Intimacy and Heart Failure: Let’s Talk About Sex

Whether you know it or not, problems with your heart affect your sex life. Think about it! Every part of your body requires blood flow – even the parts down below. In fact, how bad your sexual problems are is related to how severe your heart disease is. This means having a harder time having sex, including a lack of interest in sex, sexual dissatisfaction, and a decrease in the frequency of sexual activity. Sex is a major component of physical intimacy.1

Sexual dysfunction in men

Sexual problems in men are easier for most people to understand if they know how erections take place. When the blood flow increases into their genitals, men become aroused. Heart failure patients have issues with blood flow throughout their bodies. Some medications to treat heart failure even lower blood pressure.

So, men with heart failure tend to have problems with erectile dysfunction, premature ejaculation, and orgasms. This leads to physical intimacy problems in men. What many people don’t know is that women report just as many sexual problems as men.1,2

Sexual dysfunction in women

Problems with sex don't happen with just men. Both men and women need good blood flow to have a good sex life. Like male erections, female genital arousal occurs as blood flow increases to the vaginal region leading to clitoral erection and lubrication. Therefore, women with heart failure have issues with desire, arousal, vaginal lubrication, orgasm, sexual dissatisfaction, and pain. This leads to physical intimacy problems in women.1

However, since research in this area is limited, links between heart failure and other signs of sexual problems in women, such as clitoral atrophy, remain unknown.

Sex matters

Healthcare providers focus primarily on your survival following diagnosis. However, quality of life is also important when deciding treatment options. Biological and mental changes (e.g., depression) associated with heart failure and some medications used to treat them cause sexual problems in both men and women.2,3

Most heart failure patients want to discuss it but don’t. In fact, most heart failure patients say that none of their providers ever ask if they are having problems in their sex life over years of health care. Problems having sex can lead to other intimacy problems.1

Let’s talk about sex

Sexual problems affect patients with heart failure regardless of age. Therefore, sexual health should be a part of quality-of-life discussions. Talking about sexual health and potential problems helps minimize fears, prevents people from mismanaging their medications or using potentially harmful herbal supplements, and helps preserve intimate relationships between patients and their partners.1,4

This may be a hard conversation. However, it is something that more cardiologists need to discuss with their patients on a regular basis.1

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