Elaine E. Steinke

Sexual Activity and Cardiovascular Disease A Scientific Statement From the American Heart Association

Sexual activity is an important component of patient and partner quality of life for men and women with cardiovascular disease (CVD), including many elderly patients.1 Decreased sexual activity and function are common in patients with CVD and are often interrelated to anxiety and depression.2,3 The intent of this American Heart Association Scientific Statement is to synthesize and summarize data relevant to sexual activity and heart disease in order to provide recommendations and foster physician and other healthcare professional communication with patients about sexual activity. Recommendations in this document are based on published studies, the Princeton Consensus Panel,4,5 the 36th Bethesda Conference,6–10 European Society of Cardiology recommendations on physical activity and sports participation for patients with CVD,11–13 practice guidelines from the American College of Cardiology/American Heart Association14–16 and other organizations,17 and the multidisciplinary expertise of the writing group. The classification of recommendations in this document are based on established ACCF/AHA criteria (Table). View this table: Table. Applying Classification of Recommendation and Level of Evidence Numerous studies have examined the cardiovascular and neuroendocrine response to sexual arousal and intercourse, with most assessing male physiological responses during heterosexual vaginal intercourse.18–24 During foreplay, systolic and diastolic systemic arterial blood pressure and heart rate increase mildly, with more modest increases occurring transiently during sexual arousal. The greatest increases occur during the 10 to 15 seconds of orgasm, with a rapid return to baseline systemic blood pressure and heart rate thereafter. Men and women have similar neuroendocrine, blood pressure, and heart rate responses to sexual activity.24,25 Studies conducted primarily in young married men showed that sexual activity with a persons usual partner is comparable to mild to moderate physical activity in the range of 3 to …

Sexual Counseling for Individuals With Cardiovascular Disease and Their Partners A Consensus Document From the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP)

Sexual counseling for individuals with cardiovascular disease and their partners: a consensus document from the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP)

Sexual problems in cardiac patients: how to assess, when to refer.

It is increasingly realized that discussing sexuality is an important issue in the holistic care for cardiac patients. In this review article, the conditions of a good assessment of sexual problems are identified such as creating an appropriate environment, ensuring confidentiality, and using appropriate language. Second, we present different styles and approaches that can be used to start the assessment, differing between settings, persons, or disciplines. The PLISSIT (permission, limited information, specific suggestion, and intensive therapy) model can be helpful to initiate discussion about sexuality with the cardiac patient and his/her partner. This model is a stepwise approach using various levels of discussion or treatment. Open-ended question can facilitate discussion about sexual concerns, and validated questionnaires or diaries can be used to assess sexual problems. Patients with sexual concerns and problems should be counseled and/or treated appropriately, and adequate follow-up is needed. Additional training and research are needed to further improve the quality of sexual assessment and counseling in cardiac patients.

Sexual Counseling Following Acute Myocardial Infarction

Sexual counseling needs of myocardial infarction (I patients are frequently overlooked by nurses. This study sought to determine to what extent sexual counseling of MI patients was addressed in the acute care setting. The survey of 96 patients showed that sexual counseling was largely not addressed for this group of patients and that specific information on resuming sexual activity was not provided for most patients. Seventy-one percent of patients believed that staff should address sexuality in the hospital setting. It was found that receipt of sexual counseling significantly differed by marital status of the patient. Nurses need to take a more active role in sexual assessment and education in order to improve the quality of life of patients post-MI.

Sexual concerns of patients and partners after an implantable cardioverter defibrillator.

Sexual concerns of patients after an implantable cardioverter defibrillator (ICD) exist, but are not well understood. This study explored sexual concerns and educational needs of those living with an ICD and their partners. Study results suggest a need for written patient education tools specific to sexual issues for patients and partners, and educational resources for health professionals. Addressing the fears and concerns related to sexual function of ICD patients and partners is an essential aspect of rehabilitation and recovery.

The role of sexual satisfaction, age, and cardiac risk factors in the reduction of post-MI anxiety.

Background: Anxiety is common after myocardial infarction (MI); however, little is known about the role of sexual satisfaction and return to sexual activity on anxiety post-MI. Aim: To examine the role of sexual satisfaction in reducing anxiety post-MI. Methods: Patients with acute myocardial infarction (MI) recruited from one U.S. medical center completed questionnaires at baseline while hospitalized and at 1, 3, and 5 months post-MI. This analysis includes 64 patients compared on low or high anxiety at 5 months post-MI using sexual satisfaction and selected demographic and clinical variables in the analysis. Results: Patients with high anxiety scores reported lower sexual satisfaction (p < .001) and a higher percentage of coronary risk factors (p < .01). The OLS regression model provided similar results with an adjusted R-square of .422, accounting for approximately 42% of anxiety (p < .001). Sexual satisfaction accounted for the most variance in the model, showing an inverse relationship between sexual satisfaction and anxiety. An inverse relationship also existed between age and anxiety. Conclusions: Anxiety is common after MI, and decreased sexual satisfaction appears to contribute to heightened anxiety. Attention to sexual concerns of MI patients before and after hospital discharge may improve psychosocial outcomes.

Sexual self-concept, anxiety, and self-efficacy predict sexual activity in heart failure and healthy elders

BACKGROUND Little is known about sexual activity in patients with heart failure (HF), and existing evidence suggests that sexual activity is adversely affected. OBJECTIVE This study explored the relationships and predictors between sexual activity and psychosexual, demographic variables in healthy elders and patients with HF. METHODS Participants were 59 healthy elders and 85 patients with HF who completed instruments on depression and anxiety, sexual self-concept, sexual activity, and demographic/clinical variables. RESULTS Those with increased sexual self-concept had 1.78 greater odds of being sexually active. The sexual self-concept subscales of sexual anxiety and sexual self-efficacy showed a statistically significant (P < .01) independent effect on sexual activity. A higher sexual self-concept from greater sexual self-efficacy and lower sexual anxiety, younger age, and being married were significant predictors of sexual activity. CONCLUSION Sexual self-concept and the related subscales of sexual anxiety and sexual self-efficacy are important psychosexual variables for future research. Attention to patient psychosexual concerns is needed in both clinical practice and research.

Importance and Timing of Sexual Counseling After Myocardial Infarction

BACKGROUND This study examined differences in the perceptions of the importance and timing of sexual counseling in patients with myocardial infarction (MI). METHODS Using a longitudinal descriptive prospective design, subjects were identified from the discharge records of three health-care agencies after having experienced an acute MI in the last 4 to 8 weeks. The Sexual Counseling Needs of MI Patients Survey and a consent form were mailed to patients at 2, 4, and 6 months after MI. Patients (N = 91) rated the importance and timing of 14 sexual counseling items using a Likert scale (1 to 5), and reported the preferred method of education. The possible range for the importance score was 14 to 70. RESULTS Mean importance ratings for each of the 14 items at each of the data collection periods ranged from 3.28 to 4.59. The mean overall importance score at 2 months (56.96), 4 months (56.52), and 6 months (55.19) reflected the importance of these items for teaching. There was no significant difference between importance scores at each of these time periods. Subjects were divided as to when sexual counseling should occur, in hospital or after discharge, for items related to specific sexual counseling. The most preferred educational method at 2, 4, and 6 months after MI were written materials, followed by individual discussion, and a videotape to watch at home. CONCLUSIONS Patients validated the importance of each of the specific areas for sexual counseling after MI. The timing and educational methods for sexual counseling must be further addressed in future research. Sexual counseling initiated in the acute-care setting and continued throughout the recovery period can impact the quality of life of patients with MI and their partners.

Sexual dysfunction in women with cardiovascular disease: what do we know?

The problem of sexual dysfunction in cardiovascular disease has received attention in both professional and lay literature, particularly for men. There is only beginning awareness of the problem of sexual dysfunction in women in general and for those with cardiovascular disease. This evidence-based review focuses on the problem of sexual dysfunction in women in the general population compared with those women with cardiovascular disease. The underlying mechanisms of female sexual dysfunction are addressed, along with what is known about female sexual dysfunction in those with coronary artery disease, hypertension, and heart failure. The assessment and management of female sexual dysfunction in the presence of cardiovascular disease are addressed, although the strategies for management are controversial and evidence is lacking in some cases. Nurses can play a key role in initiating discussion with women related to sexual dysfunction and assisting them in finding appropriate resources and treatment.

Sexual counseling of MI patients: nurses' comfort, responsibility, and practice.

Myocardial infarction patients ofren have unanswered questions about resuming sexual activity afrer this life-threatening event. Critical care nurses can play apivotal role in educating patients in this sensitive area. However, sexual counseling is an area of nursing practice that isji-equently neglected. llhe authors assessed comfort and responsibility levek and their relationship to the practice of sexual counseling by critical care nurses.