According to recent data, about one in five acute myocardial infarctions (AMIs) occur among people aged 18 to 55, and one-third of these patients are women. Recently, the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study was conducted to investigate differences between women and men in their trajectory of functional recovery, including sexual activity and function, in the year after an AMI. The study population included hospital patients from both the United States and Spain. VIRGO showed that most AMI survivors were sexually active in the year before their event and many resumed sexual activity in the following year.
A Deeper Look
Despite this recommendation, little is known about the patterns of sexual recovery or sexual problems after AMI, especially among younger patients. To address this research gap, Stacy Tessler Lindau, MD, MAPP, and colleagues had a study published in JAMA Cardiology that looked at how patients were informed about sexual recovery and efforts that were made to address their expectations. “Previous research suggests that women are less likely than men to receive counseling about sex after an AMI,” explains Dr. Lindau. “This counseling is important for all AMI survivors.”
According to the results, most patients had resumed sexual activity by 1 month. More than half of women and less than half of men reported having sexual function problems in the year after their AMI. In addition, one in 15 women and one in 20 men never resumed sex during the year after their AMI. The most commonly reported sexual problems were lack of interest and trouble lubricating for women. For men, the most common problems were erectile difficulties and lack of interest.
“Despite a high prevalence of sexual function problems—especially for women—few study participants reported having any conversation with a physician about resuming sex after an AMI,” says Dr. Lindau. Those who had not communicated with their doctor about sex in the first month after AMI were more likely to delay resuming sex. Patients who had higher stress levels and those with diabetes appeared to be at greatest risk for loss of sexual activity in the year after the AMI.
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“Clinicians should include educating patients about sex after AMI as a part of medical care for recovery after AMI,” Dr. Lindau says. Cardiac care providers should be aware that loss of a partner after AMI may further impair the patient’s overall recovery and may require additional psychosocial support.
Counseling is Key
“It’s important to advise patients that sexual problems may arise after AMI,” says Dr. Lindau. “However, we can give survivors hope by letting them know the numbers.” The findings of this and a prior study by Dr. Lindau and her team showed that about 90% of women and men older than age 60 resume sexual activity within a year of their AMI. For younger men, this rate is even higher. In addition, 40% of women and 55% of men had no sexual function problems in the year after AMI. Nearly one-third of those who have problems in the year before AMI reported having no such problems in the year after it.
Providing patients with this information can help manage patient expectations and concerns. Dr. Lindau and colleagues reported that patients want to know what level of sexual function to expect during recovery from AMI. “Counseling could be a significant indicator of time to resuming sexual activity,” Dr. Lindau says.
In addition, the study authors note that AMI survivors should be educated on the link between poorer sexual function and cardiac conditions. This information might help motivate patients to address their modifiable risk factors, such as lifestyle changes and other secondary prevention strategies, and increase their likelihood to participate in cardiac rehabilitation. “The key is to improve our counseling approach so that we routinely address sexual function outcomes” Dr. Lindau says. “Patients need to know what to expect and that it’s a legitimate topic to discuss with their physicians.”
Stacy Tessler Lindau, MD, MAPP, has indicated to Physician’s Weekly that she has or has had no financial interests to report. Her study noted that support was provided by grant 1K23AG032870-01A1K23 from the NIH/National Institute on Aging and private individual philanthropic funds to the Lindau Laboratory at the University of Chicago, grant U01 HL105270-05 from the NHLBI to the Center for Cardiovascular Outcomes Research at Yale University, the AHRQ Patient Centered Outcomes Research Institutional Mentored Career Development Program grant K12HS023000, and in part by grant BA08/90010 from the Fondo de Investigación Sanitaria del Instituto de Salud Carlos III, Spain (Dr Bueno).
Lindau ST, Abramsohn E, Bueno H, et al. Sexual activity and function in the year after an acute myocardial infarction among younger women and men in the United States and Spain. JAMA Cardiol. 2016 Aug 31 [Epub ahead of print]. Available at: http://cardiology.jamanetwork.com/article.aspx?articleid=2546890.
Lindau ST, Abramsohn EM, Bueno H, et al. Sexual activity and counseling in the first month after acute myocardial infarction among younger adults in the United States and Spain: a prospective, observational study. Circulation. 2014;130:2302-2309.
Lindau ST, Abramsohn E, Gosch K, et al. Patterns and loss of sexual activity in the year following hospitalization for acute myocardial infarction (a United States National Multisite Observational Study). Am J Cardiol. 2012;109:1439-1444.