Sex and the heart patient

Is it safe to have sex if a person has heart disease? What are the precautions he/she can take to make sure that he/she doesn’t suffer a heart attack? Well, I found myself dealing with such a case sometime ago.

I reassured a 70-year-old man, despite having to take 10 different pills a day, that he could go about his usual chores with confidence. An hour of double’s tennis, brisk walking, and even half a day of business meetings.

After a moment of silence, he twitched on his seat, smiled sheepishly, and said, “Doc, can I make love to an 18-year-old girl?”

“Ahhh,” I stammered, “medically, I think your heart can survive it if you take a few precautions.” I paused to compose myself, but I wanted to add, “But morally, I’m not sure about your wife, if she finds out.”

The doctor’s job is to treat the patient. I guess if my patient wanted a moral opinion, he would have gone to a priest instead. I prescribe these tips to my patients with heart disease:

• Get a medical clearance from your doctor. According to the American Heart Association, a doctor might prohibit sex in the following instances: 1) a few days after a heart attack, 2) bothersome chest pains and 3) shortness of breath.

The reason is that during orgasm, the heart rate dramatically increases from 80 beats to 115-145 beats per minute. The blood pressure also jumps by 40 millimeters of mercury, so a systolic blood pressure of 130 can reach 170 during climax.

After a heart attack, a cardiologist would usually request a treadmill test (jogging while being monitored by an electrocardiogram). This test would determine how much physical activity, measured in metabolic equivalents or mets, a patient is allowed before the oxygen supply to the heart is hampered.

It’s been estimated that a person will expend 5 mets while making love to his wife. However, having sex with someone other than his wife will make him exert twice as much energy at 10 mets! The stress or excitement of having an unfamiliar partner in unfamiliar territory is equivalent to an hour of heavy cycling or rowing. This explains why some people unceremoniously die in motels while “in action.”

• Let the healthy partner do the work. For more serious cases, the heart patient may preferably lie on his/ her back and let the healthier spouse stay on top. It’s hard to imagine a post-heart attack patient performing acrobatic maneuvers in bed.

And in case both partners are sick, maybe this is where the phrase “intimacy without sex” can be practiced.  

 • Schedule the sex act in the morning. Patients usually feel stronger and healthier in the morning as compared to the wearisome hours of the evening. Older patients usually feel weaker and more tired as the day goes by. So having sex in the morning may be a good idea.

• Take a light meal only. Have you seen the motel advertisement offering a three-hour use of their special mirrored rooms, including a free crispy pata and soda, for only P450?

Take note: Gorging on food immediately before sex is not advisable because the digestion of food would make the blood supply preferentially go to the stomach and deprive the heart of much-needed oxygen. A word of advice: Take your free meal after sex and not before.

• Take your medications. Heart patients usually take several pills like nitroglycerine to dilate the arteries of the heart, and other pills for high blood pressure, diabetes or cholesterol problems. Just continue taking your medications a few hours before lovemaking as we want you to be strong and protected. Of course, those with chest pains should have their pills handy, just in case they feel something. Be prepared.

Lastly, there is the issue of erectile dysfunction. Those with the desire but can’t perform the deed. My 70-year-old patient also inquired about the use of Sildenafil. I told him I would prefer that he not take it because of his two previous heart attacks. But he kept on haggling so I went along for the ride.

I told him, “OK, if you insist then I can clear you for sex.” And I jokingly added, “but I have to be physically present to monitor your heart during the act.”