Talking Sex: CVD Patients Want to Hear More From Clinicians

CHICAGO, IL—More than three-quarters of patients with cardiovascular disease have concerns related to sexual health and intimacy, but few report receiving information or counseling on those topics from their healthcare team, a survey from Sweden reveals.

When it comes to talking about sex in a clinical setting, “I saw that people struggle with it, and no one [brings] the subject up,” said Tiny Jaarsma, PhD (Linköping University, Sweden), lead author of the new study, which was presented as an abstract this past weekend at the American Heart Association (AHA) 2024 Scientific Sessions.

Overall, 76% of those who took the survey said their disease affected their sexual health as well as their mood and well-being. Compared with women, men were more likely to report an impact on their sexual health (65% vs 35%; P= 0.02) and mood/well-being (64% vs 36%; P < 0.01).

Fully 78% wanted to receive information on sexual health, but counter to this interest, only 5% received it. Men were more likely than women to say they wanted this information (87% vs 64%; P= 0.02).

“If [patients] ask about it, it’s fine. Nurses and cardiologists: they can talk about it. But nobody spontaneously will ask, ‘How about your intimate life or your sexual health?’ Or [say], ‘Now we’re uptitrating this medication. If you have any problems, it could be cold hands and feet or sexual problems. Please talk to me.’ Nobody does that,” Jaarsma told TCTMD. “What I saw in clinical practice is that a lot of patients struggle with the question and don’t really dare to ask.”

Jaarsma has long had an interest in these conversations—or the lack thereof—and seen evidence of a gap between what guidance patients want and what advice they get across a variety of countries, including the United States, the Netherlands, and now Sweden.

In Sweden, said Jaarsma, there’s no formal means of communicating about sexual health with cardiovascular patients. Yet it’s clear patients want this resource, even if it’s just a pamphlet, so the researchers conducted their nationwide survey to gather data.

The Survey

Jaarsma et al reached out to patient organizations, clinical outpatient departments, and social media to survey 135 Swedish cardiac patients about their thoughts on sexual health. Mean age of the respondents was 65, and 59% were male. Nearly half (47%) had hypertension, 36% a history of MI, 30% atrial fibrillation, and 24% heart failure. The online survey consisted of 21 questions.

Specifically, the survey respondents most wanted to hear about side effects (60%), erectile dysfunction (50%), impact on relationships (47%), and anxiety before sex (35%). As might be expected, men were more keen to receive details on erectile dysfunction (80% vs 7% of women), but women were more likely to want to learn about pain during sex (13% vs 1% of men; P < 0.01 for both comparisons).

The most popular time for receiving such information would be during annual checkups (57%) and/or at the time of diagnosis (51%). While most people (79%) wanted to have an actual conversation with their healthcare professional, others wanted to receive the information over time from various sources (43%).

Based on their results, the researchers are now working with the Swedish Heart Lung Foundation to develop a brochure on the topic, Jaarsma said. They wanted to have the foundation involved so that the end result is trusted as a reliable source.

“This study aligns with a small body of research indicating that feelings of shame and discomfort about sex—sexual health—can serve as obstacles to counseling patients about their heart health and resuming sex after heart disease,” Jennifer H. Mieres, MD (Northwell Health, Lake Success, NY), said in a commentary for the media provided by the AHA. “The societal and cultural stigma associated with sex, as well as limited knowledge among healthcare professionals about how to discuss or educate patients on sexual health, definitely are obstacles.”

The data add to the literature by confirming earlier studies showing similar gaps, she noted. They also serve as a reminder that more than a decade ago, the AHA released a scientific statement devoted to sexual activity and CVD, which can guide clinicians on how to approach the topic.

“Let’s hit the pause button and go back to incorporate a discussion of sexual health into the treatment plan,” Mieres stressed.