If you have had angina, heart surgery, or a heart attack, you may:

• Wonder if and when you can have sex again
• Have different feelings about having sex or being intimate with your partner

Almost everyone with heart problems has these questions and concerns. The most helpful thing you can do is talk to your health care providers, spouse, partner, or friends.

Both you and your provider may be concerned that having sex will bring on a heart attack. Your provider can tell you when it is safe to have sex again.

After a heart attack or heart procedure:

• You may have an exercise test, to see how your heart reacts to exercise.
• Sometimes, at least the first 2 weeks or so after a heart attack, your provider may advise avoiding sex.

Make sure you know the symptoms that could mean your heart is working too hard. They include:

• Chest pain or pressure
• Feeling lightheaded, dizzy, or faint
• Nausea
• Trouble breathing
• Uneven or fast pulse

If you have any of these symptoms during the day, avoid sex and talk to your provider. If you notice these symptoms during (or soon after) having sex, stop the activity. Contact your provider for advice about your symptoms.

After heart surgery or a heart attack, your provider may say it is safe to have sex again.

But your health issues may change the way you feel about or experience sex and close contact with your partner. Besides being worried about having a heart attack during sex, you may feel:

• Less interested in having sex or being close with your partner
• Like sex is less enjoyable
• Sad or depressed
• Feel worried or stressed
• Like you are a different person now

Women may have trouble feeling aroused. Men may have trouble getting or keeping an erection, or have other problems.

Your partner may have the same feelings you are having and may be afraid to have sex with you.

If you have any questions or concerns about intimacy, talk to your provider. Your provider can help you find out what is causing the problem and suggest ways to deal with it.

• It may not be easy to talk about such private things, but there may be a treatment that could help you.
• If you find it hard to talk to your heart doctor about these topics, talk to your primary care provider.

If you are depressed, anxious, or afraid, medicine or talk therapy may help. Classes in lifestyle change, stress management, or therapy may help you, family members, and partners.

If the problem is caused by side effects of medicine you are taking, that medicine may be adjusted, changed, or another medicine may be added.

Men who have trouble getting or keeping an erection may be prescribed a medicine to treat this. These include medicines like sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis).

• The above medicines may not be safe if you are taking other medicine. Do not take them if you are taking nitroglycerin or nitrates. Taking both kinds of these medicines can lead to a life-threatening drop in blood pressure.
• Do not buy these medicines through the mail or a provider who does not know your full health history. To get the right prescription, talk to the provider who knows your health history and all the medicines you take.

If you have new symptoms of heart trouble during sexual activity, stop the activity. Contact your provider for advice. If the symptoms do not go away within 5 to 10 minutes, call 911 or the local emergency number.

American Heart Association website. Sexual activity and heart disease. www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/sex-and-heart-disease. Updated January 11, 2024. Accessed March 5, 2024.

Morrow DA, de Lemos JA. Stable ischemic heart disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 40.

Scott KM, Hastings JA, Temme KE. Sexual dysfunction and disability. In: Cifu DX, ed. Braddom's Physical Medicine and Rehabilitation. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 22.