Sexual counselling for individuals with cardiovascular disease and their partners

Abstract

After a cardiovascular event, patients and their families often cope with numerous changes in their lives, including dealing with consequences of the disease or its treatment on their daily lives and functioning. Coping poorly with both physical and psychological challenges may lead to impaired quality of life. Sexuality is one aspect of quality of life that is important for many patients and partners that may be adversely affected by a cardiac event. The World Health Organization defines sexual health as '… a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences ….'(1(p4)) The safety and timing of return to sexual activity after a cardiac event have been well addressed in an American Heart Association scientific statement, and decreased sexual activity among cardiac patients is frequently reported.(2) Rates of erectile dysfunction (ED) among men with cardiovascular disease (CVD) are twice as high as those in the general population, with similar rates of sexual dysfunction in females with CVD.(3) ED and vaginal dryness may also be presenting signs of heart disease and may appear 1-3 years before the onset of angina pectoris. Estimates reflect that only a small percentage of those with sexual dysfunction seek medical care;(4) therefore, routine assessment of sexual problems and sexual counselling may be of benefit as part of effective management by physicians, nurses, and other healthcare providers.

Metabolic Syndrome and Sexual Function in Postmenopausal Women

“…Other studies have reported a decrease in sexual function in women with coronary artery disease 33–35 . Older women with heart disease have been reported to engage in sexual activity 36, 37 , and targeted sexual counseling efforts may improve health 38 . Metabolic syndrome in women may be more closely related to coronary artery disease than other cardiovascular outcomes.…”

Effect of Sex Education on Anxiety, Stress and Depression in Patients With Myocardial Infarction (MI) and Their Spouses

“…Steink and Jaarsma (2015) pointed out that giving advice to the patients with MI and their spouses could be effective in relieving their anxiety and fear of sexual activity (26). Steinke et al (2013) conducted a study including a social-cognitive intervention. The intervention consisted of watching a video at home about resuming sexual activity by patients and their spouses, telephone counseling within four to six weeks after MI, and sending some emails within four to six weeks after MI.…”

“…Sex education can be effective for reducing the anxiety of patients (20). During rehabilitation, sexual concerns are one of the most common stressors among spouses of patients (21), thus it is important to include patients and their spouses in sex education programs (22). However, for various reasons, such as culture and modesty, sex education and its importance is neglected by health teams (19); the majority of researches show that patients and their families regretted that the treatment team members had not discussed sexual function with them after an MI.…”

Sexual function of patients with heart failure: facts and numbers

“…Some patients with HF might need specific information about activities they can undertake, as well as clear information and treatment to help cope with sexual problems 30. Because sexual problems might occur during the disease trajectory, sexual concerns need to be discussed more than once during treatment and should become an integral part of HF management and patient education.…”

“…This information needs to be adapted to the personal situation of patients, sexual preferences, and culture 30, 31. One of the approaches that can be used to guide health professionals in determining needs of patients and in providing information related to sexuality is the so‐called PLISSIT model32 ( Figure  2).…”