If clinicians are charged with the responsibility of counseling on medications, diet, and exercise post adverse cardiac events (for example a heart attack) or cardiac procedures, then why doesn't their professional expertise extend to advise on sexual activity and safety?
This issue, often considered too personal to even whisper about at a doctor's office, was recently addressed in the Canadian Journal of Cardiology.
Specifically, the study addresses many of the myths with regards to sexual activity for patients with heart disease. It goes further to provide recommendations for risk stratified heart patients using what is being called the KiTOMI model. KiTOMI is an acronym that encompasses various sexual activities. It stands for Kissing, Touching, Oral, Masturbation and vaginal/anal Intercourse.
Using the classification system, patients can be labelled as low, intermediate or high risk based on cardiac symptoms and/or where they fall on the New York Heart Association (NYHA) Functional Classification for Heart Failure. Treatment interventions can then be instituted along with a recommendation of which sexual behaviors the patient can safely enjoy. For example, a low risk patient can engage in each aspect of KiTOMI fully, while a high-risk friend would be a little more restricted to just KiT. However, with appropriate interventions and improvement/resolution of cardiac symptoms, those high risk patients can gradually progress to full KiTOMI...benefits.
What's notable about the recommendation is that no matter what category of risk the patient falls into, there is a sexual activity that they can safely engage in without detriment to their health. The researchers behind this study have found that on the spectrum of sexual activity, kissing can be likened to a slow walk, while an orgasm is comparable to a faster pace of walking, similar to crossing the street.
According to the lead author, Ricardo Stein, MD, DSc, of the Cardiology Division of the Federal University of Rio Grande do Sul, Brazil, "Overall, the risk of death during sex is very low for most clinically stable heart patients, and interestingly, even much lower for the women.
Even with this information now available, it doesn't change the taboo nature of the topic. The onus lies squarely on both the patient and the clinician to have that "awkward" conversation. It's an important discussion to have, and if it can result in a much healthier and happier disposition, then why not have it?