Cardiovascular Issues in Male and Female Sexual Dysfunction in VS .NET

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Cardiovascular Issues in Male and Female Sexual Dysfunction
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Table 281 MET equivalents as a guide to relating daily
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Table 282 Relative risk of MI during the two hours after
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activity to sexual activity
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Daily activity Sexual intercourse with established partner lower range (normal) lower range (orgasm) upper range (vigorous activity) Lifting and carrying objects (9 20 kg) Walking one mile in 20 minutes on the level Golf Gardening (digging) Do-it-yourself, wallpapering, and so on Light housework, eg ironing, polishing Heavy housework, eg making beds, scrubbing oors, cleaning windows METs
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sexual activity: physically t equals sexually t
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Patient type All patients Men Women Previous MI Sedentary life Physically active Source: [6] Relative risk 25 (17 37) 27 (18 40) 13 (03 52) 29 (13 65) 30 (20 45) 12 (04 37)
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Using METs, sexual intercourse is equivalent to 3 4 minutes of the standard Bruce treadmill protocol Where doubts exist about the safety of sexual intercourse, an exercise test can help guide decision making If a person can manage at least four minutes on the treadmill without signi cant symptoms, ECG evidence of ischemia, a fall in systolic BP, or dangerous arrhythmias, it will be safe to advise on sexual activity [2,3] Drory et al [4,5] studied 88 men with CAD (off therapy) using ambulatory ECGs and bicycle exercise tests On ambulatory ECGs one-third of the men had ischemia during sexual intercourse and all of them had ischemia on the bicycle exercise ECG All patients without ischemia on the exercise test (n = 34) also had no ECG changes during sexual intercourse All ischemic episodes during sexual intercourse were associated with an increasing heart rate, identifying a potentially important therapeutic role for heart rate lowering drugs ( -adrenoreceptor antagonists, verapamil, diltiazem) If a patient is unable to perform an exercise test because of mobility problems, a pharmacologic stress test should be utilized (eg dobutamine stress
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echocardiography an infusion of dobutamine accelerates the heart rate with the patient supine; the 12-lead ECG records evidence of ischemia and the echocardiogram ischemic-induced left ventricular wall motion abnormalities) A man who cannot achieve 3 4 METs should be further evaluated by angiography if appropriate [2] Advice on METs in the clinical setting and relating this advice to sexual intercourse should also include advice to avoiding stress, a heavy meal, or excess alcohol consumption prior to sexual intercourse
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As long as the couple are not stressed by the sexual position they use, there is no evidence of increased cardiac stress to a man or woman Man on top, woman on top, side to side, oral sex, and masturbation are cardiologically equivalent In homosexual relationships, other than casual, anal intercourse is not associated with increased cardiac stress provided proper lubrication is used and amyl nitrate ( poppers ) are not used in the presence of a phosphodiesterase type-5 (PDE-5) inhibitor
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Cardiac Risk
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There is only a small myocardial infarction risk associated with sex The relative risk of a myocardial infarction (MI) during the two hours following sex is shown in Table 282 The baseline absolute risk of an MI during normal daily life is low one chance in a million per hour for
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Risk factors
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Coronary heart disease
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Endothelial Dysfunction the common denominator
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Fig 281 Risk factors for erectile dysfunction (ED) and coronary heart disease; endothelial dysfunction (ED) = erectile dysfunction (ED) Source [8]
a healthy adult, and 10 chances in a million per hour for a patient with documented cardiac disease Therefore, during the two hours following sex, the risk increases to 25 in a million for a healthy adult and 25 in a million for a patient with documented cardiac disease; but, importantly, there is no risk increase in those who are physically active A similar study from Sweden has reported identical ndings [7] If we take a baseline annual rate of 1% for a 50-year-old man, as a result of weekly sexual activity, the risk of an MI increases to 101% in those without a history of a previous MI and to 11% in those with a previous history Coital sudden death is very rare In three large studies, sex activity-related death was 06% in Japan, 018% in Frankfurt, and 17% in Berlin Extramarital sex was responsible for 75%, 75%, and 77% respectively, and the victims were men in 82%, 94%, and 93% of cases, respectively [1] An older man with a younger woman was the commonest scenario