Relatively little is known about sexual activity in congestive heart failure. With early diagnosis and proper treatment, a patient with heart failure can often have a normal sex life, and erection problems can be treated with sildenafil (Viagra), as long as the patient does not have ischaemic heart problems and is not taking nitrates. Doctor and patient need to talk, because patients often fear a heart attack during sex, which stops them enjoying a healthy sex life.
There is plenty of medical information on sexual activity in people with angina, after a heart attack, with chronic coronary artery disease or after a heart transplant, but very little on sexual activity in congestive heart failure.
Sexual activity and metabolism
Sexual activity has four stages: rest, foreplay, arousal and orgasm. In healthy people, heart rate and blood pressure rise markedly at each stage. Heart rate can reach 140–180 beats a minute, and both systolic and diastolic blood pressure rise, to as much as 160/90. Breathing rate and oxygen use also increase.
In people with congestive heart failure, heart rate also rises, as do blood pressure and pressure in the lungs. These differences are due to the sympathetic nervous system as well as to the emotional and psychological effects (fear, anxiety and tension) that heart failure patients experience during sex.
Sexual function in heart failure
According to the American Heart Association, 4.9 million people in the United States have congestive heart failure. As the disease progresses, patients suffer more from dizziness, shortness of breath, a racing heart or angina. Their quality of life falls, and this can affect their sex life.
In one study of patients with stage III or IV heart failure, 73% had reduced or absent sexual desire and 76% had reduced sexual activity. More than half were less satisfied and happy with sex, and 58% had frequent or permanent inability to have sex.
In another study of 63 patients with congestive heart failure, 62% had sex less often, slightly or markedly, 30% had stopped having sex altogether, about 22% had lost all interest in sex, and about 59% had ongoing sexual problems.
Doctors still have little evidence on which to base advice to heart failure patients about their sex lives. But it is important for these patients to choose positions that do not need much effort, to stop or rest if they become short of breath, and to take more time over foreplay, which lets both partners judge how much exertion the patient can manage and whether they are able to have sex.
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