New research from the University of Chicago investigates what happens to men’s and women’s sexual function and relationships after a heart attack in an effort to help clinicians develop better care guidelines for patients. The study, published in JAMA Cardiology, shows impaired sexual function or new problems are common after heart attacks. They occur at the same rate as a loss of general physical function and at a higher rate than the incidence of depression after heart attack, but rarely do health care providers address these issues – particularly with women.
“Too often physicians and researchers are too embarrassed to ask questions about sexual health, and yet these issues are important to many people,” said Harlan Krumholz, MD, professor of medicine at Yale and director of the Center for Outcomes Research and Evaluation, one of the authors in charge of the study. “We need to concern ourselves with gaining knowledge about how to help our patients achieve a high quality of life in all aspects of their lives.”
The data show that if a physician talks to the patient about sexual health and function after a heart attack the patient is more likely to resume sex. However, women were less likely to be counseled by physicians on what to expect and more likely to have problems with sexual function as they recover. More than half of women (59%) and less than half (46%) of men reported sexual function problems in the year after a heart attack.
“The next step is to design the optimal intervention to improve sexual function outcomes after heart attack for men and women,” said Stacy Tessler Lindau, MD, associate professor of obstetrics/gynecology and medicine-geriatrics at the University of Chicago, who authored the research. “The rehabilitation phase begins with the cardiologist counseling the patient about her or his functional capabilities and what she or he can expect, including physical, psychological, and sexual function.”
We spoke with Lindau about her latest work:
UChicagoMed: How did the idea for this work begin?
Stacy Tessler Lindau: Several years ago, cardiologist Harlan Krumholz, the PI of this study at Yale, heard me speaking about our work on sexuality and aging. He saw an opportunity in his cardiovascular outcomes studies to build knowledge about sexual function outcomes. Dr. Krumholz and cardiologist Dr. John Spertus (St. Luke’s Mid America Heart Institute) invited us to collaborate with their studies to track what happens to sexual function, resumption of sexual activity, and counseling people about sexual outcomes after cardiovascular events.
Can you describe the study?
This study examines sexual function outcomes, including factors associated with loss of sexual activity, over the course of a year after heart attack looking at women and men enrolled from 127 hospitals in the U.S. and Spain. Our main conclusion is that impaired sexual activity and new sexual function problems are common after heart attack and even more so among women than men. However, women are far less likely to be counseled about these expected outcomes.
What were the important findings?
A large proportion of men and women with no prior sexual problems developed one or more sexual problems in the year after heart attack. The hopeful message is that 40% of women and 55% of men have no sexual function problems after heart attack and nearly a third of patients who reported having problems in the year before reported having none in the year after.
Was there anything unexpected?
The rate of loss of sexual function after heart attack was on a par with the loss of general physical function in this study group and was several fold higher than the incidence of depression in this group. In addition, treatable conditions like stress and diabetes were strong indicators of loss of sexual activity after heart attack. Cardiac rehabilitation and research on heart attack outcomes focus heavily on recovery in these areas. The relative prevalence of sexual function problems, combined with evidence that people value their sexual function as an important aspect of health, suggests that we should also attend to recovery of sexual function after heart attack. Counseling patients that sticking to care for conditions like diabetes and stress might help improve their sexual function outcomes and might help motivate their overall recovery. We need a framework of care that proactively addresses this aspect of recovery for women and men.
What gender differences were observed in the study?
We have seen in prior studies that receiving counseling from a physician about sex after heart attack is a protective factor. People who report having these conversations are more likely to have resume sexual activity after a heart attack. Women are less likely than men to have a conversation with a doctor after a heart attack about sex, so they are at a particular disadvantage in terms of knowing whether sex is safe, what warning signs to look for, and what to expect as a normal trajectory in recovering sexual function and activity after a heart attack.
How do relationships affect recovery?
Our study contributes new knowledge about changes in partnership status that occur in the year after a heart attack. Prior studies show that a person’s spouse or intimate partner is their most critical social relationship in the event of a life-threatening illness. We found more than 9% of women and 6% of men who had a partner in the year before their heart attack no longer had a partner at 1 month following their heart attack. It’s possible that loss of sexual function after a heart attack could contribute to dissolution of these important relationships. Health care providers and family members of people who have a heart attack should be aware that loss of a partner after a heart attack may impair a patient’s overall recovery – a person in this situation may require additional support from their family and friends.
What are the next steps?
The current cardiac care guidelines say doctors should talk to patients about sexual activity after a heart attack, but there is little evidence to support the content of that counseling. Previous work described recommendations patients were getting from their doctors, like ‘have less strenuous sex.’ Interestingly, women were less likely than men to be told to restrict their sexual activities, but there is really no evidence to support these kinds of recommendations. If I say to my patient – ‘have less strenuous sex’ – how do she and her partner actually implement that recommendation in practice? Is there potentially more harm than good? Our findings can be used to elaborate care guidelines to communicate to patients what to expect in terms of sexual activity and function after a heart attack. The next step is to use these findings to design the optimal intervention for improving sexual function outcomes in the context of a holistic approach to recovery after heart attack.