Coital angina appears to represent less than 5% of all anginal attacks. Sexual activity is often equated with an exercise workload of 2 to 3 metabolic equivalents of task (METS) in the pre-orgasmic phase and 3 to 4 METS in the orgasmic phase. Exercise testing is often used to assess exercise tolerance and capacity for safely resuming sexual activity after myocardial infarction (MI). Less than 1% of MIs occur during sexual activity, as an attributable risk. The relative risk of coital-induced MI is 2.5 times greater than during non-coital activities; this risk is threefold greater in individuals with previous MI. The duration of exposure to this increased risk appears to be 2 hours following coitus. Past MI patients who are asymptomatic and do not exhibit treadmill-induced ischemia are at low risk for coital MI. Exercise training after acute MI improves cardiovascular efficiency and reduces myocardial oxygen demand during customary activities, including sexual activity. A patient with a recent MI (< 2 weeks) remains at high risk for coitalinduced reinfarctions, cardiac ruptures, or coital-induced arrhythmias. Post-MI individuals should be risk stratified according to the Princeton Consensus Panel II guidelines. Low-risk patients with erectile dysfunction can be safely treated with a phosphodiesterase type 5 (PDE5) inhibitor. Patients should be cautioned about the contraindication between PDE5 medications and nitrates.
Current Sexual Health Reports – Springer Journals
Published: May 29, 2006