Heart Failure and Intimacy 

Intimacy is a crucial component of romantic relationships. It’s also an element of a healthy and good quality of life. Some people with heart failure may feel like they can’t engage in sexual intimacy after a heart failure diagnosis. This is sometimes based on the fear of experiencing a heart attack during activity. For other people, sexual dysfunction is the culprit preventing couples from engaging in sex.

Sexual function and heart failure

People with Heart failure agree that sexual health is important: approximately 50% of men and 40% of women with heart failure claim that sex is important.1 However, 60-87% of people with heart failure report sexual problems; 1 in 5 of these people believe that their condition is the reason for these sexual issues.2

Barriers

Unfortunately, sex rarely comes up as a topic of discussion during appointments with healthcare professionals. Physicians seldom discuss the topic, and on the flip side, those with heart failure don't often disclose their questions and fears. Some people may feel embarrassed, or perhaps feel like their cardiologist is not the right person to discuss these matters with.

Erectile dysfunction

Men who start experiencing loss of sexual function may choose to purchase over-the-counter herbals or other drugs to increase potency. Erectile dysfunction is common in men with heart failure. In fact, up to 80% of men with heart failure have erectile dysfunction, in contrast to 50% of people without heart failure.3

The matter is further complicated by the fact that many people with heart failure cannot take PDE-5 inhibitors, a well-known class of medications that includes Viagra and Cialis. This is only the case for people who take nitroglycerin, a medication used to relieve chest pain. In the UK, Viagra is available over-the-counter, leading to potentially fatal consequences for people who choose to self-medicate. Other people with heart failure may feel like they have no other alternatives to treat erectile dysfunction, and perhaps never seek out help.

Antidepressants

There is a link between depression and heart failure. However, one of the most common classes of drugs used to treat heart failure is a potential cause of sexual dysfunction: the SSRIs (Selective Serotonin Reuptake Inhibitors). This class of drugs includes Prozac, Cipralex, and Zoloft among many others. The SSRIs may impact sexual desire, arousal, and/or function. It’s not just the SSRIs that have been linked to sexual dysfunction; many other antidepressants have also been implicated.

SSRIs are usually first-line drugs used to treat depression and anxiety. Because sexual dysfunction is rarely discussed, a doctor may prescribe an SSRI not knowing that it may further impact their patient's sexual function. In addition, the sexual dysfunction side effect of drugs are not always counseled on at the pharmacy. The person with heart failure who takes the medication may experience further sexual issues, and further guilt/shame.

Talking about your sex life with your doctor may seem daunting and embarrassing. However, to increase awareness about this issue, we need to shift our society's perceptions into accepting that sex is a normal topic to discuss at doctor visits.

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