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    Sex and Your Heart

    Every so often, a medical research study just makes people smile.

    This was the case a few weeks ago when the American Journal of Cardiology reported that men having sex twice a week had about half the risk of developing heart disease than those having sex once a month. This was independent of age or erectile dysfunction. Good news for some, bad news for others. How about you?

    But before you head in to see your doctor about a new “prescription,” let’s think about what this study really means. It actually tells us something that isn’t very surprising – sexual health is a barometer for overall health. The ability and desire to have sex point toward a capacity for greater physical activity, healthier relationships, and stronger social support. It turns out that our lives inside the bedroom tell us a lot about our lives outside of it. Our sexual fitness can be a symbol of our overall fitness and our risk for heart disease.

    But there’s more to it than just that. While sex may be a marker of good heart health, it is important to consider that for some people, sexual activity can actually put them at risk. The good news is that it is pretty unlikely – less than one percent of heart attacks are preceded by sexual activity. But we should think about sexual activity much like we think about other types of intense exercise. Swings in heart rate, blood pressure, and stress can increase the possibility of a cardiac event, but in the majority of cases, the activity itself is less of an issue than the underlying condition. For this reason, people who have known heart disease need to directly communicate with their physicians about whether sexual activity is safe or recommended. In some situations, a stress test may be considered before recommending sexual activity, much in the same way that similar tests can be used to help guide people who wish to start a substantial exercise regimen.

    So where does sexual dysfunction fit into the picture? While less sex may be associated with more heart disease, we also know that erectile dysfunction in men and sexual dissatisfaction in women are associated with a higher risk of heart disease and peripheral vascular disease in the future. And rather than thinking of it as a “side effect” of other cardiovascular problems, erectile dysfunction in particular may be a symptom of future concerns.

    The first step involves what is sometimes the most difficult medical intervention of all – a conversation. Talk to your doctor about your heart condition if you have one, and talk about your sex life even if you don’t. Get more information about your level of risk and what might be appropriate and safe for you to do. This is also a good time to review your medications and make sure that they aren’t bringing you down – unfortunately some blood pressure medications are well known to increase the risk of erectile dysfunction and decreased sex drive. Make sure that your doctor is part of the solution rather than contributing to the problem. And while the likelihood of having a heart attack while engaging in sexual activity is low, you may feel more reassured if you approach the issue head on. In the end, it may really just boil down to the same question:

    “Do you feel lucky?”

    - James Beckerman, MD, FACC

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