Sexual health concerns are common in patients with all types of heart disease, including patients with coronary heart disease after and patients with chronic heart failure. Erectile dysfunction (ED) is a common problem that affects 15% of men in the age group of 40 to 50 years, 45% of men in their 60s and 70% of men over 70 years. Erectile dysfunction or impotence is defined as the inability to achieve and maintain an erection suitable for sexual intercourse. It is often associated with other conditions such as premature ejaculation and low mood for sexual intercourse but they are not the same problem.

Many studies have shown that ED can be an indicator of subclinical cardiovascular disease. The same risk factors for developing coronary heart disease such as smoking, obesity, hypercholesterolemia, hypertension and diabetes can also lead to the unpleasant condition of ED. The main pathophysiological mechanisms that have been implicated are systemic inflammation, endothelial dysfunction and consequent atherosclerosis. Poor circulation reduces the amount of blood that can lead to erectile dysfunction in men. The cooperation of the urologist with the cardiologist after the diagnosis,is imperative for the correct treatment of the risk factors always aiming at the timely prevention of cardiovascular events.

Unfortunately, factors such as emotional stress, anxiety, depression, fear if sexual intercourse is safe after a myocardial infarction and the side effects of certain drugs such as beta-blockers, thiazide diuretics and spironolactone can  make the relationship of the couple problematic. In general, sexual activity is safe for most people with heart disease. It’s metabolic requirements are moderate so the safety of sex, as in other physical activities, depends on the patient’s cardiac reserves. People with unregulated blood pressure, unstable angina or decompensated heart failure should postpone their sexual activity until their condition is stabilized.

There are several treatment options if you or your partner is experiencing sexual difficulties due to a heart problem. The most important step is to communicate well with both your doctor and your partner and you should not hesitate to express your concerns. A healthy lifestyle without smoking and participating in exercise programs, meditation or regular psychotherapy sessions are enough to deal with the psychological aspect of the problem. As far as medication is concerned phosphodiesterase-5 inhibitors for example sildenafil (Viagra) are the first line agents. These drugs enhance the effects of nitric oxide by increasing blood flow and allow you to get an erection in response to sexual arousal. In the absence of sexual arousal, these drugs are not as useful. Possible side effects include nasal congestion, headache, flushing and visual disturbances and stomach upsets. In addition, these drugs have been shown to cause hypotension, especially in patients receiving any type of nitrite treatment. It is important to consult your cardiologist before starting any treatment. If medications are not effective there are alternative therapies such as penile drug injections and surgery either by vascular bypass or penile implants.

It is important to remember that erectile dysfunction is a common problem. Your treatment plan will depend on a number of factors, including the severity of ED and the underlying diseases. Your doctor will work closely with you to explain the benefits and risks associated with each type of treatment.

References: 

Raheem, O. A., Su, J. J., Wilson, J. R., & Hsieh, T. C. (2016). The Association of Erectile Dysfunction and Cardiovascular Disease: A Systematic Critical Review. American Journal of Men’s Health, 11(3), 552–563. https://doi.org/10.1177/1557988316630305

Schwarz, E. R., Rastogi, S., Kapur, V., Sulemanjee, N., & Rodriguez, J. J. (2006). Erectile Dysfunction in Heart Failure Patients. Journal of the American College of Cardiology, 48(6), 1111–1119. https://doi.org/10.1016/j.jacc.2006.05.052

Rosman, L., Cahill, J. M., McCammon, S. L., & Sears, S. F. (2014). Sexual Health Concerns in Patients With Cardiovascular Disease. Circulation, 129(5), e313–e316. https://doi.org/10.1161/circulationaha.113.004846