“How my heart condition has ended my sex life – and why I wish doctors would talk about it”

Many people with heart or circulatory conditions experience problems with their sex life. Roger Fox, who has heart failure, writes frankly about how it has affected him.

Image of Roger Fox

It felt weird, somehow wrong, to be so reassured reading a newspaper headline “Heart condition stops a million from having sex.” Discovering that nearly one in five surveyed found sex “impossible” only boosted that reassurance. I’m not alone, not a freak.

When I was 52, I underwent open-heart surgery to replace a seriously damaged aortic valve. A specialist nurse told me straight: “Without this operation, you will die within two years.”

Though nowadays doctors must tell you fully about the risks of the operation, do you get told enough about possible life-long consequences of your condition? The doctor’s lot is not an easy one: preparing patients psychologically for heart surgery cannot be straightforward. But I think many patients would like at least some acknowledgement of what real problems may face them, if they come through.

What relief that would be: that someone is concerned enough to ask

For me, learning to live with heart failure involved finding out what I could do to sustain and extend the length and quality of my life. Certain drugs – beta-blockers, diuretics, an angiotensin receptor blocker – were prescribed: they took pressure off the heart, allowing the blood to flow more smoothly and the heart to pump more efficiently. The only detailed information about side effects came from the drug packages themselves. 

After the operation, as my sexual appetite regrew, something was different. The strength and length of what, at that time, still just about deserved to be called an erection made any serious attempt to have sex a non-starter. I did mention to one consultant cardiologist that I was reluctant to increase my beta-blockers because of some difficulties with erections, which he heard and accepted. (Since then, other doctors have more than doubled this dose, but I’d given in to impotence by then). 

Other than that, no hospital medic or GP has ever asked, directly or indirectly, about that part of my life. A couple of years after the heart op, I had (unrelated) enlargement of my prostate, which is classed as benign but needed another drug to reduce it. This drug has erectile dysfunction as one of its side effects.

For me - and I do count myself lucky – I’ve been able to discover and (mostly) relish all those non-sexual components of an intimate relationship: companionship, affection, mutual support. As we slipped into our sixties, when libidos do begin to wane, we slowly accepted that this nonsexual state was our lives, this was our lot. We are ex-lovers who’ve become the closest of friends. Yet there remains a sadness so deep, a grief so gut- wrenching that even with my one true love, I’ve never risked expressing it. Voicing my anger and bewildered frustration that my life should have taken this course; owning my guilt and failure as a man: all too overwhelming and frightening. 

I’d like to see things change

It isn’t about how much you love your partner; it isn’t about how sexy you feel. It’s simply that you know you cannot hack it: after the first few initial optimistic but inevitable ‘failures’, it’s easier to avoid such heartbreaking entanglements. 

Part of me felt a pressure lifting when we started using two bedrooms, as not sleeping together slowly became our norm. A deeper part, which has slowly sunk beneath my daily consciousness, is the raw loss, guilt, isolation and rage that I feel that we will never again know the inexpressibly wondrous, panting, laughing intimacy of full sexual union or the quiet closeness, the smiles, caresses and lovingness of post-coital collapse.

Why I think the medical profession needs to do more to help

I’d like to see things change. Diverting only ten percent of the effort that goes into supporting patients’ physical rehabilitation after open heart surgery towards the psychological adjustments required for a ‘life changing condition’ would be a start. 

Getting doctors, and the information sheets they use, to fully acknowledge the implications of sexual side effects of common conditions and medications would be a start. I recently reread a booklet on cardiac rehabilitation, which in the ‘Sex’ section said “However, many people with a heart condition continue to enjoy sex, and many people who have had treatment for their heart condition are able to return to their sex life”. That “many” screams at me: what about the poor souls who are not part of the many? To be fair, under ‘Loss of sex drive’ it does say some men experience impotence and sometimes this can be the result of taking certain medicines, such as beta-blockers. However, although it is a ‘common problem’, the responsibility is handed to the patient to “talk to your doctor or cardiac rehabilitation team about it”. 

Why can’t the doctor ask? At my cardiology appointments, my wife is always at my side. If we’d been asked about our sex lives, we would have answered questions honestly and openly, once we’d got over some initial embarrassment, guilt and surprise. Yet it is precisely because of such feelings that it needs to be the doctor, or the professional, who raises the matter. What relief that would be: that someone is concerned enough to ask, even if there’s probably nothing to be done about it. Are doctors competent and confident to raise such matters in a way that keeps things on a medical and professional footing yet which deals sensitively with topics that are traditionally deeply private, and therefore rarely discussed? 

I am a person with a serious heart condition. I am a whole (if broken) person, first and last. When the consequences of the condition or its treatment affect my wider life, I want that acknowledged and, if possible, ameliorated or managed, by those responsible for my treatment. They do it efficiently and effectively with all the straightforward physical stuff. Is it too much to ask them to take a more holistic view of me? I accept the cost is probably inevitable in order simply to remain alive. But a cost that’s insufficiently recognised and acknowledged, as is the psychological pain, loss and challenges of coming to terms with my ‘life-changing condition’.  

Roger Fox is a pseudonym.

Where to get more information

The Sexual Advice Association (SAA) has downloadable factsheets on a number of symptoms and sexual problems - you can show these to your GP and partner to help start a conversation.

The SMART SAA app, created by the Sexual Advice Association, gives you information and advice on what you can do if you have any type of sexual problem or concerns. You can use the app yourself or with your partner. Download it via the App Store, Google Play or via the Sexual Advice Association website.

If you want to speak to a specialist doctor or therapist you can try:

  • Institute of Psychosexual Medicine – provides both private and NHS doctors specialising in sexual health across the UK – although be aware that for a NHS consultation you will probably need to be referred by your GP.
  • College of Sexual and Relationship Therapists – provides private consultations across the UK. You can search by location for a therapist.
  • If you decide to have a private consultation, be aware that fees can vary. It’s worth ringing around to make sure you find someone you like, and that the timing of the appointment works for you (consultations over Skype and telephone are often available). The outcome is usually better if you go as a couple.