This book is an extended version of Sex and the Cardiac Patient: A Practical Guide,
which I published in English and Spanish in 1991. It sold in the United States and other countries, some as distant as Singapore and Australia. I held radio and TV interviews, and distinguished professionals and journalists offered favorable comments. People whom I had never met but had read the book, consulted me by mail and telephone. The experience was both very interesting and spiritually rewarding. I learned that patients with sexual concerns can present their problems to a professional who inspires confidence–even if they don’t know him or her personally. In fact, when the consulting doctor’s face is not seen, some patients suffering from sexual dysfunctions are less inhibited and may describe intimate conflicts in more detail and more accurately. I had this experience with phone calls and letters I received from patients I never met.
Complaints about patient—physician communication seem to be the same today as they were a decade ago:“The doctor doesn’t have enough time;” “He/she is too busy;” “I’d like to open up and talk, but I don’t know how or where to start;” “I’m not asked any questions.”SHYNESS AND INHIBITIONS
Embarrassment has always been a problem. I’ll never forget the contrasting views of two female patients. One told me:“I feel terrible talking to my doctor about sex. I’ve known him for such a short time.”The other woman said: “I can’t imagine myself discussing sexual details with my doctor. I’ve known him for such a long time. He’s like a relative. I don’t like to talk about intimacies with members of my family.”
For most people, talking about sex with a doctor is as difficult today as it was 100 years ago–and it’s likely to remain that way.
Shortly following the publication of my previous book, I received a number of phone calls from cardiac patients who had sexual concerns, but their shyness overwhelmed them.The wife of an elderly gentleman called my office, and we had this exchange:
“Hello, may I help you?”
“Are you Dr. Chapunoff?”
“Yes, Madam, I am.”
“I understand you wrote a book called Sex and the Cardiac Patient. Is that true?”
“Yes, Madam, it is.”
“My husband is a senior citizen, 83, and to be perfectly honest, I’m no spring chicken either. Do you understand that?”
“Yes, I do.”
“We are having problems. Do you get that?”
“I’m trying, Madam.What kind of problems, may I ask?”
“Oh, I see. I’ll be happy to give you an appointment.”
“An appointment? Who wants an appointment? We don’t want an appointment.We don’t want an examination, either. My husband would never agree to see a doctor for this. And I’m just about the same. It’s awful.We don’t know how to talk about these things.”
“If that’s the case, would you like to ask me a question? Perhaps I could give you some guidance.”
“Yes, I’d like to ask you a very simple question.”
“In that case, I’m warning you: I might come up with a very simple answer.”
“That’s okay. I understand.This is the question: My husband and I are both cardiac patients.We want to know if we can sleep together.”
“Well, let me tell you this: I think you can sleep together, but I don’t know if you should.”
Conversations about sex between patients and doctors (except for psychiatrists and psychologists) are frequently evasive. A combination of discomfort and bias frequently separates them. Recovering cardiac patients are curious to know when they can make love, which positions are preferable, and whether they should be admonished or congratulated for masturbating. After a heart attack or any other cardiac crisis, they wait in vain for the doctor’s blessing to resume sexual activity. If there is no blessing, they still look for guidance, and watch for a hopeful signal, maybe even a wink, anything that resembles a sign of approval to go back to the good old days. Finally, nature takes its course. Couples stumble back into some kind of sexual pattern, but without the needed counseling and reassurances.
AN UNEXPECTED INVITATION
Some years ago, while I was working at my office, I received a call from a Miami TV station requesting my participation in a program entitled “Sex and Cardiovascular Health.” At the time, I had too many commitments, so I proposed that they postpone the program for a couple of months. I didn’t know why I’d been selected since I’d never written or lectured on the subject. In any event, the station didn’t call me back, and the interview never took place. (I’m still grateful for that.)
An interesting aftermath of this incident was my reaction to it. After the initial excitement mellowed, I began to wonder how much I really knew about sex and cardiovascular diseases. I prepared a test with a number of questions. I took it, and guess what? I flunked it with honors. These were some of the questions I had raised: “Do I really know how to advise cardiac patients about precautions they should take before, during, and after sexual intercourse?” “Following a massive heart attack, when should a person be able to resume sexual activity, and then, what
special positions, if any, he or she should be recommended to use?” “How dangerous is it for patients with hypertension, heart failure, valvular heart disease, aortic aneurysm and/or cardiac rhythm disturbances to engage in passionate lovemaking? Would the risk be low or prohibitive?” And so forth. It was immediately obvious to me that I had never paid special attention to the subject, and I had homework to do.
I began the search for information on sex and the cardiac patient in classical medical and cardiology textbooks; I didn’t find any information. Articles in medical journals were few and far between.
An enormous volume has been written about cardiac disorders, and publications about sex are almost as abundant as the number of living spermatozoa.Yet, two basic issues were infrequently addressed: one, the effects of sex on cardiac patients, and two, the consequences of heart disease on sexual functioning.
Fortunately, in the past decade there have been important publications in medical journals addressing those issues. Until recently, however, scientifically speaking, this field was in a near-virginal state.
New knowledge has been gained by doing clinical research and clinical observations of patients with heart disease and their sexual performance. To begin with, new medicines and treatment modalities dealing with angina, congestive heart failure, hypertension, evaluation and treatment of disabling or life-threatening arrhythmias by ablation and intracardiac defibrillators, improved prosthetic heart valves, methods to prevent and treat acute and chronic cardiac conditions have become available and are widely used.
Many coronary bypass surgeries are currently being avoided and have been replaced by balloon angioplasty (dilatation of a narrowed artery) and implantation of stents to keep those arteries open. This has effectively shortened the length of hospitalization and reduced patients’ discomforts and accelerated the recovery process.A coronary angioplasty usually takes one day in the hospital, with minor discomfort. Cardiac surgery demands a few days in the hospital and longer recuperation time.
All of the above have changed for the better the dynamics of the cardiac patient’s sexual interaction.
Psychotherapists have also reviewed and replaced old psychoanalytic techniques with innovative, modern schools of thought that provide psychological counseling and drug therapy faster and more effectively.
Urologists have improved penile prosthesis for a selective patient population, and women with sexual dysfunctions involving desire, arousal, orgasmic, or sexual pain disorders are being more specifically treated by gynecologists with expertise in this area.
The introduction of Viagra in 1998, followed by Levitra and Cialis, has made a dramatic difference in male and female intimate experiences. Although not all who take these medications respond with an erection and/or adequate tolerance, unquestionably, they are very helpful.
Answering Your Questions about Heart Disease and Sex
discusses multiple concerns that directly or indirectly relate to cardiac patients and their sexual partners. It is difficult to tell you which are more important. To me, all of them are. Things that you’ve never focused on and perhaps considered trivial, may, in reality, be decisive for your cardiac health and sexuality. At times, just a single but important risk factor, poorly managed, may cause heart disease, impotence, and loss of life. Smoking is a typical example. Information that is very important for the preservation of your cardiovascular health and sexual functioning has been included in the Appendix section at the back of the book. Please keep in mind that this is an educational guide and not a substitute for any of your doctor’s recommendations. Medical treatments are provided by doctors, not books. What you learn here, however, may help you initiate or expand the dialogue with your physician and your domestic partner.
Throughout the book, there are anecdotal experiences that illustrate that the sex life of cardiac patients is neither as complicated as some imagine, nor as simple as others would like it to be.
While this work focuses on heterosexual sex, the same advice and cautions apply equally to gay men and lesbians with heart disease.
Any book on sex is controversial. I anticipate that for some people my book will fall into this category, too.That’s unavoidable.There are probably no two people in the entire world who think and feel alike about sexuality. Each individual’s sexuality is like his or her fingerprints or DNA: unique.
Some of my views may seem unconventional. I have a tendency to be direct and straightforward, and you’ll probably notice this as you read some of my comments and read the way I conduct interviews with my patients.The material is sprinkled with humor. (I’m not sure humor can make you live longer, but it can certainly make you live better).
HOW MANY PEOPLE ARE INVOLVED?
There are 59 million Americans who suffer from cardiovascular diseases. The two most frequent diseases are hypertension (high blood pressure) and heart disease. Atherosclerosis (thickening or hardening of the arteries that result in blockages) is the basis for most cardiovascular diseases, and it involves the coronary arteries (coronary artery disease), the carotid-cerebral circulation (strokes), and multiple arterial territories, such as the arteries of the gut, those supplying blood to the kidneys, genitals, and lower extremities.
The thoracic and abdominal aorta may have portions that become enlarged, usually due to a combination of hypertension and atherosclerosis. These are called “aneurysms.”
In the past three decades there has been a gradual decrease in cardiovascular mortality, but these diseases continue to be the most common cause of death and disability, accounting for one in five deaths annually.
Coronary heart disease is the leading cause of death in both men and women and in every racial and ethnic group, except in Asian-American women, where it is cancer.
In the United States, there are approximately 1.1 million heart attacks (myocardial infarctions) each year. About 650,000 are new, and 450,000 are recurrent heart attacks.A full 33 percent of all heart attacks go unrecognized.That means a heart attack occurs but evades recognition (by patient, doctor, or both). Half of the unrecognized myocardial infarctions show no symptoms.These are called “silent” heart attacks.
The death rate is 50 percent higher in blacks than in whites in the age group 35 to 44–a difference that narrows with increasing age and disappears by age 75. Coronary mortality is not as high in Hispanics as it is among blacks and whites.
The percentage of sudden coronary deaths that occur without previously diagnosed coronary artery disease is much greater in women than in men.
Hypertension affects 58 million Americans, and about 15 million of them are not even aware they have it.Annually, hypertension contributes to 600,000 strokes, nearly one million heart attacks, and 400,000 new cases of congestive heart failure. Hundreds of thousands also suffer from hypertension-induced kidney failure.
About 4.8 million Americans have heart failure (weakening of the heart muscle). Add in the cases of valvular heart disease, cardiomyopathies (chronic diseases of the heart muscle), cardiac rhythm abnormalities (called arrhythmias or dysrrhythmias), rheumatic heart disease, congenital lesions, pulmonary thromboembolism (clots that form in the lower extremities that travel to the lungs), and the end result is millions who suffer and become disabled, and hundreds of thousands who lose their lives. And we are just referring to the United States. What about the rest of the world? The numbers are staggering.
WHAT CAN YOU DO?
First, become familiar with the nature and extent of your cardiac and general medical conditions. Should sexual function be affected, it’s important to assess that too. The cooperation of your sexual partner is essential.
Learn basic concepts about the circulatory system in health and disease, and about sexuality, nutrition, stress control, treatment options, and so on.The prevalence and mortality from cardiovascular disease increases with decreasing levels of education. A little knowledge could prolong your life. Greater knowledge might save it.
Nowadays, medicine is practiced differently than it was just a few decades ago. The old practitioner used to spend more time talking to patients and holding their hands, providing spiritual comfort. Remember those memorable house calls? A family doctor was the clinician,
the psychologist, the psychiatrist, the obstetrician, the pediatrician, and sometimes, even the surgeon.Those days are gone.The winds of modern times blew them away. But don’t feel too badly. The good news is that when you have a heart attack, you’re quickly monitored at the Emergency Room or Intensive Care Unit, and although the physician doesn’t always hold your hand, he or she gives you a clot-dissolving medication or opens up a clogged coronary artery, saving your life in the process.
As far as the communication issue goes, if you have problems in this area address them as soon as you can. Start by trying to achieve successful communication with yourself. Become your own best friend to learn who you really are.You may think you know.You may be right, you may
be wrong.This requires introspection, a little time to think or meditate, perhaps a few productive sessions with a good psychotherapist. Analyze your surroundings (spouse, family, work environment, financial status). Look for specific solutions.
Don’t feel uncomfortable when talking about sex, do it in a natural way, and try to overcome any barriers that limit conversations with your physician.Think positively.There are excellent reasons to be optimistic: Science has never before offered so many treatment alternatives and technological advances.
Understandably, a measure of realism and acceptance of some bumps along the road to recovery are needed. A return to sexual engagement should not be rushed, but stagnation is also to be avoided. Undue delays are known to trigger nervous tension, anxiety, and on occasion, some ugliness of disposition as well.
As we can see, cardiovascular disease and sexual dysfunctions have enough power to adversely affect personal and family relations, work performance, productivity, mental health, and leisure-time pursuits. Before you continue the journey through the pages of this book, remember: if problems exist, so do solutions. Try to find them. Lovemaking, after all, is too important to be ignored. And for those who suffer socio-economic hardships in many areas of the world, and don’t have available resources to improve their lives,we can only hope that one day, they will materialize their dreams, and that will include, of course, the happiness of their intimate experiences. Good sex is something that people like thinking about, when other elementary needs (food, housing, and their children’s well-being) are secured.When extreme poverty and deprivation prevail, good sex, careful sex, romantic sex, lusty sex, and even lousy sex, become a luxury. Shouldn’t we all dream of the day when everybody, poor and affluent, will be able to learn to take care of themselves, avoid heart attacks and strokes, and have terrific sex? And then, after enjoying a night of glorious intimacy, they’d take to the streets–smiling, jumping, dancing, and singing in the rain, Gene Kelly-style–screaming to everybody who passes by, in the happiest possible way, “What a beautiful day this is!”
Excerpted from Answering Your Questions about Heart Disease and Sex by Eduardo Chapunoff, MD. . Excerpted by permission of Hatherleigh Press, a division of Random House LLC. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.