For many people who have a health condition or have recently undergone a medical procedure, there’s one question that routinely goes unasked and unanswered: Is it safe to have sex?
Experts say health providers should broach the subject but routinely don’t, and patients are often reluctant to bring it up. “I think people are really interested in this topic and oftentimes afraid to ask their physicians,” says Dr. James Stein, a cardiologist and director of preventive cardiology at the University of Wisconsin Hospital and Clinics. “That’s coupled with the fact that there’s … not a lot of high quality research about sexual function and safety in large part because sexual activity is very safe in general.”
Stein makes it a point to speak about sex with inpatients he sees who have been hospitalized due to a heart attack or other issues before they leave the hospital. “I assume it’s on their mind — even if they don’t ask,” he says. “So I just bring it up to make it more comfortable for them.”
He notes that the American Heart Association guidelines say it’s OK to resume having sex one week after an uncomplicated heart attack. “Uncomplicated means that you’re no longer having symptoms, that you’re not having heart failure or didn’t have electrical problems with your heart” — like the heart stopped or beat too slow or fast, he says.
[See: What Only Your Partner Knows About Your Health.]
However, as with more complicated or involved ongoing heart issues — like when the condition isn’t stable or a person experiences chest pain, or angina, with exertion — the best medical advice on how to proceed is typically specific to the patient. There are many shades of gray when it comes to exactly how long to put off sex for health reasons, experts say, largely because the clinical judgment needs to be tailored to the individual. That’s all the more reason to talk it over with your health provider — even if that information isn’t offered upfront.
“There’s a huge body of research on breast cancer, for example, and gynecologic cancers that often have pelvic radiation among the treatments, and those studies consistently show that most patients don’t get any information about sex from their health care providers,” says Debby Herbenick, a professor at Indiana University School of Public Health in Bloomington, and director of the Center for Sexual Health Promotion in the School of Public Health. Anecdotally, she’s heard the same type of concerns about sex not being discussed between providers and patients for all kinds of health matters. “Most of the people that I’ve talked with who have had some type of either major health condition or surgery have not had a conversation with their doctor about sexuality,” she says.
One exception to this is immediately after childbirth, when women are routinely instructed to avoid having sex until their postpartum doctor’s visit. Though that visit typically occurs at six weeks, some women are able to resume having sex earlier, while others aren’t yet ready to do so. The American College of Obstetricians and Gynecologists recommends waiting at least two weeks to resume sex after a vaginal delivery with no complications, says Dr. Jennifer Balash, an OB-GYN at Advocate Good Samaritan Hospital in Downers Grove, Illinois. “However, if a patient has a tear or an episiotomy or a C-section it could be six-plus weeks. It depends,” she says. Some women sustain injuries during childbirth that can make sex afterward painful, and full recovery takes longer.
By contrast, one instance where many women and their partners abstain from sex due to concerns about health or safety when it’s generally not necessary is during pregnancy. “A lot of women think they can’t have sex when they’re pregnant, and unless your doctor tells you so, that’s generally not the case,” Balash says. Exceptions when a doctor might recommend avoiding sex include if a woman is at risk for preterm labor — or having the baby prematurely — or has placenta previa, in which the flat round organ that supplies nutrients through the umbilical cord, is abnormally low and near or covering the cervix.
In men and women, clinicians also recommend refraining from sex when either partner has a newly diagnosed sexually transmitted infection or sexually transmitted disease, such as syphilis, gonorrhea or HIV, until it’s controlled by treatment. Then experts recommend taking precautions, such as using a condom and taking medication to prevent its spread.
[See: 10 Weird Mind and Body Changes That Are Totally Normal During Pregnancy.]
But across the board — with very few exceptions — a temporary delay in sexual activity is meant to be just that, and certainly not an indefinite time-out from bedroom theatrics.
However, for the same health reasons why one might be warranted in initially putting sex off, like a heart attack, many put the kibosh on a good time for much longer than necessary. Or sometimes embarrassment or awkwardness about something like hemorrhoids may cause a person to shy away from sex, though that’s not necessary from a health standpoint. For men with a condition called Peyronie’s disease, characterized by curved erections caused by scar tissue in the penis, both awkwardness and discomfort during sex may lead them to avoid having sex.
“I have a lot of men who come in with a new diagnosis of Peyronie’s disease, or penile curvature, and either the man or his partner is afraid that continuing to have intercourse while they have the penile curvature may make it worse,” says Dr. J. Patrick Selph, an assistant professor of urology at University of Alabama at Birmingham. “Generally speaking that is not the case. If a man is able to engage in intercourse satisfactorily with their partner, then it’s fine to have sex.” Still he recommends men with the condition see a urologist who specializes in treating it. Those treated surgically are advised to generally abstain from sex for four to six weeks; those treated with an injection of medicine should refrain from sex for two weeks, Selph says.
Similarly, for most people who undergo major surgery, experts say it’s important to get practical and specific in talking with a health provider about how it might affect sexual activity.
For example, the recommendation to abstain from all sexual activity immediately following a heart attack aims to avoid taxing the heart; but after joint replacement surgery, a little excitement is fine. It’s the stress on the artificial joint and physical (not cardiovascular) limitations that may cause one to temporarily avoid intercourse or be more careful in choosing sexual positions.
Herbenick encourages patients to ask health providers to elaborate if they recommend avoiding sex. “Does that mean no intercourse? Does that mean no masturbation? Because for some [procedures], like a hernia surgery, yeah you might not want your patient masturbating for at least a week or two or longer,” she says. Whereas for some other health conditions, like a hip replacement, it’s probably fine, Herbenick says.
Factors ranging from age to blood pressure to how stable a patient’s health is overall may also have an impact on whether a patient can have sex. Some who have chronic conditions that have progressed — like advanced heart failure — may need a more thorough exam and workup to determine if it’s safe for sparks to fly.
[See: The Facts on Heart Disease.]
The good news is that for most, the risk of perishing in the throes of passion are still pretty slight. “I think people overestimate the amount of risk that occurs during sex,” Stein says. He adds heart-related complications from having sex are very uncommon, noting the relatively modest burden it places on the ticker is generally akin to low-level exercise, like walking briskly. “The vast majority of patients can have sex, and don’t need to refrain for health reasons.”
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When Should You Really Abstain From Sex for Your Health? originally appeared on usnews.com
