What is the relationship between cardiovascular heart disease and sexual function?

Women suffer from heart disease—it is not just a man's disease. Heart disease is, in fact, the number one killer of women. As women age, they are at risk for cardiovascular events, heart attacks, strokes, and other forms of cardiovascular disease. Many women with underlying heart disease or stroke continue to engage in sexual activity well into later life. Sexual concerns are important factors for women with heart disease, and healthcare professionals and cardiologists should be cognizant that these complaints exist.

A recent study examined the prevalence and correlates of sexual functioning in more than 2,700 postmenopausal women with an average age of 67 years, all of whom had heart disease. This large, population-based study found that approximately 40% of the postmenopausal women with coronary artery disease (CAD) continued to engage in sexual activity. It is estimated that at least 65% of them may have had some type of sexual complaint. Sexual problems such as lack of interest, difficulty in arousal or orgasm, and discomfort during sexual activity were found to be common complaints in many women with heart disease.

There are approximately 5 million stroke survivors in the United States. According to the American Stroke Association, four out of five families are affected by stroke. The National Stroke Association Survey claims that one in five stroke survivors suffers detrimental effects to their sex lives. Some practical suggestions can help stroke survivors enhance and continue to experience a fulfilling sexual life: plan sexual intimacy for when fatigue is at a minimum, use pillows liberally for comfort if mobility is an issue, and even explore new body areas to find areas of sensation and sensuality. If talking has become difficult, one suggestion is to try to communicate with touch or massage. Creativity and relaxation are always important as well. If intercourse has become difficult, focus on pleasure and intimacy through other activities including caressing, hugging, and oral and manual stimulation. Love-making should focus on pleasure rather than performance.

If you have underlying heart disease or one of its risk factors such as hypertension, diabetes, or obesity, ask your healthcare provider to assess your sexual functioning; your underlying medical illness could be a significant factor in your sexual complaint.

What is black widow syndrome?

It is well known that throughout the animal kingdom some species of the female black widow spider consume their male partners after they mate and have completed the intimate act. Black widow syndrome is a term I use to describe many women I have clinically evaluated who present with reactive lowered libido as a result of their male partners' heart condition. After comprehensive assessment and evaluation, I have found that the origin of their concerns is that they are fearful that sexual activity, sexual excitement, or arousal may induce another cardiovascular event in their partner—in other words, it is safer for them to have no sexual interest because with no interest there is no opportunity for intercourse, and therefore they are safe and can protect their partners from the potential trauma of another heart attack or cardiovascular mishap.

If you suffer from this condition, the treatment for this syndrome includes extensive education of both you and your partner concerning real risks and perceived risks. The incidence of death during intercourse is remarkably low, and most men and women can resume sexual play after a cardiovascular event without any worries. Your cardiovascular surgeon and cardiologist should be able to reassure you and can do some simple, easy tests to ensure good health and sexual satisfaction.

What is a postsex headache?

Headaches after sexual activity are often seen as normal, and many men and women suffer from postcoital (after-sex) headaches. Most sexual healthcare professionals are not certain of the cause, but increased blood pressure combined with muscle tension in the head and neck region all may play a role. The headaches can be mild, moderate, or severe and might last from a few minutes to several hours. If you suffer from these types of headaches, see a doctor to ensure that it is nothing more serious going on. Some healthcare providers suggest over-the-counter medications such as anti-inflammatory pain medications prior to sexual activity. Another suggestion is at the first signal of head discomfort, try to change sexual positions, which may influence blood pressure and eliminate some of the muscle tension.

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