Impaired Sexual Activity, Function Common Among Younger Women After Acute MI

In the year after an acute MI, young women are more likely to experience impaired sex lives than are young men, according to a first-of-its-kind study examining patterns and gender differences in sexual activity among people aged 18 to 55.

Results of the study, recently published online in JAMA Cardiology, also showed that patients who do not communicate with their physician about these concerns in the first month after acute MI are 50% more likely to delay resuming sex.

“Current US and European cardiac care guidelines say doctors should talk to patients about sexual activity after a heart attack, and that sex is safe for most people after an AMI,” Stacy Tessler Lindau, MD (University of Chicago, IL), told TCTMD in an e-mail. “It is fair game for patients to expect counsel from their physician about when it’s safe to resume sex after AMI and what to do if problems arise.”

Few Discuss Problems With Their Physicians

Lindau and colleagues used data from the prospective, multicenter, longitudinal VIRGO study, which looked at patients aged 18 to 55 years who were hospitalized with acute MI between August 2008 and January 2012. The study included data on 2,802 patients (67.4% women) from the United States and Spain taken at baseline, 1 month, and 1 year.

Looking at all of the time points, 40.4% of women and 54.9% of men were sexually active. Among patients active at baseline, men were significantly more likely than women to have resumed sexual activity at 1 month (63.9% vs 54.5%; P < 0.001) and at 1 year (94.4% vs 91.3%; P = 0.01).

Among participants who were sexually active before and after their acute MI, women were significantly less likely to report no problems with sexual function in the year after their event compared with men (40.3% vs 54.8%; P < 0.01). In fact, 41.9% of women with no sexual problems at baseline had developed one or more in the year after acute MI compared with only 30.5% of men (P < 0.01).

For women, the most commonly reported sexual problems at 1 year were lack of interest (39.6%) and trouble lubricating (22.3%). Among men, the most common issues were erectile difficulties (21.7%) and lack of interest (18.8%).

In the United States, only 18.5% of women and 29.4% of men reported having discussed sex with a physician since the time of their MI. In both the United States and Spain, women were significantly less likely than men to receive counseling about resuming sexual activity during the 1 year after (26.7% vs 41.2%; P < 0.001). Overall, patients who did not communicate with their physician about sex within the first month post-MI were more likely to delay resuming sex (adjusted OR 1.51; 95% CI 1.11-2.05).

Finally, those patients with higher stress level (adjusted OR 1.36; 95% CI 1.01-1.83) and diabetes (adjusted OR 1.90; 95% CI 1.15-3.13) were more likely to have loss of sexual activity in the year after acute MI.

Strengthening Relationships, Reducing Shame

Based on these results, Lindau said, it is clear that acute MI patients want to know what to expect for recovery of their sexual life and that they want their cardiologists to address the topic.

Cardiologists should tell patients that 40% of women and 55% of men have no sexual function problems in the year after an acute MI and nearly one-third of people who had problems in the year before their event reported none in the year after, Lindau advised.

“On the flip side, the rate of loss of sexual function after AMI was several-fold higher than the incidence of depression after AMI and on par with the loss of general physical function,” Lindau said. “For women and men, taking care of stress and diabetes is important for overall health after AMI and may also be good for maintaining an active sex life.”

For women with acute MI, this study adds to evidence showing that they value their sexual function, regard it as a topic that is appropriate for discussion with their cardiologists, and benefit from a discussion with their doctor about sex, Lindau added.

“Based on our study findings, cardiologists can advise younger women with AMI that most women who were sexually active before AMI resume sex by 1 month after, and nearly all have resumed sexual activity a year after AMI,” Lindau said.

In an editorial published with the study, Kevin P. Weinfurt, PhD, Duke Clinical Research Institute (Durham, NC), agrees that patients’ sexual function is deserving of more attention from cardiologists in both practice and in research.

“When a physician creates an environment in which sexual problem can be acknowledged, normalized, and managed, that physician is helping to maintain or strengthen the couple’s relationship and stave off debilitating shame,” Weinfurt writes.

These data also serve “as a model for making the assessment of sexual function a normal part of clinical research in cardiology and other therapeutic areas,” he says. “Patients want to know how their disease and/or their treatments will affect their day-to-day lives, including their sex lives, and it is incumbent on researchers to collect and disseminate this information.”