December 18th, 2014
Demystifying the Taboo of Sex Counseling After Acute MI
The CardioExchange Editors interview Stacy T. Lindau about her research group’s prospective observational study of sexual-activity counseling for adults, age 18 to 55, in the U.S. and Spain during the first month after acute MI. The study is published in Circulation.
Editors: Please briefly summarize your results.
Lindau: Our main finding was that very few patients, particularly women, reported receiving counseling about sexual activity after an acute MI, even though the majority had been sexually active during the year before the MI. Those who received counseling were often given restrictions not supported by evidence or guidelines.
Editors: Why do you think this is an important area to study?
Lindau: Healthcare providers are people, and sexuality is both a core characteristic and a private matter for most people — so I understand why the topic is often avoided. However, our study and others show that people — even those with life-threatening illnesses — value their sexual function and believe that it is appropriate for healthcare professionals to raise the issue. When the topic of sexual function is omitted, patients perceive that it’s not relevant to their medical condition or that they are alone in experiencing problems resuming normal sexual activity. Healthcare providers simply need to bring up the topic.
U.S. and European guidelines on best practice after MI recommend counseling about sexual activity. So if the physician does not bring it up, the patient may need to put aside his or her discomfort and ask the doctor straight up, “Is it ok for me to resume sexual activity — and when? What symptoms should I look out for?” Our prior research shows that in the year after MI, mortality risk was no higher among people who resumed sexual activity than among those who didn’t — in fact, the risk for death was lower among the people who did resume sex.
Editors: Did anything in your results surprise you?
Lindau: Interestingly, among women who received counseling about sexual activity after MI, those in Spain were significantly more likely than those in the U.S. to be given restrictions. That finding suggests that cultural factors, physician factors, or both influence decisions about sexual-activity counseling after an MI. Such factors are mutable, and no clear medical reason explains this difference in practice.
Editors: What should we do to improve our care in this area?
Lindau: I will continue encouraging physicians to talk with their patients about sexual activity in the context of healthcare. Healthcare providers, especially the physician who knows the patient’s heart best (to quote a finding from one of our prior studies), should routinely inform all patients — women and men, young and old, married and single, sexually active before the MI and not — that it is ok to engage in sexual activity. They should also explain which symptoms should prompt cessation of sexual activity and be reported to the doctor. For reproductive-age people who have a heart attack, preserving sexual function is not only relevant to preserving intimacy and pleasure, but obviously also critical with respect to childbearing.
JOIN THE DISCUSSION
Do you counsel your post-MI patients about sexual activity? Will Dr. Lindau’s study change your approach to this issue?