Comparison of sexual activity of women and men after a first acute myocardial infarction

doi:10.1016/S0002-9149(00)00756-6

The American Journal of Cardiology

Volume 85, Issue 11, 1 June 2000, Pages 1283-1287

https://doi.org/10.1016/S0002-9149(00)00756-6 Get rights and content

Abstract

Studies of gender differences in the sexual activity of men and women after a first acute myocardial infarction (AMI) have produced conflicting results. The present study was performed to determine whether there are gender differences (1) in the quantity and quality of sexual activity after a first AMI, and (2) in the relations between selected demographic and medical variables and sexual activity after AMI. Four hundred sixty-two men and 51 women with a first AMI were interviewed once before discharge and again 3 to 6 months after AMI. Patients’ demographic and medical background and their frequency of and satisfaction with sexual behavior were obtained from the interviews and from medical charts. Analyses of variance showed that women reported significantly less frequency of and satisfaction with sexual activity than men before and after AMI. Both women and men reported significantly less sexual activity and less satisfaction with sexual activity after AMI than before AMI. The decrease in frequency of and satisfaction with sexual activity after AMI was similar for women and men. The relations between selected demographic and medical variables such as age, education, and perceived health before the first AMI and the frequency of and satisfaction with sexual activity of the women and men did not appear to be affected differently by the AMI. A first AMI appears to reduce the frequency of and satisfaction with sexual activity of women and men similarly 3 to 6 months after AMI.

Section snippets

Study design

This research was part of a larger longitudinal follow-up of the medical outcome and psychosocial adjustment of patients admitted into 1 of 8 hospitals in Israel with a first AMI. Because it was concerned with patients who were potentially socially and vocationally active, it focused on those who were ≤65 years old. During the period of the initial interview, 314 women and 1,312 men who met this age criterion were admitted to these hospitals. Of these, 291 women and 1,254 men who survived

Before and after AMI frequency of and satisfaction with sexual activity for women and men

Resumption of sexual activity was reported 3 to 6 months after a first AMI by 72% of the women and by 89% of the men. This gender difference was statistically significant (chi-square = 9.76, df = 1, p <0.003).

This study also compared the quantity and quality of sexual activity before and after AMI for women and men. Table Ipresents the means and standard deviations for the pre- and post-AMI frequency of and satisfaction with sexual activity. Women reported less sexual activity and less

Discussion

A major finding of the study was that the impact of a first AMI on the frequency of and satisfaction with sexual activity did not differ significantly for women and men. Both women and men reported a statistically significant decrease in frequency of and satisfaction with sexual activity after AMI, and, in general, women reported lower frequency of and satisfaction with sexual activity both before and after an AMI. However, the decrease in frequency of and satisfaction with sexual activity due

Acknowledgements

We want to express our gratitude to Dov Har-Even for his considerable assistance with the statistical analyses.

References (29)

W.B. Tuttle et al.
Sexual behavior in post-myocardial patients
Am J Cardiol
(1964)
L.A. Abramov
Sexual life and sexual frigidity among women developing acute myocardial infarction
Psychosom Med
(1976)
M.J. Stern et al.
Life adjustment postmyocardial infarctiondetermining predictive variables
Arch Intern Med
(1977)
C. Papadopoulos
A survey of sexual activity after myocardial infarction
Cardiovasc Med
(1978)
C. Papadopoulos et al.
Myocardial infarction and sexual activity of the female patient
Arch Intern Med
(1983)
C. Papadopoulos et al.
Sexual concerns and needs of the postcoronary patient’s wife
Arch Intern Med
(1980)
C. Papadopoulos
G.A. Hamilton et al.
A comparison of the recovery period for women and men after an acute myocardial infarction
Heart Lung
(1993)
J.G. Baggs et al.
Sexual counseling of women with coronary heart disease
Heart Lung
(1987)
A. Bloch et al.
Sexual problems after myocardial infarction
Am Heart J
(1975)

J.H. Horgan et al.

Resumption of sexual activity after myocardial infarction

Ir Med J

(1978)

S. Mann et al.

The effects of myocardial infarction on sexual activity

J Cardiac Rehab

(1981)

A. Grand et al.

Sexual behavior of coronary patients after myocardial infarction

Arch Mal Coeur

(1982)

L. Westin et al.

Quality of life in patients with ischaemic heart diseasea prospective controlled study

J Intern Med

(1997)

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Each year, 63,000 Canadians are diagnosed with acute coronary syndrome (ACS)
and 73 % survive. Sexual health education for ACS survivors is recommended but is not routinely provided. A scoping review was performed to inform health care providers about factors shaping sexual health education for ACS survivors.
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This review confirmed absent to limited provision of sexual health education to individuals with ACS. Key factors influencing lack of provision of sexual health were categorized according to macro, meso, and micro levels. At the macro level, societal and cultural factors were noted. The meso level included healthcare environment and limited healthcare provider knowledge. At the micro level, healthcare professional-healthcare consumer relationships and role clarity were noted.
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Citation Excerpt :
The present analysis thus supports previous reports, but extends their findings to myocardial infarction patients. Post-myocardial infarction patients differ from healthy adults with regard to both sexual activity frequency14–16 and mortality risk.17,18 Our findings reveal that, in a cohort of first acute myocardial infarction patients aged ≤ 65 years followed up for more than 2 decades, a strong inverse relationship existed between sexual activity and death.
Previous studies have shown an inverse relationship between sexual activity and mortality in the general population. We evaluated the association between sexual activity and long-term survival among patients with acute myocardial infarction.
Patients aged ≤ 65 years (n = 1120; mean age, 53) discharged from 8 hospitals in central Israel after first myocardial infarction from 1992-1993 were followed for mortality through 2015. Frequency of sexual activity was self-reported during the index hospitalization (baseline; referring to the year preceding the infarct) and after 5 and 10-13 years, along with sociodemographic and clinical data. Cox proportional hazards models were constructed to estimate the association with all-cause mortality in time-dependent sexual activity categories.
At baseline, a > once per week frequency of sexual activity was reported by 42% of the patients, whereas no sexual activity was reported by 6%. After 10-13 years, the rates were 21% and 27%, respectively. Lower sexual activity was associated with older age, female sex, lack of a steady partner and more comorbidities. During follow-up, 524 deaths (47%) occurred. An inverse relationship was observed between sexual activity frequency and death, with hazard ratios (95% confidence intervals) of 0.30 (0.23-0.38) for > once per week, 0.36 (0.28-0.46) for once per week, and 0.53 (0.42-0.66) for < once per week, compared with none. After adjusting for relevant confounding factors, the estimates were attenuated to 0.68 (0.50-0.91), 0.63 (0.48-0.83), and 0.72 (0.57-0.93), respectively (P for trend = .004).
Using repeated assessments of sexual activity after myocardial infarction, an inverse association was demonstrated with mortality, which was only partly accounted for by measured potential confounders.
Comparison of Correlated Comorbidities in Male and Female Sexual Dysfunction: Findings From the Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)
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Many of the same mechanisms involved in the sexual arousal-response system in men exist in women and can be affected by underlying general medical conditions.
To assess whether sexual function in men and women is correlated with similar comorbidities.
This study was a secondary analysis of the 3rd National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a prospective stratified probability sample of British individuals 16 to 74 years old interviewed from 2010 to 2012. We assessed for an association between sexual function and the following comorbidities: heart attack, heart disease, hypertension, stroke, diabetes, chronic lung disease, depression, other mental health conditions, other neurologic conditions, obesity, menopause, incontinence, smoking status, and age.
An association was found between multiple medical comorbidities and sexual dysfunction in women and in men.
6,711 women and 4,872 men responded to the survey, were in a relationship, and reported sexual activity in the past year. The average age of the women was 35.4 ± 14.1 and that of the men was 36.8 ± 15.6. There was an association between sexual function and all variables assessed except for chronic lung disease, heart attack, and incontinence in women compared with stroke, other neurologic conditions, incontinence, and smoking status in men. Comorbidities associated with erectile dysfunction included depression, diabetes, and other heart disease, whereas comorbidities associated with difficulty with lubrication included depression and other heart disease. Menopause was predictive of sexual dysfunction. Male sexual function appeared to decline after 45.5 years of age.
Physicians should be aware of the correlation between medical comorbidities and sexual dysfunction in women and men and should ask patients about specific symptoms that might be associated with underlying medical conditions.
Use of a stratified probability sample compared with a convenience sample results in capturing of associations representative of the population. Inclusion of multiple comorbidities in the multivariate analysis allows us to understand the effects of several variables on sexual function. Although this study shows only an association, further research could determine whether there is a causal relation between comorbidities and sexual dysfunction in women.
Multiple medical comorbidities are associated with sexual dysfunction not only in men but also in women.
Polland A, Davis M, Zeymo A, et al. Comparison of Correlated Comorbidities in Male and Female Sexual Dysfunction: Findings From the Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). J Sex Med 2018;15:678–686.
Perceived Sexual Difficulties and Sexual Counseling in Men and Women Across Heart Diagnoses: A Nationwide Cross-Sectional Study
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Citation Excerpt :
Men reported sexual difficulties more often than women, corroborating previous studies.2,5 However, Drory et al30 found that the relative decrease in sexual activity after myocardial infarction was similar in men and women and that differences were present beforehand. For men, but not for women, several biological factors were statistically significantly associated with having at least one sexual difficulty; most of these (ie, older age, diabetes, and hypertension) are known risk factors of peripheral vasculature disease.
Ischemic heart disease and heart failure often lead to sexual difficulties in men, but little is known about the sexual difficulties in women and patients with other heart diagnoses or the level of information patients receive about the risk of sexual difficulties.
To investigate perceived sexual difficulties and associated factors in a mixed population of men and women newly diagnosed with heart disease and provide insight into sexual counseling and information given by health care professionals.
This article reports on a cross-sectional, questionnaire study sent to a randomly selected sample of men and women newly diagnosed with heart failure, ischemic heart disease, atrial fibrillation, or heart valve surgery. Eligible patients were identified by diagnosis using the Danish National Patient Register, which contains all diagnoses.
Sexual difficulties were self-reported using single-item questions, and factors associated with sexual difficulties were collected from the survey and national registers.
The study population consisted of 1,549 men and 807 women (35–98 years old) with heart failure (n = 243), ischemic heart disease (n = 1,036), heart valve surgery (n = 375), and atrial fibrillation (n = 702). Sexual difficulties were reported by 55% of men and 29% of women. In a multiple regression analysis, difficulties in men were associated with being older (≥75 years old; odds ratio [OR] = 1.97, 95% CI = 1.13–3.43), having heart failure (OR = 2.07, 95% CI = 1.16–3.71), diabetes (OR = 1.80, 95% CI = 1.15–2.82), hypertension (OR = 1.43, 95% CI = 1.06–1.93), receiving β-blockers (OR = 1.37, 95% CI = 1.02–1.86), or having anxiety (OR = 2.25, 95% CI = 1.34–3.80) or depression (OR = 2.74, 95% CI = 1.38–5.43). In women, difficulties were significantly associated with anxiety (OR = 3.00, 95% CI = 1.51–5.95). A total of 48.6% of men and 58.8% of women did not feel informed about sexuality, and 18.1% of men and 10.3% of women were offered sexual counseling.
Heart disease increases the risk of sexual difficulties and there is a need for improved information and counseling about sex and relationships for patients.
This large nationwide survey of men and women combined a survey with administrative data from national registries. However, this study used non-validated single-item questions to assess sexual difficulties without addressing sexual distress.
More than half the men and one fourth the women across common heart diagnoses had sexual difficulties. No difference was found among diagnoses, except heart failure in men. Despite guidelines recommending sexual counseling, sexual difficulties were not met by sufficient information and counseling.
Rundblad L, Zwisler AD, Johansen PP, et al. Perceived Sexual Difficulties and Sexual Counseling in Men and Women Across Heart Diagnoses: A Nationwide Cross-Sectional Study. J Sex Med 2017;14:785–796.
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Even though there is biologic plausibility for an association between low testosterone levels and female sexual interest/arousal disorder, several large clinical studies have failed to establish a direct link.23,24 The evaluation of sexual dysfunction is complex because multiple intrinsic and extrinsic factors contribute to female sexuality (Table).25–41 The failure to detect a relationship between reduced circulating testosterone and low libido in women may be attributed to the failure to adequately control for the complexity of the issue (Table).
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Divers troubles de santé génésique chez la femme découlent d'un taux anormal d'androgènes. C'est pourquoi les médecins demandent souvent un dosage du taux sérique de testostérone chez les femmes atteintes d'hirsutisme ou souffrant de dysfonctionnement sexuel. L'efficacité des tests commerciaux de dosage des androgènes est toutefois limitée chez la femme, et les résultats ne permettent pas toujours de poser un diagnostic, de planifier un traitement ou de formuler un pronostic. Le présent article se penche sur les limites du dosage des androgènes chez les femmes semblant présenter une activité androgénique anormale et étudie les situations où une thérapie hormonale est appropriée chez les femmes atteintes d'un trouble de l'intérêt ou du désir sexuel.

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^☆: This study was partially supported by grants from the Israel Ministry of Health, the National Insurance Institute, the Administrator General, Israel Ministry of Justice, the Committee for Research and Prevention in Occupational Safety and Health, and Israel Ministry of Labor, Jerusalem; and Welfare and the Tel-Aviv University Research Fund, Tel Aviv, Israel.

^∗: See for complete list of participating medical centers and investigators.

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CORONARY ARTERY DISEASEComparison of sexual activity of women and men after a first acute myocardial infarction☆

Abstract

Section snippets

Study design

Before and after AMI frequency of and satisfaction with sexual activity for women and men

Discussion

Acknowledgements

Am J Cardiol

Sexual life and sexual frigidity among women developing acute myocardial infarction

Psychosom Med

Life adjustment postmyocardial infarctiondetermining predictive variables

Arch Intern Med

A survey of sexual activity after myocardial infarction

Cardiovasc Med

Myocardial infarction and sexual activity of the female patient

Arch Intern Med

Sexual concerns and needs of the postcoronary patient’s wife

Arch Intern Med

A comparison of the recovery period for women and men after an acute myocardial infarction

Heart Lung

Sexual counseling of women with coronary heart disease

Heart Lung

Sexual problems after myocardial infarction

Am Heart J

Resumption of sexual activity after myocardial infarction

Ir Med J

The effects of myocardial infarction on sexual activity

J Cardiac Rehab

Sexual behavior of coronary patients after myocardial infarction

Arch Mal Coeur

Quality of life in patients with ischaemic heart diseasea prospective controlled study

J Intern Med

CORONARY ARTERY DISEASE
Comparison of sexual activity of women and men after a first acute myocardial infarction☆