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Friday, October 25, 2013


The American Heart Association (AHA) said in 2012 that sex is safe for most heart attack patients, and now a new statement from the AHA and a European cardiology group provides a road map for how to conduct sexual counseling.

Sexual counseling should be tailored to each patient with cardiovascular disease (CVD) along with his or her partner, and should address topics such as when to resume sex, specific methods and recommended positions, and the role of intimacy without sex, according to writing chair Elaine Steinke, APRN, PhD, a professor of nursing at Wichita State University in Kansas, and colleagues.

Studies have shown that sexual counseling is often overlooked by providers, and that effective strategies are needed to increase the comfort of healthcare professionals for delivering such information, according to the consensus statement from the AHA and the European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions.

The statement, published online in Circulation: Journal of the American Heart Association and the European Heart Journal, suggested that sexual counseling be included in basic professional training and continuing education.

"The 2012 scientific statement primarily addressed the safety and timing of return to sexual activity after a cardiac event," Steinke told MedPage Today.

"While return to sexual activity is a common concern, patients and their partners frequently request information on how to resume sexual activity. Therefore, the intent of this consensus statement is to provide guidance to healthcare providers on what to discuss with patients and their partners," she said.  The document noted the importance for healthcare providers to initiate the conversation about resuming sexual activity for those with CVD because patients might shy away from it.

"Patients are anxious and often afraid sex will trigger another cardiac event -- but the topic sometimes gets passed over because of embarrassment or discomfort," Steinke said in a statement.

The document suggested that modeling and role modeling with common patient questions and scenarios may be a useful strategy to increase both knowledge and comfort about resuming sexual activity.

The consensus statement is the first to provide "how to" information about resuming sexual activities and applies to patients who have had a heart attack, heart transplant, stroke, received an implanted heart device, or have other heart conditions, as well as to their partners, Steinke and colleagues said.

All patients regardless of gender, age, and sexual orientation should receive counseling.  Past recommendations focused on when to resume sex, risks with sex, and managing medications.  In the current statement, researchers said that a multidisciplinary team approach can be beneficial for sexual counseling (class IIa, level of evidence [LOE] B).

They noted that information and support regarding sexual issues are not readily available to patients. Healthcare professionals who provide sexual counseling to patients with CVD should receive training in certain aspects such as taking a sexual history, communication techniques, referrals to specially trained sex counselors, and awareness of cultural differences that might guide the discussion (class I, LOE B).

Sexual counseling can help reduce the psychological impact of CVD such as fear, anxiety, and depression associated with the disease itself or with resuming sexual activity (class IIa, LOE C).

Depression, for example, can be a contributing cause of erectile dysfunction, decreased libido, and difficulty with orgasm, Steinke and colleagues pointed out.

Consideration has to be given to certain heart medications that might have an impact on sexual function. Providers should encourage patients to report any side effects and to continue taking the medication until the problem is thoroughly discussed in a healthcare setting (class IIa, LOE C).

If patients did not experience cardiovascular symptoms during exercise testing, they can be encouraged to resume sexual activity (class IIa, LOE B).

Physical activities such as brisk walking may be suggested for some heart patients before resuming sexual activity. Patients should also be encouraged to engage in regular physical exercise. (class IIa, LOE B).

"All healthcare providers should be ready and willing to address these areas of sexual counseling," Steinke said. "That includes cardiologists, primary care practitioners, nurses, nurse practitioners, and physical therapists."


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