How to talk to your cardiac rehabilitation patients about sex

People with a heart condition can feel like they’re not getting enough information about sex – how can healthcare professionals start the conversation?

16 April 2019, by Siobhan Chan

Man and woman holding hands on a bed

After a cardiac event, many patients can feel worried about resuming sexual activity – and failure to address this early on can lead to anxiety and depression during recovery.

Yet a recent BHF survey shows many are not getting the information and advice they need during cardiac rehabilitation – described as an “ideal time” for healthcare professionals to offer support.

So how can healthcare professionals best approach this challenging conversation at the right time? 

'Resuming and maintaining sexual relations and dealing with sexual dysfunction' is listed as a component of cardiac rehab by the British Association for Cardiovascular Prevention and Rehabilitation (BACPR), and is recommended under NICE guidelines.

However, 74% of 570 people surveyed by the BHF patient magazine Heart Matters who had attended cardiac rehab did not talk about sex during their programme.

Almost half (47% of 158 people who responded) said they either wanted more information on sex during cardiac rehab or wished to discuss this subject one-to-one with the nurse. While 64% said they talked to their GP about concerns regarding sex, only 9% discussed it with their cardiac rehab nurse.

Avoiding anxiety

Kate Blayney, Cardiac Rehabilitation Manager at Oxford University Hospitals NHS Foundation Trust, says healthcare professionals can find it challenging to talk to patients about sex. It is vital that the conversation takes place, as it can help to avoid problems with anxiety and depression related to sexual activity during a patient’s recovery, she says.

“Cardiac rehab is an ideal time to talk to patients about it – as soon as you see your patient,” says Blayney.

Professor Patrick Doherty, Professor of Cardiovascular Health at the University of York and Director of the National Audit for Cardiac Rehabilitation (NACR), says: “People can decide to abstain after a cardiac event and no longer consider having sex – but that shouldn’t [need to] be the case.”

Starting the conversation

At the John Radcliffe Hospital, Oxford, where Blayney works, cardiac rehab nurses speak to patients on the ward and have the opportunity to provide early support and education, including answering questions about sex.

“We are lucky because we speak to patients on the ward before discharge, and patients sometimes ask about it then,” she explains. “Even in a busy ward, you can be discreet about how you approach it – or you can choose a less busy time. People want to know before they go home.”

Sex can be a difficult topic to raise, but including it as part of a wider conversation about physical activity and medications can be an easy way to start the conversation, she says.

“You can say: ‘Erectile dysfunction often occurs before coronary artery disease, has that been a problem for you?’, or normalise it with people by saying: ‘Many patients I see are concerned about sex – is that something you’re worried about?.

“It makes it more of a normal thing by saying that other people worry about it too.”

Discussing sex can be a good way of engaging with a patient, Blayney adds. “It gets people to engage more if you talk about things that are important to them. They realise that we’re trying to address their concerns.”

Professor Doherty adds that it’s important for healthcare professionals to ensure patients are taking the right medications and that their blood pressure is controlled.

Common questions about sex

According to Blayney’s experience, most patients ask when they can have sex again, whether having sex will trigger a heart attack, or whether it will set off their implantable cardioverter defibrillator.

The Heart Matters survey found that 41% of people worried most about losing libido and 33% had concerns about their medication’s effects on their sex drive.


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Resources on sexual advice

A small study of cardiac rehabilitation professionals in Ireland found that 45% lacked confidence in addressing sexual health problems with their patients, 58% lacked knowledge and 85% lacked training. Similarly, some GPs in an Irish survey also reported a lack of awareness, knowledge and confidence in addressing sexual problems.

NICE guidance gives some advice to cardiac rehab professionals. For example, professionals should reassure patients that after recovery from a myocardial infarction (MI), sexual activity presents no greater risk of triggering a subsequent MI than if they had never had an MI.

Heart Matters also contains useful advice about sex that healthcare professionals such as cardiac rehab staff, GPs, and cardiac nurses can share with their patients: