You just had heart bypass surgery: Cardiac surgeons cracked your breastbone, opened your chest and grafted blood vessels from one part of your body onto another. You have fresh surgical wounds, both on your leg and chest — the famous zipper — and it takes all the energy you’ve got to simply get out of bed and walk to the bathroom. As you cope with recovery and process the enormity of what you’ve been through, sex is the last thing on your mind.
Eventually, though, you and your partner wonder if it’s time to, well, get busy. But you’re anxious: Are you ready? Is it safe? Maybe your doctor gave you some guidelines; maybe not. Here’s what experts say about resuming sex after major heart surgery.
Let’s Talk About Sex
Sex starts with a conversation — ideally with your doctor. “We don’t know as health care providers if it’s an issue for a particular person unless we ask,” says James Beckerman, a cardiologist at Providence Heart and Vascular Institute in Portland, Oregon. But many patients are understandably hesitant to bring up the subject.
So Beckerman breaks the ice and asks about sexual concerns. “I think one of our jobs is to try and make people feel comfortable about less-comfortable things,” he says. Sometime patients are surprised, he adds, but mostly they’re appreciative. “It shows that we’re thinking about the whole person, not just their heart.”
When it comes to discussing sex with heart patients, Beckerman may be the exception, not the rule. According to a study appearing last December in the journal Circulation, which looked at some 3,500 heart attack survivors in the United States and Spain, only about 12 percent of women and 19 percent of men reported discussing sexual activity with a physician in the following month.
Transforming Experience
Coronary artery bypass grafting, or CABG, is a big deal. “After people have gone through a significant medical experience — with bypass surgery one of the more significant ones — people sometime feel transformed,” Beckerman says. “They’re not sure what they’re able to do.” Confidence is “a huge potential issue,” he says. “Having a traumatic experience of any form — and for many people, surgery is understandably traumatic — it impacts your sense of self.”
Emotional issues are “surprisingly common” after cardiac surgery, he says. “Some people experience depression; some experience emotional lability.” For instance, they may start to cry or feel anger more easily than they used to. Lingering soreness and discomfort can also leave people less than eager to hop back into the sack.
Decreased frequency of sexual activity after cardiac surgery has been seen in some studies, says Elaine Steinke, a professor in the School of Nursing at Wichita State University. “There’s poor sexual response, and that include desire as well as fears about resuming sex,” she says.
Medication Connection
Certain medications often prescribed for people with heart disease can affect libido after heart bypass surgery, Beckerman notes. These include blood pressure-lowering drugs in the beta blocker class. Because erectile dysfunction drugs may reduce blood pressure, he says, they should not be used within 72 hours of taking nitrates — including nitroglycerin, which is used to manage chest pain.
If patients are having sexual issues related to prescribed drugs, these can be adjusted. “In my experience, we’ll usually try to help the situation by taking a careful look at medications and making sure the patient is on a good regimen that isn’t impacting their quality of life too much,” Beckerman says.
Safe for Sex?
People may worry that sex will lead to a heart attack or chest pains, but that isn’t common. “In some situations, if people experience symptoms following a procedure like [CABG], a stress test might be indicated before engaging in more vigorous exercise or sexual activity,” Beckerman says. That could mean symptoms such as chest pain, shortness of breath and easy fatigue. “But,” he adds, “if people have undergone a successful procedure and they’re feeling well and participating actively in a cardiac rehab program, then further testing is usually not recommended.”
It’s helpful to think about sexual activity as another type of intense exercise, he says. If exercise is safe for patients, then sexual activity usually is too.
Pillow Talk
According to American Heart Association guidelines, patients with a sternal incision after traditional bypass surgery can resume sex in six to eight weeks.
When doing so, people “want to choose positions that support the incision, and they want to avoid strain on that sternum,” Steinke says. Extra pillows can help people feel comfortable, even placing a pillow across the chest to support the sternum. While partners are often concerned they might somehow cause damage, she says that as long as couples are taking precaution to avoid strain and direct pressure, “there should be no issues.”
Steinke says injuries to the sternum during sex are probably “pretty rare,” and she hasn’t seen any documented in medical literature. Beckerman, for his part, isn’t too concerned that a scar could reopen. “Well, anything’s possible, but typically it does not,” he says. “Usually it heals really well.”
Women who undergo CABG may experience breast discomfort. “Some women have described things like shooting pain, numbness in the breast area, tingling and heaviness,” Steinke says. Taking a mild pain reliever such as ibuprofen or acetaminophen (if OK with the doctor) before sexual activity may help, she adds.
If emotional problems with resuming sex persist months after surgery, psychological counseling could help.
Getting Back in Sexual Shape
Just like resuming running or going back to the gym after bypass, people can gradually get in shape and rebuild their confidence in the bedroom. Cardiac rehabilitation is a good way to do that, and it’s recommended for all heart-bypass patients (and covered by insurance). “Cardiac rehabilitation is a formalized exercise program that we prescribe for our patients after they undergo heart surgeries like this,” Beckerman says. “They bounce back more quickly and feel more confident and get back on track.”
As the partner of a recent bypass patient, you also help get your sex lives back to normal. “Know that this is a big event, if you will, for your partner,” Steinke says. Besides being aware of positioning, avoiding pressure yet “not being afraid of the incision,” she says, you can just be there to listen. And you should talk through any concerns either of you has. Support your partner during exercise “and just be their cheerleader during rehabilitation and recovery,” she advises. “Taking daily walks together — those types of things tend to help promote sexual intimacy as well.”
More from U.S. News
Exercising After You’ve Gone Under (the Knife, That Is)
How to Find the Best Mental Health Professional for You
10 Questions Doctors Wish Their Patients Would Ask
Sex After Heart Bypass Surgery originally appeared on usnews.com
