Many older heart patients have questions about sex, but few are getting answers

Talking about sex can be uncomfortable. But older adults with heart conditions often have questions they want answered – and new research suggests they may not be getting the information they'd like.

A small survey of adults with heart conditions in Sweden found only 5% of people received information about sexual health, despite more than 3 in 4 respondents saying they wanted it. Health experts say the problem exists in the U.S. as well.

"This isn't the first time we're hearing that there's a gap in this area," said Dr. Michael Blaha, director of clinical research at Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore. He was not involved in the new research. "It puts numbers to what we generally believe to be true."

Study researcher Dr. Tiny Jaarsma, a professor of nursing at the University of Linkoping in Sweden, will present the findings Sunday at the American Heart Association's Scientific Sessions in Chicago. They are considered preliminary until full results are published in a peer-reviewed journal. "The need for information is universal and under addressed," she said.

Jaarsma and her colleagues conducted an online survey of 135 people in Sweden who were an average 65 years old. Among respondents, 47% said they had high blood pressure; 36% were heart attack survivors; 30% had atrial fibrillation, or AFib, a type of irregular heart rhythm; and 24% had heart failure, a condition in which the heart isn't pumping enough blood to the rest of the body.

Overall, 76% of participants said their heart condition affected their sexual health, as well as their mood and general well-being, with men significantly more likely than women to feel this way. Among participants, 65% of men said their disease affected their sexual health, compared to 35% of women.

Although 78% of participants said they wanted sexual health information from their health care professionals, only 5% said they got it. A larger proportion of men – 87%, compared to 64% of women – said they wanted more information.

The type of information men and women wanted also differed. Men overwhelmingly wanted information on erectile dysfunction, whereas women were more likely to want information on pain during sex. Other topics of interest included medication side effects, which 60% of all respondents wanted; the impact of sexual health on relationships, sought by 47% of respondents; and anxiety before sex, of interest to 35% of respondents. Nearly 80% said they preferred to get the information from conversations with health care professionals.

"A substantial number of patients with heart disease or who have had cardiac interventions have problems related to sexual health," Jaarsma said. "These patients are often in need of reliable information about how to return to sexual activities or how to deal with challenges related to sex."

The American Heart Association recommends people who have heart attacks or who are diagnosed with heart conditions speak to a health care professional before resuming sexual activity.

Blaha said doctors may not feel there's enough time to address the issue.

"I don't think physicians are poorly intentioned," he said. "They are under pressure to have efficient and short visits with patients."

Health care professionals, Blaha said, spend their time talking about lowering blood pressure, taking medications, the importance of cardiac rehabilitation following cardiac events and other issues critical to maintaining physical health, but patients also want information about quality of life. "There's only so much information a physician can deliver in an office visit. The thing that gets lost in the shuffle is sexual health."

Another reason the topic may be overlooked is that health care providers – or their patients – are embarrassed, he said. Sex is "something we all need to feel more comfortable talking about."

"Over the years, many studies have asked why doctors and patients don't talk about sex," said Dr. Stacy Tessler Lindau, a professor of obstetrics/gynecology and medicine and director of the program in integrative sexual medicine at the University of Chicago. "But over the 25 years I've been practicing, I see patients becoming more confident and courageous about asking their doctors about sexual concerns, and doctors are becoming more competent on this topic."

Many people rate sexual function among their top priorities, said Lindau, who was not involved in the new study. "It's of the essence to their feeling of being human, their identity, their happiness. It takes some time to talk about sex in a constructive, therapeutic way," she said.

"In the U.S., doctors are frustrated they don't have the time to care for the whole patient," Lindau said. "Doctors have to prioritize cardiologic signs and symptoms. It would be better if they could address concerns holistically, but time is often our enemy in caring for the whole patient."

Blaha suggested that physician assistants might be better equipped to deliver the information on sexual health to patients, or that it be delivered during cardiac rehab.

Including such information in materials given to heart patients as part of their follow-up care might help normalize the topic, Lindau said.

"If there is a diagnosis of a new condition like AFib or a heart attack, it is routine to provide educational materials so patients can understand the condition and how to live with it," she said. "Including sexual health information in these materials signals that the patient is not alone in their concerns and should not be blamed if they are having sexual function problems. It also shows that the doctor regards this domain as just as important as the other material included."

Blaha said health care professionals would do well to take note of the new findings.

"We always want to deliver what our patients want," he said. "This is just an alert that we need to talk about this more and ask patients what their concerns are in an open-ended way."

Find more news from Scientific Sessions.