Patients with stable cardiovascular disease can have sex as long as they can handle other mild or moderate physical activities without symptoms, according to a scientific statement from the American Heart Association.
Still, it is reasonable for patients diagnosed with cardiovascular disease to receive a comprehensive evaluation from their healthcare provider before resuming sexual activity, the authors stated.
Patients with unstable disease or severe symptoms should be stabilized before attempting sexual activity, according to the writing group, which was chaired by Glenn Levine, MD, of Baylor College of Medicine in Houston.
The guidance was endorsed by several other professional societies, including the American College of Cardiology and American Urological Association, and published online in Circulation: Journal of the American Heart Association.
The authors set out to summarize data on sexual activity and heart disease "in order to provide recommendations and foster physician and other healthcare professional communication with patients about sexual activity," the authors wrote.
In studies conducted primarily among young married men, sexual activity with a person's usual partner was roughly equal to mild to moderate physical activity, such as climbing two flights of stairs or walking briskly.
Levine and colleagues noted that that comparison might not apply to older individuals, people who are less physically fit, and patients with cardiovascular disease, who might have to exert themselves more than their healthier counterparts.
The authors provided several general recommendations for sexual activity among patients with cardiovascular disease:
Women with cardiovascular disease should receive counseling about the safety and advisability of pregnancy and various types of contraception when appropriate.
It is reasonable for patients with cardiovascular disease to undergo a physical examination and provide a thorough medical history before starting or resuming sexual activity.
Sexual activity is reasonable for patients with cardiovascular disease who have a low risk of complications following clinical evaluation.
For those who are not at low risk of cardiovascular complications or who have an unknown cardiovascular risk, exercise stress testing is reasonable to assess exercise capacity and the development of symptoms, ischemia, or arrhythmias.
Sexual activity is reasonable for patients who can exercise with mild to moderate intensity without angina, excessive dyspnea, ischemic ST-segment changes, cyanosis, hypotension, or arrhythmia.
Cardiac rehabilitation and regular exercise can be useful to reduce the risk of sexual activity-related cardiovascular complications for patients with cardiovascular disease.
Patients who develop cardiovascular symptoms while having sex and those with unstable, decompensated, or severe symptomatic cardiovascular disease should not have sex until their condition is stabilized and optimally managed.
In addition to those general recommendations, the authors provided specific guidance for various conditions and advice for dealing with sexual dysfunction -- particularly erectile dysfunction -- in the setting of cardiovascular disease.
Although cardiovascular medications are rarely the cause of sexual dysfunction, numerous classes of medications, particularly diuretics and beta-blockers, have been associated with erectile dysfunction.
The authors recommended that drugs needed for cardiovascular disease not be withheld because of concerns about sexual function.
Widely available erectile dysfunction drugs -- such as the phosphodiesterase-5 (PDE5) inhibitors sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) -- are useful for treating that condition in male patients with stable cardiovascular disease, according to the guidelines. Safety is unknown, however, in patients with severe aortic stenosis or hypertrophic cardiomyopathy.
There is also an absolute contraindication to PDE5 inhibitor use in patients receiving nitrate therapy. Nitrate therapy should not be administered within 24 hours of the patient using sildenafil or vardenafil, and within 48 hours for tadalafil.
For postmenopausal women with cardiovascular disease, the authors said that it is reasonable to use local or topical estrogen to treat painful intercourse.
Levine and colleagues noted the need for further research on sexual activity for specific cardiovascular conditions.
"When possible, pharmacotherapy, device and surgical intervention, registries, and longitudinal studies of patients with cardiovascular disease should specifically include data on sexual activity and function," they wrote.
"Future studies of interventions to improve sexual activity in the context of cardiovascular disease, including sexual counseling, should address sexual concerns and activity of both men and women, young and old, and both patients and partners."
source: medpagetoday
No comments:
Post a Comment