Sexual Activity and Counseling in the First Month After Acute Myocardial Infarction Among Younger Adults in the United States and Spain

Abstract

Background United States and European cardiovascular society guidelines recommend physicians counsel patients about resuming sexual activity after acute myocardial infarction (AMI), but little is known about patients’ experience with counseling about sexual activity after AMI. Methods and Results The prospective, longitudinal Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study, conducted at 127 hospitals in the U.S. and Spain, was designed, in part, to evaluate gender differences in baseline sexual activity, function and patient experience with physician counseling about sexual activity after an AMI. This study used baseline and 1-month data collected from the 2:1 sample of women (N=2349) and men (N=1152) ages 18-55 years with AMI. Median age was 48 years. Among those who reported discussing sexual activity with a physician in the month after AMI (12% of women, 19% of men), 68% were given restrictions: limit sex (35%), take a more passive role (26%), and/or keep the heart rate down (23%). In risk-adjusted analyses, factors associated with not discussing sexual activity with a physician included: female gender (RR 1.07, 95% CI 1.03-1.11), age (RR 1.05 per 10 years, 95% CI 1.02-1.08) and sexual inactivity at baseline (RR 1.11, 95% CI 1.08-1.15). Among patients who received counseling, women in Spain were significantly more likely to be given restrictions than U.S. women (RR 1.36, 95% CI 1.11-1.66). Conclusions Very few patients reported counseling for sexual activity after AMI. Those who did were commonly given restrictions not supported by evidence or guidelines.

Acute Myocardial Infarction in Women

“…[335][336][337] In the VIRGO study, only 12% of young women reported discussing sexual activity with a physician in the month after AMI. 338 Those who did were commonly given restrictions on sexual activity not supported by evidence-based guidelines. Guidelines for the safe return to sexual activity are available to assist healthcare professionals to provide individualized and culturally sensitive sexual counseling.…”

Change in sexual activity after a cardiac event: the role of medications, comorbidity, and psychosocial factors

“…Recent studies suggest that changes in sexual activity persist, despite evidence that shows sexual activity for most cardiac patients is safe (Levine et al, 2012). Lindau et al (2014) studied MI patients in the United States and Spain, comparing 1 year prior to 1 month post-MI. For those sexually active prior to MI, 63% of men and 54% of women returned to sexual activity post-MI, although rates were considerably lower than before MI.…”

“…For those sexually active prior to MI, 63% of men and 54% of women returned to sexual activity post-MI, although rates were considerably lower than before MI. In an earlier study, these authors compared sexual activity 1 year before and after MI to determine loss of sexual activity, finding that those sexually active before MI tended to return to sexual activity by 1 year after, although rates were somewhat lower, showing a 4% decline for women and 6% for men (Lindau et al, 2012). Of note, patients who did not receive sexual counseling at hospital discharge, loss of sexual activity was more frequently reported, with the adjusted relative risk for women as 1.44 and 1.79 for men, illustrating the importance of nurses initiating sexual discussions.…”

When the Topic Turns to Sex

“…29 In addition, while specific instructions for women with angina are generally the same as in men, sexual counseling occurs less frequently in women. 6 If the patient had refractory or unstable angina, further evaluation would be needed and sexual activity should be deferred ( Table 3 ). 8…”

“…Evidence shows that patients expect health care providers to initiate sexual activity discussions, 2 although providers often rely on patients to ask questions. 6 In addition, there are age and sex disparities, with older individuals and women less likely to receive counseling. 2 , 6 It is important for providers not to assume that a particular patient is likely sexually inactive or not in need of sexual counseling information.…”