Safety of sexual activity in patients with cardiovascular diseases

The activity of sexual intercourse is often accompanied by physical exertion, causing concern among people, especially those with cardiovascular diseases, about potential complications that could restrict or completely eliminate sexual activity. These fears are amplified by rumors of famous individuals who purportedly passed away during sexual activity. However, research data demonstrates that the risk of cardiovascular complications in patients with cardiac pathology during and immediately after sexual activity is relatively low. For instance, a healthy 50-year-old man has a 1% risk of developing myocardial infarction within a year. This risk increases to 1.01% in a healthy man and 1.1% in a man with confirmed coronary artery disease as a result of sexual activity. The absolute risk of developing cardiovascular complications for a healthy man is one chance in a million. This rises to two chances in a million within two hours of intercourse for a healthy man and 20 chances in a million for a man with coronary artery disease.

During sexual intercourse, a man’s maximum heart rate reaches 120-130 beats/min, with systolic blood pressure rising to 150-180 mm Hg. These indicators persist for only 3-5 minutes, with sexual intercourse lasting on average from 5 to 15 minutes. Stress on the heart is usually measured in metabolic equivalents (MET), where one MET equals the energy requirement expressed as resting oxygen consumption, which is 3.5 ml of oxygen/kg of body weight per minute. During sexual activity with a habitual partner, the load is typically 2-3 METs, with a maximum value of 5-6 METs depending on intensity and posture. This is equivalent to walking 1.5 km in 20 minutes or climbing 20 steps in 10 seconds. Thus, sexual activity under habitual conditions and with a familiar partner does not present a greater danger for both healthy men and those with coronary artery disease than various forms of everyday physical activity.

To standardize the assessment of cardiac risk in men with coronary artery disease who resume sexual activity, guidelines such as the Princeton guidelines have been created. Patients are categorized into three risk groups depending on the number of coronary heart disease risk factors and/or the severity of cardiovascular pathology. The low-risk group does not require additional cardiac examination before resuming sexual activity, which poses no danger to them. Patients in the intermediate-risk group require additional cardiac examination and are subsequently referred to the low or high-risk group. Patients in the high-risk group have severe cardiovascular pathology accompanied by severe heart failure and require specialized treatment before considering the potential danger of sexual activity.

After the introduction of the first phosphodiesterase-5 (PDE-5) inhibitor, sildenafil, reports surfaced about the development of serious cardiovascular complications, including myocardial infarction and sudden coronary death in those taking this drug. However, numerous studies have shown that sildenafil does not cause clinically significant changes in hemodynamic parameters and cardiac activity at rest and during exercise in both healthy individuals and those with coronary artery disease or those receiving antihypertensive drugs. Importantly, the assessment of hemodynamics and cardiac activity was conducted under loads that occur during sexual intercourse, and these findings were confirmed during long-term clinical observation.


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