Safety of sexual activity in patients with cardiovascular diseases

Sexual intercourse in most cases is accompanied by physical activity. This makes some people, especially men suffering from cardiovascular diseases, and their partners, worry about the possibility of developing various complications due to sexual activity, which can lead to a restriction or complete rejection of it. These fears are reinforced by stories of famous people whose death allegedly took place during sexual intercourse. At the same time, research data show that the risk of cardiovascular complications in patients suffering from cardiac pathology during and immediately after sexual activity, although it exists, is relatively low. For example, the risk of developing myocardial infarction in a healthy 50-year-old man during the year is 1%. As a result of sexual activity, this risk increases to 1.01% in a healthy man and 1.1% in a man with a confirmed diagnosis of CAD. 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 intercourse, on average, the maximum heart rate of a man reaches 120-130 beats/min, while systolic blood pressure rises to 150-180 mm Hg. Art. These indicators take place within only 3-5 minutes with an average duration of sexual intercourse from 5 to 15 minutes. The level of stress on the heart is usually expressed in metabolic equivalents (MET). One MET corresponds to the energy requirement expressed as resting oxygen consumption, which is 3.5 ml of oxygen/kg of body weight per minute. In most cases, during sexual activity with a habitual partner, the load is 2–3 METs, with a maximum value of 5–6 METs, depending on the intensity and posture. This corresponds to walking 1.5 km in 20 minutes or climbing 20 steps in 10 seconds. All of the above indicates that sexual activity in habitual conditions and with a familiar partner does not represent a greater danger for both a healthy man and a patient 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, several guidelines have been created, the most widely known of which are the Princeton guidelines. By these recommendations, all patients are divided into 3 risk groups depending on the number of CHD risk factors they have and/or the severity of cardiovascular pathology. Most patients belong to the low-risk group and do not need additional cardiac examination before resuming sexual activity, which poses no danger to them. Patients in the intermediate-risk group require additional cardiac examination, after which they are referred to the low or high-risk group. Patients from the high-risk group have severe cardiovascular pathology, accompanied by severe heart failure. These patients need specialized treatment, after which the question of the danger to them from sexual activity is again considered.

 

After the introduction of the first PDE-5 inhibitor sildenafil into the clinic, reports began to appear about the development of serious cardiovascular complications, including myocardial infarction and sudden coronary death in people taking this drug. However, later numerous studies have shown that the use of sildenafil is not accompanied by clinically significant changes in hemodynamic parameters and cardiac activity at rest and during exercise, both in healthy individuals and in patients with coronary artery disease, as well as in patients receiving antihypertensive drugs. It is important to note that the assessment of hemodynamics and cardiac activity was carried out under loads that occur during sexual intercourse. These data were also confirmed during long-term clinical observation.

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