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Sexual activity and cardiovascular risk

Y. Drory1

Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel

1 Correspondence: Yaacov Drory, MD, Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel.

Abstract

For the majority of patients, sexual activity in a familiar and monogamous setting poses a very modest coronary risk; in fact, some epidemiological studies suggest longevity benefits for sexually active persons. Although the relative risk for myocardial infarction is increased during and within 2 h after sex, the absolute risk remains minuscule. The metabolic and haemodynamic demands of sexual activity, as well as any cardiac rhythm disturbances observed during sex, are generally consistent with those of daily activities, although there is considerable inter-individual variation in energy requirements. Risk for myocardial infarction during risk sex can be reduced through exercise training, and exercise testing plays a central role in determining the risks associated with sexual activity and treatment for erectile dysfunction. Consensus guidelines have been released to assist the clinician in risk-stratifying patients with concomitant cardiovascular disease and erectile dysfunction, determining the advisability of resuming sexual activity or treatment for erectile insufficiency, and otherwise counselling the cardiac rehabilitation patient. Phosphodiesterase type 5 inhibitors can potentiate the blood pressure lowering effects of nitrates and nitric oxide donors; concomitant administration of these agents with sildenafil citrate and likely other phosphodiesterase type 5 inhibitors is contraindicated.

Key Words: Cardiovascular disease • myocardial infarction • nitrates • safety • sexuality

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