant associations between no discussion of sexual activity with physicians and female gender (RR=1.07; 95% CI, 1.03-1.11), advanced age (RR=1.05; 95% CI, 1.02-1.08 per 10 years) and being sexually inactive at baseline (RR=1.11; 95% CI, 1.08-1.15).
Women in Spain were significantly more likely to receive restrictions from physicians than women in the United States when discussing sexual activity (RR=1.36; 95% CI, 1.11-1.66). The researchers also observed a gender-by-country interaction (P=.03): women were more likely than men to receive instruction to restrict sexual activity after MI in Spain (adjusted RR=1.38; 95% CI, 0.95-2.02), but less likely than men in the United States (RR=0.86; 95% CI, 0.74-1).
“Even with life-threatening illness, people value their sexual function and believe it is appropriate for health care providers to raise the issue of resuming sexual activity,” Stacy Tessler Lindau, MD, MAPP, associate professor of obstetrics and gynecology and geriatric medicine at the University of Chicago Medical Center, said in a press release. “When the topic of sexual function is left out of counseling, patients perceive that it’s not relevant to their medical condition, or that they are alone in the problems they have resuming normal sexual activity.”
Disclosure: See the full study for a list of relevant financial disclosures.
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