Weak Erections Or Erectile Dysfunction (ED)?

Ever hear of the “mistress’ nightmare?” A middle-aged man is having sex with a woman other than his wife. While making love, he has a heart attack and dies, leaving his lover with a difficult choice: She can slip away, perhaps calling 911 later anonymously. Or she can stand by her (dead) man, call 911, and risk having his wife learn of his affair as she’s coping with his death.

Can Sex Trigger Heart Attack?

The mistress’ nightmare is usually presented as a moral dilemma, a what-would-you-do? situation. But underlying it is the assumption that sex is a risk factor for heart attack. Many people—both men and women—believe this is true. After men or women suffer heart attacks or episodes of angina, a form of heart disease that causes chest pain during (possibly minor) exertion, many become very nervous about sex, convinced that it might do them in. The same thing often happens to those told by doctors that they need treatment for heart disease (angioplasty or bypass surgery), or those warned that they have a combination of risk factors that raise their risk of heart disease, among them: smoking, diabetes, obesity, social isolation, high cholesterol, high homocysteine, high blood pressure, a high-fat diet, lack of exercise, a stressed-out Type A lifestyle, and a strong family history of heart disease or stroke.

Heart Attack During Sex: Rare

It’s certainly possible to suffer a heart attack while making love. But contrary to the conventional wisdom, it’s rare.

Strenuous exercise can trigger heart attack. During the late 1970s, Jim Fixx, author of the Complete Book of Running, the man who popularized running for fitness and recreation, dropped dead of a heart attack while running. And every winter, people die of heart attacks while shoveling snow. Sex is exercise, but it’s nowhere near as strenuous as running or shoveling snow. Sometimes it feels that way, but according to a recent analysis in American Family Physician, the typical sexual interlude taxes the heart no more than walking up two flights of stairs.

Sex After Heart Attack: Enjoy

Depending on the results of various medical tests, most heart attack survivors and people recovering from heart disease surgery can safely return to lovemaking in  few months. But when doctors say, “It’s okay,” many people don’t believe them. Two recent studies should provide some perspective:

  • After reviewing a large number of studies of sex and heart attack, Stanford researchers concluded that sex is a “weak” risk factor, “accounting for only 0.5-1.0 percent” of heart attacks, in other words somewhere between one in 100 and one in 200.   
  • Swedish researchers interviewed 699 survivors of first heart attacks. Only nine (1.3 percent) were sex-related—and those heart attacks tended to occur in the individuals who were among the least physically fit. The researchers concluded that risk of sex-related heart attack is “very low. Sex once a week [among heart attack survivors] increases the annual risk of heart attack only slightly.”

Heart Disease? How To Enjoy Sex

  • Follow your doctor’s advice. There might be special circumstances that make sex inadvisable, for example, moderate-to-severe congestive heart failure, which involves substantial heart fatigue and shortness of breath with minor exertion. But in general, heart disease, including surviving a heart attack, need not limit lovemaking. If you can walk up a few flights of stairs without chest pain, chances are you can make love.
  • Adopt a heart-healthy lifestyle. It’s never too late to quit smoking, lose weight, manage stress, get regular exercise, eat less meat and cheese and more fruits and vegetables, enjoy social support from those you love, and take medication to reduce blood pressure and cholesterol. In addition to helping the heart, heart-healthy lifestyle changes are also associated with increased libido and better sexual function, notably fewer erection problems.
  • Speaking of stress management, heart-healthy exercise, and spending time with loved ones, here’s a heart-saving tip: Make love regularly. Sex involves meditative deep relaxation, which helps reduce stress. It’s gentle exercise that can help strengthen the heart. And assuming a loving relationship, it’s a marvelous way to enjoy social support. Maybe that’s why so many people call their lovers “sweetheart.”

If either partner continues to feel uncomfortable with sex after a heart attack, consult a sex therapist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.


DeBusk, RF. “Evaluating the Cardiovascular Tolerance for Sex,” American Journal of Cardiology,” (2000) 86:51F.

Moller, J. et al. “Sexual Activity as a Trigger of Myocardial Infarction: A Case-Crossover Analysis in the Stockholm Heart Epidemiology Program (SHEEP),” Heart (2001) 86:387.

Nusbaum MRH et al. “Chronic Illness and Sexual Functioning,” American Family Physician, (Jan. 15, 2003) 67:2:347.

Stein, RA “Cardiovascular Response to Sexual Activity,” American Journal of Cardiology (2000) 86(2A):27F.

White, JR. et al. “Enhanced Sexual Behavior in Exercising Men,” Archives of Sexual Behavior (1990) 19:193.

Bacon, C. et al. “Sexual Function in Men Older Than 50: Results from the Helath Professionals Follow-Up Study,” Annals of Internal Medicine (2003) 139:161.


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