Written by Monica Matys, a Communications Advisor at Sunnybrook.
For people who have heart disease, have suffered a heart attack or who have an implantable heart device, resuming sexual activity can be concerning. Is sex safe, or will it increase the risk of complications or death? At a recent Sunnybrook Speaker Series event, cardiologist Dr. David Newman examined the topic and offered some sound guidance.
Erectile dysfunction and heart disease
Erectile dysfunction -- the inability to keep an erection firm enough for sex -- has many shared risk factors with heart disease, including diabetes, obesity, physical inactivity, hyperlipidemia (elevated fat levels in the blood), smoking and high blood pressure. There is a strong connection between heart disease and erectile dysfunction, so it's important that men speak with their doctors before starting any new medications.
Are medications to blame?
Dr. Newman says all medications may interact or associate with erectile dysfunction. That said, men should never discontinue a medication because they think it's impacting another area of their health. Studies have shown that eight per cent of men treating high blood pressure stop their medication because they think it's contributing to erectile dysfunction. Adjusting or stopping your medication can be dangerous, so talk to your doctor first to determine what's best for you.
Are drugs for erectile dysfunction safe?
Many family doctors and cardiologists are asked by their heart patients if it's safe to take medications designed specifically for erectile dysfunction, which fall into a class of drugs called PDE5 inhibitors. There are many different treatment options available in this category, but they work in a similar way by improving blood flow to the penis. Generally, PDE5 inhibitors should be used with caution in patients:
- taking nitrates
- with active ischemia (symptoms of impaired coronary blood flow)
- with significant congestive heart failure
- with low blood pressure
- taking multiple blood pressure lowering drugs
- with significant liver or kidney disease
- taking erythromycin
How much physical activity is safe?
The American Heart Association (AHA) has developed guidelines on the use of PDE5 agents. As a rule of thumb, if men with heart disease can walk up two flights of stairs, it should be safe to resume sexual activity.
There is a value score called Metabolic Equivalent (MET) for various physical activities. The MET score looks at exercise capacity, the exercise energy expended and the age and weight of the patient. As Dr. Newman points out, it doesn't take a lot of capacity to have the exercise ability to safely engage in sexual activity. Here is how sexual activity rates against some other common activities:
- walking up the stairs at home: 2 METS
- sexual activity: 2-3 METS
- sexual activity with orgasm: 2-4 METS
- cycling: 6-7 METS
- brisk walking: 13 METS
- laundry: 2.07 METS
- food preparation: 2.16 METS
- grocery shopping: 2.10 METS
- dancing or fishing: 4.5 METS
- rugby: 10 METS
Dr. Newman says it's rare to have a heart attack during intercourse, and there is only a small increased risk if you've already had a heart attack. At the end of the day, having sex is part of life, and so is inherently healthy. That said, each patient should discuss his specific circumstances with his doctor.
Read more men's health information from Sunnybrook experts at health.sunnybrook.ca
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Sexual headaches are headaches that aren’t caused by a specific medical condition, and happen around sex. They can happen at different times during sexual activity, with different intensities, and in different parts of the head.
You might hear sexual headaches referred to by a variety of names: headaches with sexual activity, orgasmic thunderclap, orgasmic migraines, coital headaches, coital cephalgia, or orgasmic cephalgia.
There are three classifications for headaches with sexual activity (HSAs) or sexual headaches, according to the International Headache Society. Type I HSAs are usually felt across the head and are pre-orgasmic — the pressure builds as your sexual excitement does. And Type II HSAs are more sudden or severe and happen with or near orgasm.
They can be triggered by any sexual activity that can lead to orgasm, according to the Mayo Clinic. Some medications can make HSAs more likely, including marijuana, birth control pills, pseudoephedrine, and Amiodarone. "As is the case with headaches as a whole, there isn't a great understanding of what causes them or how to prevent them,” says sex therapist Vanessa Marin. "Sex can be a rather fun treatment in mild cases, but anyone who has persistent, intense headaches should seek out a headache specialist."
Sexual headaches are usually more unpleasant than anything, but sometimes they can be a sign of something more serious. For example, in men they can be a sign of low testosterone, according to Dr. Laura Berman. They could also be an indication of an aneurysm, bleeding in the brain, or stroke. That’s why it’s important to see a doctor when you experience a sexual headache for the first time.
These headaches can vary in intensity, from dull to sharp and stabbing. Those that occur with orgasm can feel more intense. Some people have a combination of the two, according to the Mayo Clinic. The headaches can last from a few minutes to hours or even days.
They can happen at any point during sex: before, during, after, with or without orgasm. Some people may experience them often, while for others sexual headaches are fortunately rare or a one-time occurrence. Others might never get them at all.
Both men and women can get sexual headaches, though they appear to be more common in men. They occur in more than one in 100 people. It appears that you may be more likely to get them if you suffer from migraines, tension headaches, or exertion headaches.
Try a painkiller like an NSAID or beta-blocker, the Mayo Clinic notes, or talk to your doctor about the best timing to take them in order to prevent headaches.
Some people find using an NSAID like ibuprofen or a beta-blocker helpful in preventing sexual headaches. Taking a less active role during sex sometimes may help. And while it’s frustrating, sometimes waiting it out helps — some people experience sex headaches in clusters for a few weeks or months, and then they go away.
For some people, sexual headaches may be triggered by poor breathing during sex — you could be holding your breath without realizing it, and that could be related to headaches. "If someone has the habit of not only holding their breath but applying pressure to the closed airway, the result is a Valsalva maneuver,” says sex and relationship therapists Patricia Johnson and Mark Michaels. "Holding the breath creates pressure in the chest, increases the outflow of blood, and slows the heart rate. This constricts the blood vessels in the brain and causes a drop in blood pressure.” As your breathing becomes normal again, the blood could rush back to your brain and lead to headache, they say. Try being conscious of your breath during sex and making sure that you’re not holding it.
If you ever have a headache you could describe as your "worst ever," you should see a doctor. The same goes for a first sexual headache, in order to rule out any other underlying causes. And finally, see a doctor if you get a headache with symptoms like vomiting, stiff neck, confusion, or reduced coordination.
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