Sexual rehab could have benefits for men with heart disease

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By Carolyn Crist

A sexual rehabilitation program could help with erectile dysfunction in men who have heart disease, a study from Denmark suggests.

Men assigned to the rehabilitation program had improved erectile function and better exercise capacity after 16 weeks compared to those who just got usual medical care, the study team reports in the journal Heart.

“Sexual problems have a profound negative impact on several aspects such as quality of life, general wellbeing, relationship problems and psychological outcomes such as depression and anxiety,” said lead study author Pernille Palm of Copenhagen University Hospital Rigshospitalet.

For some cardiovascular issues such as ischemic heart disease, erectile dysfunction is a problem in up to 80 percent of men, she said.

“Patients hesitate to seek help because it’s still a taboo,” Palm told Reuters Health by email. “They want health professionals to address the topic, but health professionals in general don’t feel they have the competence or correct intervention to offer.”

In the CopenHeart trial, Palm and colleagues randomly assigned 154 men either to just continue with their normal outpatient follow-up visits or to also take part in a 12-week sexual rehabilitation program that included physical exercise and psychoeducation around sexual health and dysfunction.

The men had either ischemic heart disease – meaning blocked or narrowed arteries – or a heart rhythm disorder that required an implanted defibrillator. Half were older than 62. Those assigned to the rehab program followed a cardio and strength-training regimen, as well as stretching and pelvic floor exercises, plus a tailored counseling program that covered each man’s specific issues and concerns.

The men answered questionnaires about their sexual functioning and their level of wellbeing at the start of the study, and the research team measured exercise capacity at the outset and again after four months and six months. Measurements of erectile function included questions about erection quality, orgasmic function, sexual desire and intercourse satisfaction. Another set of questions gauged quality of life related to having a disease.

The research team found that sexual rehabilitation, as compared with usual care, improved physical sexual function at four months and six months. The rehabilitation program also improved exercise capacity and pelvic floor strength. However, there was no difference between the groups in the psychosocial component of the assessments or in their self-reported health or mental health.

“What stuck out the most was the fact that so many men had this problem for so long and hadn’t sought professional help,” Palm said. “But also, the ones seeking help weren’t able to get sufficient advice.”

As part of the trial, the study authors elicited feedback from the men’s partners regarding erection function, yet only 10 percent of partners responded. Future studies should find other ways to engage partners and build the social aspect of the program, Palm said.

In fact, during the trial, some of the patients “teamed up with peers and met up after training sessions for a beer, thereby creating a special place for discussing their life with heart disease, including sexual issues,” she said.

Palm and colleagues are planninga larger study with different types of patients who may require different treatments, she explained. Other studies are specifically focused on sexual outcomes for women, too.

“Although the clinical guidelines recommend counseling of women and men about sex after a heart attack, women are far less likely to receive this counseling,” said Dr. Stacy Lindau of the University of Chicago, who wasn’t involved in the study.

Lindau directs WomanLab, a website that provides information about female sexuality and health conditions, especially with regard to menopause, cancer and heart disease. This week, WomanLab launched a new resource (bit.ly/2FNxEHj) with questions to ask doctors about sex after a heart attack.

“Both men and women should ask their heart doctor when it’s safe to start having sex again and, if possible, include their partner in the conversation,” Lindau told Reuters Health by email. “A life-threatening illness can be a wake-up call where couples reset their thinking about their life priorities and renew their commitment to caring for and loving each other each day.”

Complete Article HERE!

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Gay, Straight, Or Bisexual – Which Group Of Men Are More At Risk Of Heart Failure?

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Can your sexuality increase or decrease your risk of heart failure?  A new study released by the NYU Rory Meyers College of Nursing states that Bisexual men have a higher risk for heart disease compared with heterosexual men.

Now, of course it is not because you’re sleeping with men, but it’s because of everything else that may come with it.

In a new study published online in the journal LGBT Health, Billy Caceres, the study’s lead author, states:

Our findings highlight the impact of sexual orientation, specifically sexual identity, on the cardiovascular health of men and suggest clinicians and public health practitioners should develop tailored screening and prevention to reduce heart disease risk in bisexual men.

More than 30 percent of men in the US have some form of heart disease making it a leading cause of death for American men. Not many studies have been done to understand the impact of sexual orientation on heart disease risk for men.

In this study, NYU researchers examined differences in modifiable risk factors for heart disease and heart disease diagnoses in men of different sexual orientations. Risk factors measured included:

mental distress
health behaviors such as

  •       tobacco use
  •       binge drinking
  •       diet
  •       exercise

biological risk factors such as

  •       obesity
  •       hypertension
  •       diabetes
  •       cholesterol.

Responses from 7,731 men ages 20 to 59 were part of the National Health and Nutrition Examination Survey (2001-2012). Differences were analyzed across four groups based on their sexual identities: gay men, bisexual men, heterosexual men who have sex with men, and heterosexual men.

The researchers found no differences in heart disease diagnoses based on sexual orientation, but risk for heart disease was more complicated.

  • Gay men, heterosexual men, and heterosexual men who have sex with men had similar heart disease risk.
  • Gay men reported lower binge drinking compared with heterosexual men, but otherwise few differences in health behaviors were noted.
  • Bisexual men, however, had higher rates of several risk factors for heart disease relative to heterosexual men: mental distress, obesity, elevated blood pressure, and three different measures of diabetes (medication use, medical history, and average glycosylated hemoglobin level).

“Poor mental health is a recognized risk factor for the development of heart disease,” said Caceres. “Clinicians should be educated about sexual minority health and should routinely screen bisexual men for mental distress as a risk factor for heart disease. This is particularly important as healthcare organizations increasingly include sexual orientation as part of demographic questionnaires in electronic health records.”

Complete Article HERE!

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These scientists say you’ll probably never have heart-stopping sex

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[H]eart patients have worried that they may die suddenly from having sex, but a new study suggests they probably won’t.

Researchers found that less than 1 percent of people who experienced sudden cardiac arrest were having, or just had, sex. Now Sumeet Chugh, one of the study’s authors, has some “happy news” to tell his nervous patients.

“As a cardiologist, from time to time, in an awkward way, patients would ask me, ‘You know doc, what’s my risk of dying suddenly with sexual activity?’ We could say to them it’s probably low, but we never had data,” Chugh said. “Now we have data to answer that question.”

Researchers described sudden cardiac arrest as a “mostly lethal condition” that manifests as “an unexpected collapse and loss of the pulse.”

More than 300,000 people die of sudden cardiac arrest every year in the United States, yet about 1 in 100 men and 1 in 1,000 women experience sudden cardiac arrest relating to sexual activity, according to the study, which was presented at the American Heart Association’s Scientific Sessions and published in the Journal of the American College of Cardiology.

The community-based Oregon Sudden Unexpected Death Study examined data on more than 4,500 sudden cardiac arrests in the Portland, Ore., metropolitan area from 2002 to 2015. Of those, 34 were related to sex, and most were men with a history of heart diseases.

Researchers collected medical records, autopsy data and details of what the person was doing when sudden cardiac arrest occurred. Any cases that occurred during sex or within one hour of having sex were considered related to sexual activity.

Sudden cardiac arrest occurred during sexual activity in 18 cases and within minutes of it in 15 cases. In one case, the timing could not be determined.

“We were pleasantly surprised to see how low it was,” said Chugh, the associate director of the Heart Institute for Genomic Cardiology at Cedars-Sinai in Los Angeles.

This study is an opportunity to reassure patients that they can return to a good quality of life, including sexual activity, said Nieca Goldberg, who is the medical director for the Joan H. Tisch Center for Women’s Health at New York University. She is also an AHA spokeswoman and was not involved with the study.

“These are real concerns of our patients,” she said. “We have so many tools to prolong people’s lives. We want them to have a good quality of life, returning to exercise, eating a healthy diet and returning to sexual activity.”

The study also shows that sex “obviously isn’t as strenuous as we thought,” Chugh said, and Goldberg agreed. Sex, in general, is equivalent to walking up two flights of stairs, she said.

But a concerning result of the study, Chugh and Goldberg noted, is that it seems to suggests that sexual partners aren’t very willing to perform CPR, or don’t know how to do it, if a partner goes into sudden cardiac arrest.

Within 10 minutes of sudden cardiac arrest, a person is likely to die, and only one-third of those who experienced sudden cardiac arrest relating to sexual activity received bystander CPR, according to the study.

“We would think that if the witness is right there, everybody would get CPR,” Chugh said. “But it turns out only a third of the subjects got CPR. And since most of the subjects were men it seems like two-thirds of the women really didn’t do the CPR.”

“It’s a good idea to be aware of CPR, know how to do CPR, and do CPR even if it’s as awkward and difficult a scenario as cardiac arrest during sexual activity,” Chugh said.

On average, those who went into sudden cardiac arrest related to sexual activity were five years younger and more likely to be African American than the rest of the cases, the study states. Sudden cardiac arrest in relation to sexual activity was also more likely to have ventricular fibrillation, when the heart pumps little to no blood, according to the study.

Researchers did not examine how often patients in the study had sex, the type of intercourse, or how long it lasted. In any case, the results show that there isn’t a high risk associated with sex and sudden cardiac arrest, Chugh said.

Complete Article HERE!

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Redefining Sexuality after Stroke

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You can have a healthy sex life after having a stroke.

By StrokeSmart Staff

You can have a healthy sex life after having a stroke. In fact, it’s a key part of getting back into a normal routine. The need to love and be loved is significant. Also, the physical and mental release that sex provides is important.

The quality of a couple’s sexual relationship following a stroke differs from couple to couple. Most couples find that their sexual relationship has changed, but not all find this to be a problem. The closeness that a couple shares before a stroke is the best indicator of how their relationship will evolve after the stroke.

However, having sex after a stroke can present problems and concerns for both you and your partner.

Stroke survivors often report a decrease in sexual desire. Women report a strong decrease in the ability to have an orgasm and men often have some degree of impotency. A stroke can change your body, how you feel and impact your sex life.

Having good communication with your partner, managing depression, controlling pain or incontinence and working with impotence can all help you resume a healthy sex life.

Communication is Key

Talking about sex is hard for many people. It gets even more complicated after having a stroke, when you may be unable to understand or say words or have uncontrollable laughing or crying spells. But it is critical to talk openly and honestly with your partner about your sexual needs, desires and concerns. Encourage your partner to do the same. If you are having a difficult time communicating with your partner about sex, an experienced counselor can help.

Depression, Pain and Medication — How They Effect Your Sex Drive

It is common for stroke survivors and their partners to suffer from depression. When you are depressed, you tend to have less interest in sexual intimacy. Depression can be treated with medications. You may also be taking medicine for anxiety, high blood pressure, spasticity, sleeping problems or allergies. Addressing these medical concerns can increase your sex drive. But know that some medication can also have side effects that interfere with your sex life. If your ability to enjoy sex has decreased since your stroke, talk with your doctor about medicines that have fewer sexual side effects.

Many stroke survivors also have problems with pain, contributing to a loss of sexual desire, impotence and the ability to have an orgasm. This is a normal reaction. Work with your doctor to develop a program to manage your pain and increase your sexual desire.

Controlling incontinence

If you are having trouble with controlling your bladder or bowel, being afraid that you will have an accident while making love is understandable. There are a few steps you can take to help make incontinence during sex less of a concern.

  • Go to the bathroom before having sex
  • Avoid positions that put pressure on the bladder
  • Don’t drink liquids before sexual activity
  • Talk to your partner about your concerns
  • Place plastic covering on the bed, or use an incontinence pad to help protect the bedding
  • Store cleaning supplies close in case of accidents

If you have a catheter, you can ask your doctor’s permission to remove it and put it back in afterwards. A woman with a catheter can tape it to one side. A man with a catheter can cover it with a lubricated condom. Using a lubricant or gel will make sex more comfortable.

Working With Impotence

Impotence refers to problems that interfere with sexual intercourse, such as a lack of sexual desire, being unable to keep an erection or trouble with ejaculation. Today, there are many options available to men with this problem. For most, the initial treatment is an oral medicine. If this doesn’t work, options include penile injections, penile implants or the use of vacuum devices. Men who are having problems with impotence should check with their doctors about corrective medicines. This is especially true if you have high blood pressure or are at risk for a heart attack. Once you have talked to your partner and you are both ready to begin a post-stroke sexual relationship, set yourself up to be comfortable. Start by reintroducing familiar activities such as kissing, touching and hugging. Create a calm, non-pressure environment and remember that sexual satisfaction, both giving and receiving, can be accomplished in many ways.

Ask the Doctor

Things to discuss with your doctor:

  1. Medications for depression and pain that have fewer sexual side effects.
  2. Changes you should expect when having sex and advice on how to deal with them. Be sure to discuss when it is safe to have sex again.
  3. Impotence and corrective medications.
  4. Incontinence — a urologist who specializes in urinary functions may be able to provide help in this area.

Tips for Enjoying Sex After a Stroke

  • Communicate your feelings honestly and openly.
  • if you have trouble talking, use touch to communicate. It is a very intimate way to express thoughts, needs and desires.
  • after stroke, your body and appearance may have changed. Take time for you and your partner to get used to these changes.
  • Maintain grooming and personal hygiene to feel attractive for yourself and for your partner.
  • explore your body for sexual sensations and areas of heightened sensitivity.
  • have intercourse when you are rested and relaxed and have enough time to enjoy each other.
  • try planning for sex in advance, so you can fully enjoy it.
  • Be creative, flexible and open to change.
  • the side of the body that lacks feeling or that causes you pain needs to be considered. Don’t be afraid to use gentle touch or massage in these areas.
  • if intercourse is too difficult, remember there are many ways to give and receive sexual satisfaction.

Complete Article HERE!

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Study shows impaired sexual health and function common after heart attacks

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New research from the University of Chicago investigates what happens to men’s and women’s sexual function and relationships after a heart attack in an effort to help clinicians develop better care guidelines for patients. The study, published in JAMA Cardiology, shows impaired sexual function or new problems are common after heart attacks. They occur at the same rate as a loss of general physical function and at a higher rate than the incidence of depression after heart attack, but rarely do health care providers address these issues – particularly with women.

heart attack

“Too often physicians and researchers are too embarrassed to ask questions about sexual health, and yet these issues are important to many people,” said Harlan Krumholz, MD, professor of medicine at Yale and director of the Center for Outcomes Research and Evaluation, one of the authors in charge of the study. “We need to concern ourselves with gaining knowledge about how to help our patients achieve a high quality of life in all aspects of their lives.”

The data show that if a physician talks to the patient about sexual health and function after a heart attack the patient is more likely to resume sex. However, women were less likely to be counseled by physicians on what to expect and more likely to have problems with sexual function as they recover. More than half of women (59%) and less than half (46%) of men reported sexual function problems in the year after a heart attack.

“The next step is to design the optimal intervention to improve sexual function outcomes after heart attack for men and women,” said Stacy Tessler Lindau, MD, associate professor of obstetrics/gynecology and medicine-geriatrics at the University of Chicago, who authored the research. “The rehabilitation phase begins with the cardiologist counseling the patient about her or his functional capabilities and what she or he can expect, including physical, psychological, and sexual function.”

Complete Article HERE!

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