So what's the big fuss about? It turns out that a good percentage of men who've sustained some cardiac event are deathly afraid of engaging in sexual activity for fear of precipitating another event. In an attempt to put them (and their partners) at ease, the American Heart Association just released early online a scientific statement that will be published in print next month in Circulation. The authors noted that in systolic & diastolic blood pressures increase just modestly during sexual arousal, mildly during foreplay, and transiently higher during 10-15 seconds of orgasm with quick return to baseline in both men & women.
In young men, sexual activity is comparable to 3-4 metabolic equivalents (METS), eg climbing 2 flights of stairs or walking briskly. Furthermore, the authors noted that systolic blood pressure rarely exceeds 170mm Hg and that heart rate rarely exceeds 130bpm, at least in normotensive individuals. Given that some individuals may have to work harder (no pun intended) to achieve orgasm, the authors then went on to give themselves a bit more leeway in declaring sexual activity in older adults to be equivalent to 3-5 METS. Most important of all, they noted that individuals who can perform 3-5 METS of activity without complaining of chest pain are very unlikely to suffer from anginal pain during sexual activity.
The only reason to perform exercise stress testing is in those patients who have unknown or more than low risk for cardiovascular events. Obviously, anyone with unstable severely symptomatic disease (as opposed to mild stable) should be managed appropriately first before engaging in sexual activity. That goes without saying. The good news is that cardiac rehability and regular exercise can reduce the risk of complications from sexual activity in those with known cardiovascular disease.
This scientific statement is a good read as it also goes into more detail regarding specific cardiac conditions, such as heart failure, valvular disease, dysrhythmias, pacemakers, congenital heart conditions, and even hypertrophic cardiomyopathy. There is also a brief discussion on the use of local & topical estrogens, herbal medications, PDE5 inhibitors (avoid use in those receiving nitrates! remember the emergency room scene in Something's Gotta Give ), and cardiovascular drugs. The take home point? Heart disease does not preclude sexual activity with one's usual partner!