November 30, 2018 / 4:38 PM / 14 days ago

Sexual rehab could have benefits for men with heart disease

(Reuters Health) - A sexual rehabilitation program could help with erectile dysfunction in men who have heart disease, a study from Denmark suggests.

Men assigned to the rehabilitation program had improved erectile function and better exercise capacity after 16 weeks compared to those who just got usual medical care, the study team reports in the journal Heart.

“Sexual problems have a profound negative impact on several aspects such as quality of life, general wellbeing, relationship problems and psychological outcomes such as depression and anxiety,” said lead study author Pernille Palm of Copenhagen University Hospital Rigshospitalet.

For some cardiovascular issues such as ischemic heart disease, erectile dysfunction is a problem in up to 80 percent of men, she said.

“Patients hesitate to seek help because it’s still a taboo,” Palm told Reuters Health by email. “They want health professionals to address the topic, but health professionals in general don’t feel they have the competence or correct intervention to offer.”

In the CopenHeart trial, Palm and colleagues randomly assigned 154 men either to just continue with their normal outpatient follow-up visits or to also take part in a 12-week sexual rehabilitation program that included physical exercise and psychoeducation around sexual health and dysfunction.

The men had either ischemic heart disease - meaning blocked or narrowed arteries - or a heart rhythm disorder that required an implanted defibrillator. Half were older than 62. Those assigned to the rehab program followed a cardio and strength-training regimen, as well as stretching and pelvic floor exercises, plus a tailored counseling program that covered each man’s specific issues and concerns.

The men answered questionnaires about their sexual functioning and their level of wellbeing at the start of the study, and the research team measured exercise capacity at the outset and again after four months and six months. Measurements of erectile function included questions about erection quality, orgasmic function, sexual desire and intercourse satisfaction. Another set of questions gauged quality of life related to having a disease.

The research team found that sexual rehabilitation, as compared with usual care, improved physical sexual function at four months and six months. The rehabilitation program also improved exercise capacity and pelvic floor strength. However, there was no difference between the groups in the psychosocial component of the assessments or in their self-reported health or mental health.

“What stuck out the most was the fact that so many men had this problem for so long and hadn’t sought professional help,” Palm said. “But also, the ones seeking help weren’t able to get sufficient advice.”

As part of the trial, the study authors elicited feedback from the men’s partners regarding erection function, yet only 10 percent of partners responded. Future studies should find other ways to engage partners and build the social aspect of the program, Palm said.

In fact, during the trial, some of the patients “teamed up with peers and met up after training sessions for a beer, thereby creating a special place for discussing their life with heart disease, including sexual issues,” she said.

Palm and colleagues are planninga larger study with different types of patients who may require different treatments, she explained. Other studies are specifically focused on sexual outcomes for women, too.

“Although the clinical guidelines recommend counseling of women and men about sex after a heart attack, women are far less likely to receive this counseling,” said Dr. Stacy Lindau of the University of Chicago, who wasn’t involved in the study.

Lindau directs WomanLab, a website that provides information about female sexuality and health conditions, especially with regard to menopause, cancer and heart disease. This week, WomanLab launched a new resource (bit.ly/2FNxEHj) with questions to ask doctors about sex after a heart attack.

“Both men and women should ask their heart doctor when it’s safe to start having sex again and, if possible, include their partner in the conversation,” Lindau told Reuters Health by email. “A life-threatening illness can be a wake-up call where couples reset their thinking about their life priorities and renew their commitment to caring for and loving each other each day.”

SOURCE: bit.ly/2FRIJqX Heart, online October 31, 2018.

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