I Had a Mild Heart Attack. Can I Safely Have Sex Again?
John Entwistle's exit from this plane of existence is one of the most rock 'n' roll deaths ever.
On the eve of launching a new tour in 2002, the 57-year-old bassist for the Who left a Las Vegas bar around 3 a.m. to retreat to his hotel room with an exotic dancer on his arm.
At some point in the early-morning hours, the man known as the Ox joined the pantheon of rock gods at that great gig in the sky. He died after suffering a heart attack attributed to undiagnosed ischemic heart disease. Cocaine use and a pack-a-day smoking habit probably didn't do him any favors, either.
Entwistle never got a chance to give it another go, that night or any other. But for mere mortals who have survived a heart attack, the thought of getting back in the sack with a partner might give pause.
So when is it safe to have sex again after a heart attack? Is there a strict timeline? How common is it to suffer a second heart attack while having sex?
Stairway to heaven
Heart attack is another name for myocardial infarction, a condition in which part of the heart muscle doesn't get enough blood. The most common cause is coronary artery disease, a buildup of plaque in the arteries that blocks blood flow to the heart.
An American suffers a heart attack every 40 seconds, adding up to 805,000 myocardial infarctions each year, according to the Centers for Disease Control and Prevention (CDC). Of those, around 200,000 are second heart attacks.
But once you've recovered or even had a minimally invasive surgery to place a stent, those second heart attacks aren't likely to occur while you're enjoying sexy times—as long as you're not trying any advanced porn-star-type moves.
"Whenever a man can walk up a flight of stairs, he can resume sex," said Jesse Mills, M.D., director of the Men's Clinic at UCLA. "Maybe not swinging-from-the-chandelier sex, but judicious, low-key intercourse is about as tiring as walking up stairs."
For men who've had bypass surgery, the wait is usually longer, but the reason isn't their heart.
"Each patient's situation is unique, but in general, patients who have had bypass surgery need to heal their sternum (breastbone), which is usually around six to eight weeks," said Megan Kamath, M.D., an advanced heart failure and transplant cardiologist at the David Geffen School of Medicine at UCLA.
It's important to note that everyone's situation is different. That's why there's no set time frame for when it's safe to resume sex.
"Specific considerations need to be taken into account: How severe was the heart attack? Were there any other complications? And what was the patient's state of health before the heart attack?" Kamath said.
Muscle of love
Erectile dysfunction (ED) is a condition that's strongly linked to physical issues, including blood pressure, diabetes and cardiovascular disease. It's important for men recovering from a heart attack to address the underlying causes that led to it, and those causes are often indicated by prior bouts with erectile dysfunction.
"If a man develops ED before he's 50, he is twice as likely to suffer a coronary event within 10 years of his ED diagnosis," said Mills, whose book "A Field Guide to Men's Health" is due out in December 2021. "The arteries that supply blood for erections are half as big as the arteries that supply the heart. If a man is developing cholesterol plaques in his penile arteries, they'll shut down prior to the heart giving in."
Don't go breaking my heart
While the consensus is that it's generally safe to resume reasonably demanding sexual activities soon after a heart attack, it's important to be aware of potential issues with medication. Beta blockers, which are commonly prescribed after a heart attack, can cause some men to have trouble getting an erection.
"A person who has had a heart attack will often be on several new medications in order to help protect the blood vessels of the heart and also strengthen the heart muscle," Kamath said. "Many of the medications used to treat these conditions can affect the ability to have an erection.
"For example, there are special medications called nitrates that are used to treat angina, which can interact with medications used to treat erectile dysfunction," she added.
The combination of ED meds and nitroglycerin or other nitrates can cause a catastrophic drop in blood pressure, leading to dizziness, fainting, heart attack, stroke or even death.
Tube steak boogie
A more sustainable solution to keeping your erections firm and reliable following a heart attack is to improve your physical conditioning through exercise and diet.
Of course, men with a history of heart trouble face potential psychological issues, as well. For those of us who don't have the cavalier confidence of a rock god, à la Entwistle, being a little gun-shy about sex following a heart attack is understandable.
According to Mills, a thoughtful partner can go a long way toward helping a man come back stronger than ever.
"Be supportive and encourage him to stick to his cardiac rehab program, since exercise of any kind is as good for the penis as it is the heart," Mills said. "He may not be as horny for a while after suffering a life-altering event, but he will get better."