Heart disease, including hypertension, angina, and myocardial infarction (MI), is the

number one cause of death in the United States. A person with heart disease—even a person who has had a heart transplant—can return to a normal sex life shortly after re­covery. Most cardiologists allow intercourse as soon as the patient feels up to it, although they usually recommend that heart transplant patients wait from 4 to 8 weeks to give the incision time to heal. However, researchers have found that the frequency of sexual in­tercourse after MIs does decrease. Why does this occur?

One reason is fear. Many patients (or their partners) fear that their damaged (or new) heart is not up to the strain of intercourse or orgasm. This fear can be triggered by the fact that, when a person becomes sexually excited, his or her heartbeat and respira­tion increase, and he or she may break out into a sweat (these are also signs of a heart attack). Some people with heart disease actually do experience some angina during sex­ual activity. Although not usually serious, these incidents may be frightening. Research has found that although sexual activity can trigger a MI, this risk is extremely low (Muller et al., 1996). In fact, except for patients with very serious heart conditions, sex puts no more strain on the heart than walking up a flight or two of stairs. (See Chapter 10, page 320, for a personal account of sex after a cardiac incident.)

Not all problems are psychological, however. Because achieving an erection is basi­cally a vascular process, involving the flow of blood into the penis, some forms of heart disease can result in erectile difficulties (in fact, many men who have had a MI report having had erectile difficulties before their heart attack). Some heart medications also can dampen desire or cause erectile problems, or, less often, women may experience a decrease in lubrication (see Table 14.2). Sometimes, adjusting medications can help couples who are experiencing such problems.

TABLE 14.2 Specific Drugs and Symptoms of Sexual Problems

Type of Drug

Possible Problems in Women

Possible Problems in Men

Antihypertensive (blood

Aldomet

Reduced sexual desire, impaired orgasm

Reduced sexual desire, erectile and ejacu-

pressure) medications

Catapres, Inderal, Minipress

Reduced sexual desire

latory problems, impaired orgasm Reduced sexual desire, erectile problems

Lopressor

Reduced sexual desire

Reduced sexual desire, Peyronie’s disease

Tranquilizers

Barbiturates

Reduced sexual desire

Reduced sexual desire, erectile problems

Valium, Xanax

Reduced sexual desire, impaired orgasm

Reduced sexual desire, ejaculatory prob-

lems, impaired orgasm

Antidepressants

Clomipramine (Anafranil)

Reduced sexual desire, impaired orgasm

Reduced sexual desire, ejaculatory prob-

lems, impaired orgasm

Desyrel

Erectile problems, priapism

Elavil

Reduced sexual desire

Reduced sexual desire, erectile and ejacu-

latory problems, testicular swelling

SSRIs (Prozac, Paxil, Zoloft)

Reduced sexual desire

Reduced sexual desire

Antipsychotics

Mellaril

Reduced sexual desire, menstrual

Reduced sexual desire, ejaculatory prob-

problems

lems, priapism, gynecomastia

Stelazine

Menstrual problems

Erectile and ejaculatory problems, pri­apism, gynecomastia

Thorazine

Menstrual problems

Erectile and ejaculatory problems, priapism

Ulcer Medications

Tagamet

Reduced sexual desire

Reduced sexual desire

Xantac

Reduced sexual desire

Reduced sexual desire, erectile problems

Other Drugs

Antabuse (treats alcoholism)

Erectile problems

Naproxen (anti-inflammatory)

Erectile and ejaculatory problems

Alkeran (cancer therapy)

Reduced sexual desire, menstrual

Reduced sexual desire, erectile problems,

problems

gynecomastia

 

After a heart attack or other heart problems, it is not uncommon to have feelings of depression, inadequacy (especially among men), or loss of attractiveness (especially among women; Schover & Jensen, 1988). In addition, after a heart attack, the patient’s partner often assumes the responsibility of enforcing the doctor’s orders: “Don’t smoke!” “Don’t eat fatty foods!” “Don’t drink alcohol!” “Don’t get so excited!” “Don’t put so much salt on that!” “Get some exercise!” This is hardly a role that leads to good feelings and sexual desire. Any combination of these factors may lead one or both partners to avoid sex. Consequently, distance in the relationship may grow, and the couple may drift apart just when they need each other most (Sandowski, 1989).

Strokes, also called cerebral vascular accidents (CVAs), happen when blood is cut off from part of the brain, usually because a small blood vessel bursts. Although every stroke is different depending on what areas of the brain are damaged, some common re­sults are hemiplegia (he-mi-PLEE-jee-uh), aphasia (uh-FAY-zhee-uh), and other cogni­tive, perceptual, and memory problems. As with other types of brain injury (such as those caused by automobile accidents), damage to the brain can affect sexuality in a number of ways.

In most cases of stroke, sexual functioning itself is not damaged, and many stroke vic­tims do go on to resume sexual activity. The problems that confront a couple with nor­mal functioning are similar to those with cardiovascular disease: fear of causing another stroke, worries about sexual attractiveness, and the stresses and anxieties of having to cope with a major illness. However, a stroke can also cause physiological changes that af­fect sexuality. Some men find that after a stroke their erections are crooked because the nerves controlling the erectile tissue on one side of the penis are affected. Hemiplegia can result in spasticity (jerking motions) and reduced sensation on one side of the body. Paralysis can also contribute to a feeling of awkwardness or unattractiveness. In addition, aphasia can affect a person’s ability to communicate or understand sexual cues.

Some stroke victims also go through periods of disinhibition, in which they exhibit behavior that, before the stroke, they would have been able to suppress. Often this in­cludes hypersexuality, in which the patient may make lewd comments, masturbate in public, disrobe publicly, or make inappropriate sexual advances (Larkin, 1992). Others

 

stroke

Occurs when blood is cut off from part of the brain, usually because a small blood vessel bursts.

 

hemiplegia

Paralysis of one side of the body.

 

aphasia

Defects in the ability to express and/or under­stand speech, signs, or written communication, due to damage to the speech centers of the brain.

 

disinhibition

The loss of normal control over behaviors such as expressing sexuality or taking one’s clothes off in public.

 

hypersexuality

Abnormally expressive or aggressive sexual be­havior, often in public; the term usually refers to behavior due to some disturbance of the brain.

 

hyposexuality

Abnormal suppression of sexual desire and be­havior; the term usually refers to behavior due to some disturbance of the brain.

may experience hyposexuality, in which they show decreased sexual desire, or they may experience ED. Sexual intervention programs have been designed for use in rehabilita­tion hospitals, and they can be of great help in teaching couples how to deal with the difficulties of adjusting to life after a stroke.

ReviewQuestion

Explain how stroke and heart disease ^can psychologically and physiologically affect sexual functioning.

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