Sex and Heart Disease - The Woman’s Perspective

My first blog about this topic generated a lot of comments. Readers felt that my writing was mostly focused on men and many of you wanted to know more about how heart disease affects women’s sexuality.  

Unfortunately, not as much research has been focused on women in this area and the link between vascular health and sexual function is less well studied. That doesn’t mean women are not affected. According to the American Heart Association, women diagnosed with heart disease are more likely to experience decreased sexual desire, problems with orgasm, vaginal dryness, and pain during intercourse. Although these symptoms can be multifactorial, reduced blood flow to the genital region can definitely contribute and be as physically impactful in women as it is in men.

But that also means lifestyle measures advised for men to improve vascular function are applicable to women. So quitting smoking, losing weight, increasing physical activity, managing high blood pressure and high cholesterol, and following a whole food plant based Mediterranean-type diet should yield significant intimacy benefits for women as well.

In addition, vaginal lubricants and vaginal estrogen preparations are considered safe and can be utilized in women diagnosed with heart or vascular disease to combat vaginal dryness and painful intercourse when needed, regardless of patient age.

By the way, women who have had a heart attack or were recently diagnosed with coronary artery disease may be just as concerned as men regarding safety of participating in sex given their condition. To reiterate, sexual activity is safe for most individuals (men and women) with heart disease and is comparable to mild to moderate physical activity (ie, climbing 2 flights of stairs or walking briskly). Patients with advanced disease or unstable cardiac symptoms (eg, chest pain or discomfort) should talk to their doctor before engaging in sexual activity. 

And just to put things in perspective, the American Heart Association will tell you that less than 1% of all heart attacks occur during sexual activity. You have a greater chance of experiencing a shark bite (1 in 60 453) or being hit by lightning (1 in 79 746) than having a heart attack during sex.

A question also came in about the heart disease risk related to menopause.  Natural menopause is a normal part of a woman’s life and does not cause cardiovascular disease. On the other hand, premature menopause, especially before age 40, typically due to surgical removal of the uterus and both ovaries, can increase long term cardiovascular risk from premature estrogen loss. Most women who undergo surgical menopause at an early age are therefore felt to benefit from estrogen replacement for purposes of heart disease prevention.

Speaking of, hormone replacement therapy after natural menopause was actively discouraged 20 years ago following release of the Women’s Health Initiative study. That study showed increased risk of breast cancer, blood clots and death in postmenopausal women placed on hormone replacement therapy (HRT). This trial, although highly influential, was limited by several methodological flaws including enrolling women who had stopped menstruating many years before being included. Since that time, more favorable health data has emerged around HRT indicating that certain combinations of hormone therapy may provide cardiovascular benefits when started in early menopause. Some hormone therapy studies also show a decreased risk of type 2 diabetes and protection from bone loss. These benefits seem to outweigh the risks for most women in early menopause (within 10 years of start of menopausal symptoms and before age 60). Therefore, the American College of Obstetrics and Gynecology now recommends that women in early menopause who are in good cardiovascular health should be considered candidates for the use of hormone replacement therapy for relief of menopausal symptoms.  However, initiation of HRT is still not recommended during late menopause (more than 10 years from menopause onset or after age 60) and is not indicated to help lower heart disease risk per se – we’re back to lifestyle there.

Having said all that, natural menopause might not increase cardiovascular disease directly but secondary effects matter.  Estrogen typically pushes HDL (good) cholesterol levels higher and depresses LDL (bad) cholesterol levels. It’s not surprising that cholesterol profiles of postmenopausal women, who now have very low estrogen levels, typically deteriorate compared to their pre-menopausal numbers.  That's why it's important to have your cholesterol profile rechecked when you reach menopause, even if your numbers have been stellar all along.  And why it's never a bad idea to eat in a way that supports healthy cholesterol profiles.