When is it safe to get intimate after a heart attack?

By James Beckerman, M.D. , cardiologist, Providence St. Vincent Medical Center, Providence St. Vincent Heart Clinic-Cardiology

You've had a heart attack. You underwent surgery or had a stent placed, and now you're on the mend. But some questions still remain. Could sex trigger another heart attack? Will your sex life ever be the same? The truth is that sex and heart health are intertwined in a rather intimate way.

We already know that 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.

For some, rekindling their sex life after a heart attack – with the green light from the doctor – can be a helpful part of the healing process. But for others, sexual activity can actually put you at risk. Swings in heart rate, blood pressure and stress can increase the possibility of a cardiac event. In most cases, however, the activity itself is less of an issue than the underlying condition.

The good news is that less than 1 percent of heart attacks are preceded by sexual activity. Think about sexual activity like you would other types of intense physical activity. If exercise is appropriate, then sexual activity usually is appropriate as well.

Your doctor may recommend a stress test before giving the OK for sexual activity. Some experts suggest waiting two weeks to have sex after having a heart attack, while others recommend waiting at least six weeks before engaging in any vigorous activity. What you do will depend on your speed of recovery and the severity of your cardiac event.

Cardiac rehab builds confidence

After a heart attack, it's common to worry that physical activity will trigger another event. Cardiac rehabilitation can help you regain confidence and recognize when physical activity is safe again. Despite the wealth of evidence to support it, cardiac rehabilitation is one of the least-used cardiac therapies. While not as technical as the next-generation stent or as convenient as a daily medication, structured and supervised exercise programs are known to be associated with better cardiovascular outcomes. Talk to your doctor if you're interested in learning more about a rehab program near you.

Some people certainly should avoid sexual activity, just as they should be careful about exerting themselves in other ways. Slow down if you experience symptoms such as chest pain, shortness of breath, dizziness or palpitations. Your doctor may have prescribed nitroglycerin for these kinds of symptoms. You also shouldn't mix medications used for erectile dysfunction with nitrates in any form. If you struggle with sexual dysfunction, talk to your doctor about your options.

Understandably, you may be uncomfortable approaching the subject of sex after a heart attack with your health care provider directly. But once you broach the topic, you may be surprised to find there's greater awareness of this particular issue – and a greater willingness to discuss it. It shouldn't be taboo; it's a normal and healthy part of your recovery. The benefits of sex are akin to the benefits of exercise, which we wholeheartedly advocate if you're in the right physical condition to engage: beneficial endorphins, reduced stress, a fortified immune system and enhanced self-esteem.

Don't let fear stand in the way of the things you used to enjoy – including sex. Talk to your doctor. You'll be glad you had the conversation.