Can Sex Be Dangerous for Someone With Heart Issues?

Here's everything you need to know.

By
Published December 12, 2024
bed with heart balloons tied to the side, one heart balloon is bursting.
Valero Doval

In my many years running a sexual medicine and menopause clinic, it was the rare woman who didn’t have at least one medical condition that impacted her ability to have a pleasurable sexual experience. There are over 50 medical conditions and classifications of medications that have been identified as having an impact specifically on the ability to have a normal sexual response and/or the ability to have intercourse.

And more than half of post-menopausal women are coping with at least one of those issues. It may be diabetes, cancer or arthritis, but at the top of the list is cardiovascular disease. Heart disease is the number-one killer of women in this country. It is also one of the top killers of sexual health. There are four issues for women with heart disease when it comes to sex:

Do you have the physical stamina for a sexual workout?

There is a difference between what is safe to do and what you can do. The safety of having sex depends on the specifics of your cardiac capabilities, so you need to check with your cardiologist on this one. Don’t be afraid to be specific. I promise they won’t be shocked.

If you have been given the green light but you simply feel like you don’t have the physical strength to engage in sexual activity, you may need to make some adjustments. This is where the power of the pillow comes into play. Pillows and bolsters optimize comfortable positions and minimize the effort for intercourse, oral sex and self-stimulation.

There are pillows specifically designed to facilitate comfortable sex. Ergoerotics.com is a site that specializes in the ergonomics of sex (yup — that’s a thing) for folks with any type of physical challenge. On the site (run by a clinical sexologist) you will find a wide assortment of sexual support pillows, along with suggestions for placement depending on the issue and the desired sexual activity. Most come in a variety of fabrics to match any décor. Only you will know that it is not something your designer chose.

Will your body become aroused and have a pleasurable sexual experience?

If you have heart disease, you likely have compromised blood flow, not just to your heart, but to other parts of your body … including your genitals. Most women are already dealing with vaginal dryness from a lack of estrogen. Further reducing blood flow to the vaginal walls will often result in a total lack of lubrication.

And then there is the orgasm issue. While it’s fairly well known that men with cardiac disease often have erectile dysfunction, your cardiologist may have forgotten to mention that up to 50 percent of women with significant coronary artery disease have a reduced ability to reach orgasm. It makes sense that if there is limited blood flow to the clitoris, not much is going to happen. This reduction in blood flow will not only impair engorgement and keep erectile tissue from responding but also inhibit the proper flow of blood needed to ensure that nerve endings are healthy and responsive.

A local vaginal estrogen cream (this requires a prescription) is a vasodilator and should regularly be applied inside the vagina and at the vaginal opening. And then take a dab and apply it to the clitoris. And yes, it is safe to use a local vaginal estrogen product if you have heart disease. If your medication is part of the problem ask your doctor if there is a substitute that won’t impact sexual response. In any case, don’t forget the silicone lube.

If you have fabulous sex and an explosive orgasm, is your heart going to be able to take it? What is the risk factor?

Nelson Rockefeller, the long-serving governor of New York, died while having sex with his mistress. Other than making your heart go “pitter-patter,” what are the serious cardiac effects of sexual activity? Here’s a fun fact — in studies conducted among married couples in their own bedrooms — there was no increase in heart rate during sex! In fact, on average, married couples have heart rates that are lower during sex than the rates recorded during their normal daily activities. It’s somewhat depressing (and reassuring at the same time) that having sex with your spouse in your own bedroom requires only the same amount of exertion as a two- to four-mile-per-hour stroll on a level surface for a few minutes.

This is probably why studies show that sexual activity is rarely responsible for a myocardial infarction. Risks are even smaller in men and women who are routinely sexually active and have regularly participated in a post-heart-attack exercise program.

If you continue to avoid intimacy from a fear of dying or having another heart attack, it may help to have an exercise stress test to assure you that your heart can take it.

In general, most cardiologists say that you are safe to have sex with your regular partner if you can climb up two flights of stairs without having chest pain or becoming out of breath. Note the word “regular." The excitement of sex with a new partner, or maybe someone else’s partner, may be a little too exciting for your heart to take.

Obviously, it’s important to check with your own doctor, but in general, patients who have no symptoms, have mild, stable angina, have controlled hypertension and do not have exercise-induced reduced blood flow or chest pain should feel free to have sex with a regular partner six to eight weeks after a heart attack. If you have a pacemaker, there is no reason to believe that using a vibrator will cause it to malfunction. It’s probably best, however, not to put your vibrator directly on your pacemaker.

Facing the Fear Factor

While people might joke about a heart attack during sex being a great way to go, this fear significantly reduces the amount of sexual activity of patients with known heart problems.

Make an appointment to talk specifically to your doctor about the appropriate level of sexual activity for you. Often women will ask these questions as the doctor is headed out the door and get only a quick “Sure, it’s fine” which is not particularly reassuring and offers very little information.

If your doctor doesn’t suggest a stress test, again, you can request one to prove to yourself that you are not going to die during sex.

More important than anything else may be to schedule an appointment with a cardiac psychologist who is specifically trained to help you address anxiety about returning to your day-to-day activities including resuming your sex life. And bring your spouse or partner along to your appointment so that he or she can also be reassured that you are not going to drop dead if you have a decent orgasm.

Do any of you suffer from heart issues? Has this stopped you from having sex? Let us know in the comments below.

Lauren Streicher, MD, is a Clinical Professor of Obstetrics and Gynecology at Northwestern University’s medical school, The Feinberg School of Medicine and is the medical director of the Northwestern Medicine Center for Sexual Medicine and the Northwestern Medicine Center for Menopause in Chicago. She is the host of the hit podcast, THE Menopause Podcast, and the author of Dr. Streicher’s Inside Information Series, which includes: Slip Sliding Away: Turning Back the Clock On Your Vagina-A gynecologist’s guide to eliminating post-menopause dryness and pain, and Hot Flash Hell: A Gynecologist’s Guide to Turning Down the Heat. She is also the author of Sex Rx: Hormones, Health and Your Best Sex Ever, and The Essential Guide to Hysterectomy. Dr. Streicher is a Fellow in the American College of Obstetricians and Gynecologists, a member of the Sexual Medicine Society of North America, Inc. and is a Certified Menopause Practitioner of The North American Menopause Society. She was the 2019 recipient of the North American Menopause Society Media Award.