June 18th, 2012
Sexual Outcomes Following an MI: Let’s Talk About Sex, Doc
Emily M Abramsohn, MPH
Today, most patients survive an MI. People live after an MI not just to leave the hospital, but to go home, resume work, play sports, and sometimes even enjoy life more. What about sex? Did you know that most patients who have an MI were sexually active in the year prior to the event? And many patients resume sexual activity within a month of discharge from the hospital. Sex after an MI is not without problems. Fear is a major issue that can inhibit patients and their partners from initiating sexual activity. Many couples worry that sexual activity could trigger another MI or even result in death.
The evidence-base for long-term sexual outcomes after MI is scarce, especially for women. Our research on sex after an MI for the TRIUMPH Study, a national, multisite, longitudinal study that followed patients for one year following an acute MI, was recently published in the American Journal of Cardiology. In this study, we looked at patient-physician communication about sex following an MI and predictors of “loss of sexual activity,” or less frequent or no sexual activity following an MI. Additionally, it was the first study to prospectively evaluate, in a large population of men and women with MI, the association between sexual activity in the month after an MI and 1-year mortality. If people have sex soon after an MI, are they any more likely to die in the first year after the MI?
Many men and women were sexually active both in the year leading up to and following the MI, yet few reported receiving discharge instructions about resuming sex. Men and women who did not receive instructions were more likely to report a loss of sexual activity at 1 year, even when controlling for demographic and other health variables. Additionally, while limited by a small number of deaths, 1-year mortality was similar in those who reported having sex in the month following the MI and those who were inactive.
| Gender-separate models predicting of loss of sexual activity | ||
|
Females RR (95% CI) |
Males RR (95% CI) |
|
| Age (10 yr.) |
0.98 (0.84-1.15) |
1.05 (0.89-1.25) |
| Did not receive instructions |
1.44 (1.16-1.79) |
1.27 (1.11-1.46) |
| Discussion with doctor |
0.99 (0.78-1.26) |
1.16 (1.04-1.29) |
| Married at baseline |
0.80 (0.62-1.03) |
0.97 (0.83-1.14) |
| Depressed at baseline |
0.88 (0.72-1.09) |
1.14 (0.88-1.47) |
| Physical function* |
1.08 (0.98-1.19) |
1.17 (1.10-1.24) |
| MI severity^ |
1.00 (0.83-1.20) |
1.10 (0.93-1.30) |
| CI = Confidence Interval; RR = Relative Risk*Physical function was measured using the SF-12 Physical Component Score^MI severity was measured using the GRACE 6-Month Risk Score | ||
Sexual activity is an important factor in the health and quality of life of middle-age and older adults.
How often do you talk to your patients about sexual activity after an MI?
Do you reassure patients about the condition of their heart and explain when sex is safe to resume?
Do you talk to patients about possible sexual side effects, or lack thereof, of medications you prescribe?
Do your patients understand what kinds of symptoms during sexual activity would be a reason to stop having sex and check in with you?
Doctors seem to avoid the topic with women more than with men. Do you tend to avoid the topic of sex with female patients? Your older patients? Patients who are not married? There is no evidence that profiling patients based on these factors is a good way to identify who is and is not interested in sex after an MI. Here are some tips for talking about resuming sexual activity after an MI:
1) Don’t profile. Our study shows that patients who are female or single are less likely to have a doctor talk to them about sex, even if they are sexually active. Single patients may be hoping to find a new sexual partner. There is no good evidence that sociodemographic characteristics are a good way to know which patients are interested in sex.
2) Talk to patients before they go home from the hospital. This is a teachable moment. It may feel like too much information, but even if the patient is not interested at the moment, you are signaling to her/him that this is a reasonable topic for future discussion. They will remember that you mentioned this topic.
3) Patients trust their cardiologist first and foremost to know what is safe for their heart and they want to hear the recommendation about sex and other activities from the treating cardiologist. Don’t turf this issue to someone else on the team, especially the first time it’s addressed.
4) The American Heart Association recently published new guidelines regarding sexual activity and cardiovascular disease. These guidelines state that sex is reasonably safe soon after MI in stable, asymptomatic patients who can withstand mild physical activity.
2 Responses to “Sexual Outcomes Following an MI: Let’s Talk About Sex, Doc”
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Talking about sex and indirect suggestions(after accurately talking about available medical facts and figures)in my opinion may depend upon the philosphy of the physician and that in turn depends upon his age.( It could be ‘pure’age or the sum up of his experience or the wisdom collected over the years)
In the year 1982(when I was myself 37 yrs)one of my patient 55 yrs(was my nonmedical big boss also) in all confidence was looking fot my advice about his poor performance.My philosphy probably at that time was, old man has had enough and now he should relax. When I reached that age myself, I realised how wrong I was and I keep repenting till this day for letting the ‘old’man down.
I was really glad to have been a part of this study, as I was also guilty of not talking to my patients about resuming sexual activity. It just was not something at the forefront of my brain – after all we are overwhelmed with reinforcing the importance of taking plavix daily and making sure they have good follow-up.
But I have made a special point to incorporate a discussion on resuming sexual activity in every post-MI discussion. I usually fit it in with how to resume physical activity. Just as we counsel people about returning to daily activity, and then strenuous activity, it is easy to say, “by activity, I mean physical activity – including sexual activity.” I also will pre-empt it by saying that many are scared to return to strenuous physical activity such as jogging/running or even sexual activity… I also encourage them to go to cardiac rehab and to have ongoing discussions with their physicians should they have questions, concerns, fears about resuming physical/sexual activity.
Even if it is not the first thing on patient’s mind after they had an MI, I think just mentioning it leaves an opening for them to discuss it in the future. Also, checking in with them 1-month post AMI on their resumption of activity can help.