How To Get Your Sex Life Back After Your Partner Has A Heart Attack

Mark Reyes* had a heart attack this past summer at the age of 42. He had bypass surgery and was out of the hospital in a few weeks. But 2 months later, he and his wife still haven’t had sex again. (Got 10 minutes? Then you’ve got time to lose the weight for good with Prevention’s new 10-minute workouts and 10-minute meals. Get Fit in 10: Slim and Strong for Life now!)

Not only has he not yet been medically cleared for intercourse, but the thought of jumping back in the sack makes him and his wife nervous.

“It’s a joke between us—if I get too excited, she’ll say, ‘You be careful!'” he says. “But it’s also a half truth. I don’t want to go through that again.”

Reyes is just one of many men who must deal with sexual difficulties in addition to the other life-changing effects of a heart attack. In fact, 31% of men 55 and younger who had no sexual problems before their heart attacks reported at least one new issue in the year after, new research from the University of Chicago found.

Nearly a quarter of them experienced erectile dysfunction, 19% reported a lack of interest in sex, and 16% felt anxious about their performance.

Read on to discover the complex mix of physical and psychological factors that can get in the way of your sex life after a heart attack—and more importantly, what to do about it.

Heart attacks can also cause mental health problems.

A heart attack can easily make a person worried—despondent, even—about his health and ability to maintain his usual lifestyle. As a result, a third of heart attack patients end up experiencing depression, according to the American Heart Association (AHA).

Depression can, in turn, interfere with the complex cascade of neurotransmitters required to feel sexual desire and have an erection, Dr. Wright says.

That’s normal on antidepressants: They can actually cause low libido, according to a review in Current Opinions in Psychiatry. Many heart attack survivors also feel anxious about sex after a heart attack: They may worry about whether they’ll be able to get hard or about triggering another heart attack. And that anxiety only exacerbates a low libido.

Reyes knows this all too well: After his heart attack, he became depressed. He didn’t even feel the urge to have sex, and when he thought about how he couldn’t fulfill all his responsibilities as a husband, it brought him down even more. He began taking antidepressants to stabilize his mood, but he still struggled to feel desire.

But the risk of sex actually causing another heart attack is extremely low: Having sex increases your chance of having a heart attack by only about one in a million, even if you’ve had a heart attack before, according to a JAMA study.

There’s a good chance his erection was already in danger.

Erectile difficulties tend to go hand in hand with heart attacks, because the same factors that put a man at risk for a heart attack can also make him go soft. One example: clogged arteries. Most heart attacks occur when a clot sticks in a clogged artery, blocking blood flow to the heart.

Looking back, 60-year-old Clark Oliver* now realizes that his occasional erectile difficulties might have been a harbinger of the heart attack he experienced this past February.

“If I’d have paid attention to those symptoms early on, I might not have had the heart attack in the first place,” he says.

Many people who have heart attacks also have buildup in their other arteries—including those that supply blood to the penis, says Lawrence Phillips, MD, medical director of outpatient cardiology at NYU Langone Medical Center. When blood can’t flow freely to the penis, a man will have trouble getting or keeping an erection.

Evaluating his lifestyle could have clued him in, too. Before his heart attack, Oliver was a smoker—a habit that causes blood vessels to contract, blocking the blood flow needed for an erection, according to a study in the American Journal of Epidemiology.

Other heart disease risk factors like diabetes, high blood pressure, and high cholesterol can also interfere with the blood flow that fuels erections, says Brad Pfeffer, MD, a cardiologist at the LifeBridge Health Cardiovascular Institute in Baltimore.

Heart drugs can cause sexual problems, too.

Bruce Thomas* learned this after he had two heart attacks at age 71. He was already taking a 10-milligram dose of Cialis for erectile problems. Now that he’s also on beta-blockers, he’s had to double his Cialis dose to counter the beta-blockers’ effect on his erection.

Even if your partner didn’t already have erectile difficulties, the same heart medications that prevent him from having another heart attack can create or worsen sexual problems. For instance, drugs called beta-blockers can lower blood pressure, which is good for his heart—but not for his penis, says Richard Wright, MD, a cardiologist at Providence Saint John’s Health Center in Santa Monica, California.

While some heart meds just require a tweak to ED meds’ dosage, others make it impossible to continue taking them. For instance, men can’t take heart drugs called nitrates—which open blood vessels and relieve chest pain or pressure—along with erectile dysfunction drugs like Viagra or Cialis, Dr. Pfeffer says. That combination can cause a life-threatening drop in blood pressure, so the doctor would need to find another way to treat ED.

You might be anxious, too.

Often, a heart attack survivor’s partner is more scared of having sex than the survivor himself is, says Dr. Wright.

Jim Carroll*, 61, who had a heart attack at age 55, says of his wife: “She was probably more nervous than me, thinking, ‘Am I going to do anything to hurt you? Is this going to be a problem?'” So when he and his wife were ready to try sex again—about 9 months after his heart attack—they approached it cautiously. But it didn’t take long for the nerves to fade.

“Once we started, then it was just like nothing happened before,” he says.

Thomas, too, said he and his wife worried about his heart when they started having sex again. When things would start to get heated, his wife would interrupt and ask him if he was experiencing any symptoms. But as with Carroll, once they did the deed successfully, he and his wife both relaxed.

“It was like, yeah, okay, we got this,” he says.

When—and how—to start having sex after a heart attack

Most men can and do resume their normal sex lives within 1 to 6 weeks after leaving the hospital, says Elaine Steinke, PhD, a professor of nursing at Wichita State University. After that time, the heart muscle typically heals enough so that it can withstand the minor stress placed on it by sexual activity.

Sex puts about as much strain on the heart as climbing a flight or two of stairs, Dr. Pfeffer says. Once the patient can do that without symptoms like chest pain or tightness, he’s probably good to go.

That was the case for Oliver, who found himself pleasantly surprised to be interested and able to have sex just a week after leaving the hospital.

Once cleared, ease back into sex slowly, Steinke says. Start in a familiar environment with your usual position. Trying new moves—even ones that might seem like they require less effort—can cause more stress and strain than the ones you’re used to, says Steinke, who wrote two sets of guidelines for the AHA on sex after heart attacks.

Stop and rest if he experiences any of the types of symptoms felt during the heart attack, such as chest pain, shortness of breath, heart palpitations, or dizziness, Dr. Phillips says. If they subside, you can try again after a few minutes, Steinke says. If the symptoms stick around, call the doctor—or, in the case of chest pain that lasts longer than 15 minutes, seek emergency care.

A cardiologist can tell for sure when he’s ready, since specifics will vary. For instance, with bypass surgery, you’ll need to wait longer—more like 6 to 8 weeks—for the sternum and incision to heal, Steinke says. And if he’s received a stent through the femoral artery in his thigh to open up any blockages—like Thomas did after his second heart attack—you may need to wait 5 to 6 weeks for the incision in the leg to heal.

One caveat: Put receptive anal sex on the back burner at first, even if it’s a regular part of your repertoire. There’s some evidence it puts extra pressure on the vagus nerve that runs between the brain and the abdomen, triggering symptoms like chest pain, Steinke says. Ask the doctor when it’s safe to resume again.

What if he has erectile difficulties after recovery?

Having sex successfully just once after a heart attack can build the confidence you need to keep at it, Dr. Nguyen says. That was the case for Thomas and Carroll, who say their anxiety—and their wives’—subsided after the first positive encounter. In fact, their sex lives even improved a bit on the other side of treatment and recovery.

If there’s trouble getting or keeping an erection after a few weeks, he can ask a doctor to tinker with his heart medications or add in an ED drug. If sexual problems last 3 to 6 months or longer, he may need to visit a specialist like a urologist or a psychologist, says Bryant Nguyen, MD, a cardiologist at Sharp Grossmont Hospital in San Diego.

“It’s kind of like, there was this problem we didn’t know I had, and it was slowly and insidiously getting worse,” Thomas says. “Now it’s fixed, so it’s like ‘Okay, we’re cleared for takeoff.’ That’s a good feeling.”