4 themes described the sexual concerns and educational needs of patients with an implantable cardioverter defibrillator
Q What are the experiences of patients and partners regarding return to sexual activity after implantable cardioverter defibrillator (ICD) insertion?
12 patients (10 men and 2 women) (age range 20–83 y) with ICDs and 4 partners (1 man and 3 women) (age range 22–76 y). All but 1 patient reported being sexually active; this patient ceased all sexual activity after an episode of ICD discharge during sexual activity.
Data were collected using semistructured interviews, which were recorded, transcribed verbatim, and analysed using a qualitative descriptive approach.
(1) Anxiety and apprehension regarding sexual activity. Most patients and partners expressed concerns about resuming sex after ICD implantation. 9 of 12 patients expressed sexual concerns. They were apprehensive about what might set off the ICD and feared that the ICD would fire with each sexual encounter. Some patients described this as an initial concern, whereas for others, it was an ongoing concern. All 4 partner interviews reflected considerable worry and anxiety about the effect of the ICD on the patient. Partners reported being watchful of patients, particularly with respect to activities, the device itself, and medications. Concerns about ICD discharge during sexual activity also had an effect on the couple’s usual activities. One partner stated, “It’s the fear that you have to not go as far as you used to. Because you don’t know if it will go off…maybe we should just kind of wait.” Partner anxiety often resulted in overprotectiveness of the patient with an ICD. (2) Varying interest and patterns of sexual activity. Most patients described continued or increased interest in sexual activity. 10 of 12 patients reported strong sexual interest. 2 patients described an increase in sexual activity. Likewise, 3 partners reported strong sexual interest, although anxiety was evident. However, a few patients—particularly those who had the ICD discharge with sexual activity—reported decreased sexual interest during some time periods. Both patients and partners discussed sexual activities outside of sexual intercourse. Also, the frequency and usual patterns of sexual activity were affected by the ICD. Backing off and waiting to resume sex after ICD discharge was common. (3) Powerfulness of ICD discharge. Patients compared ICD discharge to having the “top of your head blown off” or “being shot up close with a 9 mm (gun).” Some patients also described the surprise, fear, and sensations that occurred when the ICD discharged with sexual activity. Sensations included seeing lights or flashing and “ears popping.” Partners felt physical sensations such as “bumping together really hard,” being kicked (by the patient) while asleep in the middle of the night, or a bolt of lightening. Furthermore, ICD discharge with sexual activity did not have a predictable pattern. (4) A need for information and sexual counselling. Some participants identified a cardiologist, family physician, nurse practitioner, or physician assistant as healthcare providers with whom they would prefer to discuss sexual concerns related to the ICD. However, 7 patients did not have a preference as long as the provider was knowledgeable and could provide the needed information. Although talking with healthcare providers was one approach for obtaining information, 6 patients believed that topics such as living with the ICD, including sexual issues, could be discussed with an ICD support group member. The ideal support group member was described as a sexually active patient who had had an ICD discharge. The lack of information on resuming sexual activity was also evident from participant reports. 7 patients and 1 partner discussed the need for more information and what to expect on resuming sexual activity. 6 participants specifically wanted information on the possibility of ICD discharge with sexual activity. Advice on what to tell other patients with an ICD included that patients with newly inserted ICDs should be given permission to resume sexual activity, reassurance that one could resume a normal sex life, and the importance of open communication between the patient and partner about the experience of living with the ICD. Overall, the ICD was viewed as a way to resume a normal lifestyle.
Patients with an implantable cardioverter defibrillator approached sexual activity with anxiety, apprehension, varied interest and patterns of activity, and expressed a need for information and sexual counselling.
- Sandra L Carroll, RN, BSc
The study by Steinke et al highlights the presence of anxiety, fear, and apprehension with resumption of sexual activity in patients and their partners in the context of having an ICD. These findings support the need for developing educational interventions for patients receiving ICDs because few, if any, studies have explored the topic directly.
As noted by Steinke et al, transferability of the findings to the general ICD population may be limited by the fact that 42% of patients in this study had already had an ICD shock during sexual activity. These patients may have been more willing to discuss sexual concerns. It would be interesting to know why some partners declined the invitation to participate in the study; reasons for choosing not be interviewed may be related to particular partner concerns. Additional insights may also be gained from patients with newly implanted ICDs; the average length of time from implant in the patients interviewed was 5.3 years.
Additional investigations that distinguish between primary and secondary indications for receiving an ICD should be considered before developing educational interventions because survivors of life threatening arrhythmias may have different concerns than patients receiving an ICD for prophylactic (primary) indications. Steinke et al found patients had a need for information and sexual counselling. Specialised ICD nurses are well suited to provide information and ongoing education to patients; for example, a randomised controlled trial of patients who received an ICD for secondary prevention of sudden cardiac arrest showed that a structured telephone education intervention delivered by expert cardiovascular nurses reduced physical symptoms, fear, and anxiety at 1 year.1
The qualitative inquiry by Steinke et al offers nurses important information about the experiences of patients with ICDs with regard to specific sexual concerns and identifies possible future directions for research to reduce anxiety in patients and their partners.
For correspondence: Dr E E Steinke, School of Nursing, Wichita State University, Wichita, KS, USA.
Source of funding: Epsilon Gamma Chapter-at-Large Sigma Theta Tau International.