Originally written for About.com by Corey Silverberg, December 1, 2009
Most doctors receive little or no training on how to talk about sex with patients who have heart disease or have survived a heart attack. Their training in human sexuality is often very basic, covering anatomy, disease, and dysfunction. It is rare for them to have learned much about sexual pleasure or the psychological and interpersonal experience and importance of sex. As a result, a lot of doctors won’t initiate conversations about sex with patients and do their best to avoid being asked questions about sex. This is particularly problematic when it comes to heart disease, a condition where one of the biggest obstacles to sex is getting accurate information.
It’s also frustrating because if you or someone you’re having sex with has heart disease or has had a heart attack, the doctor who is treating the condition is the best person to help you figure out when and how you can begin to bring sex back into your relationship. If the doctor isn’t bringing it up, you may have to make the first move. Here are some tips on how to start a conversation with your doctor about sex and heart disease, and some questions you may want to ask.
When Do I Ask? If sexuality is important to you, in some ways it’s a good idea to let your doctor know from the outset. If you’ve been diagnosed with heart disease and/or are having scheduled surgery, you may want to let your doctor know you have questions and concerns about how your sexuality may be impacted. They may not be able to give you concrete answers, but it puts sex on the table for later, when your condition may be better understood.
Timing is important in getting your sex questions heard and answered. Try not to leave the sex questions to the end of your appointment as you have one hand on the doorknob. This increases the chance that the sex conversation will be “left for next time” and then not raised again.
Who Do I Ask? Not all health care professionals receive the same training in human sexuality, and different kinds of doctors will have different boundaries when it comes to talking about sex. If you have questions specifically about your body, your medical condition, and functional issues of sex, your family doctor, internist or cardiologist is an appropriate person to ask (even if they wish they weren’t).
If your questions are more about your partner, your sexual relationship, or how you feel about your condition, talking to a psychiatrist, psychologist, or social worker, or psychotherapist is probably a better bet. If your sexual problems predate your heart condition you may also want to consider talking to a sex therapist. They may or may not know a lot about heart disease (some sex therapists have medical training, many don’t), but they specialize in sex and so won’t have any discomfort with the topic.
Prepare Some Questions. If you’re uncomfortable raising the issue of sex it can help to prepare some questions in advance. You may want to do some reading in advance. A good resource is the book Answering Your Questions About Heart Disease & Sex. Written by a cardiologist, Dr. Eduardo Chapunoff, it offers a medical overview of what is known about sex and heart disease and speaks at length to the relationship between patient and doctor. Below are a just a few of the many questions Dr. Chapunoff offers in his book as conversation starters:
- When can I start having sex again?
- Are there certain kinds of sexual activities (e.g. intercourse, oral sex, sensual touch and massage, anal sex, etc…) that I need to avoid, or that I can start doing first?
- Are certain sexual positions better than others to reduce the risk of pain or strain to my heart?
- What should I do if I feel pain or get short of breath during sex? How do I know when I need to call you, or go to an ER?
- Are any of the drugs I’m on going to impact my sexual function or feelings?
- Is it safe for me to take drugs like Viagra, Cialis, or Levitra?
- Are there specific things I should tell a partner about my condition and having sex?
You aren’t going to be able to change who your doctor is, and if they are fundamentally uncomfortable with sex you may need to get answers elsewhere. But at a minimum, your doctor should be able to offer a referral. It’s your right to get honest and direct answers to these questions, and it’s your physician’s professional responsibility to address these issues in a respectful way.