Sexual Response in Cardiovascular Disease
Jackson, Graham, The Journal of Sex Research
Cardiovascular disease (CVD) is the greatest cause of morbidity and mortality in the developed and developing world. Although women perceive breast cancer as their most common danger, they are seven times more likely to die from CVD (Jackson, 2008). Although nearly all of the literature focuses on men with erectile dysfunction (ED) and their risk of a cardiac event, it follows that men and women with or without sexual dysfunction (or disorder) will be at risk because of the CVD prevalence. Therefore, we need to consider the cardiovascular response to sexual activity and the risks, whether real or imagined.
Cardiovascular Response to Sex
The cardiovascular response to sexual activity, including intercourse, is similar to mild to moderate daily nonsexual effort. Several investigators, using ambulatory electrocardiography (ECG) and blood pressure monitoring, have compared heart rate, electrocardiographic, and blood pressure responses during sexual activity and other normal daily activities. Nemec, Mansfield, and Kennedy (1964) evaluated 10 healthy men, comparing heart rate and blood pressure responses during sexual intercourse with their wives at home. They recorded only modest changes, whether the man was on top or underneath. When the man was on top, the peak heart rate was 114 [+ or -] 14 beats per minute returning to 69 [+ or -] 12 beats per minute by 120sec post orgasm; and when the man was underneath, a similar peak heart rate of 117 [+ or -] 4 beats per minute was recorded. The peak blood pressure responses were similar for both positions, with a systolic reading at orgasm of 160mg Hg. Bohlen, Held, Sanderson, and Patterson (1984), again using 10 healthy men, looked at man-on-top, woman-on-top, self-stimulation, and partner stimulation and found no significant differences in heart rates or blood pressure responses. Although less information is available on women, in a postmyocardial infarction study, cardiovascular responses were similar, with a peak heart rate in men of 111 beats per minute and in women of 104 beats per minute and similar recovery times of 3.1 min and 2.6min, respectively (Garcia-Barreto, Sin-Chesa, Rivas-Estany, Nieto, & Hemondez-Catiero, 1986). In my study of stable angina patients using 24-hr ECG monitoring, the heart rate response averaged 122 beats per minute with a range of 102 to 137 (30 men and 5 women) during intercourse compared to a maximum of 124 beats per minute during the rest of the day (Jackson, 1981). Many years on, my conclusion remains valid: "There is no reason why most patients with angina cannot have a normal sex life, and physicians should ask and advise routinely" (p. 37).
Expressed as a multiple of the metabolic equivalent of the task (MET; 1 MET is the energy expenditure at rest, which is approximately 3.5 ml of oxygen per kg body weight per minute), sexual activity between couples in a long-standing relationship is associated with a peak workload of 3 to 4 METs at orgasm, although younger couples, who may be more vigorous in their activity, may expend 5 to 6 METs (Jackson & Hutter, 2006). The average duration of intercourse is 5 to 15min, so sexual intercourse is not an extreme or sustained cardiovascular stress. Casual sex may involve a greater cardiac workload due to lack of familiarity and age mismatch, most often an older man with a younger woman (Drory, 2002).
With our knowledge of METs, we can advise patients on sexual activity using a simple comparison with other activities, such as walking 1 mile (1.6 km) on the level in 20 min (Table 1).
Only a small risk of myocardial infarction is associated with sexual activity. The relative risk of a myocardial infarct during the 2hr after sexual intercourse is shown in Table 2 (Muller, Mittleman, MacLure, Sherwood, & Tofler, 1996).
The baseline absolute risk of a myocardial infarction during normal daily life is low--I chance in a million per hour for a healthy adult and 10 chances in a million per hour for a patient with documented cardiac disease. …