SOURCES: Stacy Tessler Lindau, M.D., associate professor, obstetrics and gynecology and geriatric medicine, and director, Program in Integrative Sexual Medicine, University of Chicago Medical Center; Nieca Goldberg, M.D., medical director, Women's Heart Program, NYU Langone Medical Center, New York City; Karen Englert, Suburban St. Louis, Mo.; Dec. 15, 2014, Circulation
MONDAY, Dec. 15, 2014 (HealthDay News) -- After suffering cardiac arrest, Karen Englert recalled that her doctors freely dispensed advice about not lifting milk jugs, not driving, not showering -- but nothing about resuming sex with her husband, Jeff.
"I've had six different heart procedures, and never had any specific instructions about when that activity could resume," said Englert, 33, of suburban St. Louis, Mo.
People who survive serious events such as cardiac arrest -- when the heart suddenly stops functioning -- or heart attack are understandably concerned about overexertion, and that fretting extends to whether sex might be harmful or dangerous.
A new study of younger heart attack survivors finds that fewer than one out of five get any advice from their doctor on whether they can resume sexual activity -- and what information they do get often is wrong.
"The vast majority of people who have a heart attack do not receive any counseling from their physician about sex," said lead author Dr. Stacy Tessler Lindau, director of integrative sexual medicine at the University of Chicago Medical Center. "If a doctor doesn't bring it up, there are some who will not resume sexual activity because they fear it could trigger another heart attack."
One month after their heart attacks, only 12 percent of women and 19 percent of men in the study reported receiving sexual counseling from their health care provider, according to the findings, published Dec. 15 in the journal Circulation.
Guidelines say it is perfectly safe to resume sexual activity after a heart attack, as long as the patient is not still suffering angina or chest pain, Lindau said.
But many doctors fail to share that information with patients, the researchers found.
In the study, more than 3,500 women and men ages 18 to 55 were asked about the counseling on sexual activity they received following their heart attacks. The questions were asked of patients at 127 hospitals in the United States and Spain from 2008 to 2012.
In the rare instances when patients did discuss sex with their doctors, 68 percent were given unwarranted restrictions, the researchers found.
About 35 percent of those counseled were told to limit sex, 26 percent were told to take a more passive role, and 23 percent were instructed to keep their heart rate down during sex.
"There's no evidence for making these specific kinds of recommendations, and they're also kind of hard to implement, when you think about it," Lindau said.
The researchers found that when doctors talked to patients about sex, it helped. Two-thirds of patients who reported discussions said they were completely satisfied with the recommendations they received.
After her abrupt loss of heart function, Karen Englert said she and her husband struggled sexually. Englert, who suffers from (coronary) sinus syndrome and atrial fibrillation, both heart rhythm disorders, said her husband worried about hurting her or causing another heart episode, while she struggled with feelings of inadequacy and unattractiveness.
It took a long time to get their groove back, she added, noting "It was a little awkward at first. We would start to have sex, and he was very fearful, so he would constantly stop and say, 'Are you okay? Do we need to stop?' Mood kill."
Englert said doctors shouldn't wait for patients to initiate the discussion. "Even if they just subtly handed out some reading material on it, that would be better than nothing," she said.
Dr. Nieca Goldberg, medical director of the women's heart program at NYU Langone Medical Center, said she's not surprised that so few heart attack patients received counseling about sex.
"I think maybe it just gets lost in all the other messages we're giving our patients, about lipids and blood pressure and other ways to prevent a second heart attack," Goldberg said.
Doctors should counsel both heart attack survivors and their partners about sex, she added. "Oftentimes it's the partner who's anxious about not wanting to cause the patient a problem," she noted.
Heart attack patients should feel free to ask their doctor if it appears the physician won't broach the subject, Lindau and Goldberg said.
"They shouldn't go home and keep worrying about it," Goldberg said. "They should bring it up with their doctor."
For more on sex and heart disease, visit the American Heart Association.