Can you give me some advice in preparing for sex since my heart attack?

When heart disease has been diagnosed, it is important to follow the lifestyle changes discussed in previous chapters, and particularly in Chapters 9 and 10. Improving exercise ability and losing weight will help sexual ability also. Here is some practical advice to minimise the stress on the heart during sex.

• Avoid sex within two hours of a bath or a heavy meal. Taking a shower and eating a light salad will be better.

• Keep the bedroom and sheets warm. You could invest in an electric blanket if it is cold.

• Don't make love if you are tired at the end of the day. Wait until the morning when you are refreshed and relaxed.

• Avoid caffeine, smoking or alcohol before or after sex. Alcohol may raise expectations that you cannot fulfil and it certainly does not enhance your sex life!

• If you get angina, use your nitrate tablets before lovemaking (but not if you are using Viagra, Levitra or Cialis).

• Don't rush into it - take your time.

• Use lubricants if necessary (see question below).

I have heard that K-Y jelly can be useful if lovemaking is a problem or painful. How safe is it to use?

K-Y jelly is a lubricant which can be particularly useful if your vagina is dry. This sometimes occurs after the menopause and can be a problem in patients with heart problems who naturally, but unnecessarily, feel reluctant or are afraid of resuming a normal sex life. K-Y jelly has no effect on the heart and is totally safe. It does not reduce the effectiveness of condoms or damage them. Topical oestrogens are also effective, and other non-hormonal moisturisers are available.

Where anal intercourse is practised, K-Y jelly is very helpful at reducing any physical trauma to the anus or penis, the pain of which occasionally causes palpitations (see question below).

Does oral or anal sex stress the heart?

Oral sex should not stress your heart, providing both you and your partner are comfortable with it. There is some evidence that anal sex increases palpitations but this has not been proved in a secure long-standing homosexual relationship.

I have resumed sex after my bypass and there are no problems, but I'm afraid that it might do some damage to the operation site. Is this possible?

Firstly, it is good to know that you have returned to a normal sexual relationship - we would like all people undergoing heart surgery such as yours to achieve the same, because it is safe and enjoyable. To answer your question directly - no, the operation cannot be damaged: stitches will not be torn and nothing will fall apart! It is important to remember that sex should be an enjoyable fulfilling experience whether there is heart disease or not - people with heart disease can enjoy a sexual relationship whatever their age.

I read in the newspaper that ED could be a marker for silent coronary disease. Is this true?

Yes. Over 50% of men with coronary disease have some degree of X erectile dysfunction (ED) and it can occur 2-5 years before a coronary event. This is why men with ED and no heart complaints need checking for silent heart disease: their lives may depend on it.

My husband has lost all interest in sex even though he has made a good recovery from his small heart attack. Is it my fault?

Boss of interest in sex is known as loss of libido. It is not something you should blame yourself for. It could be a result of ED - a kind of vicious circle. A low testosterone level leads to lack of sex drive and sometimes ED. Your husband should be checked by his family doctor and get a blood test (before 10 a.m.) for testosterone.

Men with low testosterones are more likely to get coronary disease but we don't know if replacing or boosting it prevents coronary disease. If his testosterone is low, replacing it with a topical gel daily or an injection every 8-10 weeks can make the world of difference, restoring libido and overall energy and well-being. Tests for prostate cancer (prostate specific antigen, PSA) are done on the same blood sample because of a (very controversial) possible link between testosterone and prostate cancer - this is a precaution and should not put anyone off getting tested. As men get older, testosterone gradually falls but replacement or boosting works at all ages. No man or woman should consider themselves 'too old' for intimacy