CHICAGO -- Many heart specialists are hardly Dr. Ruth – sex is not something they relish bringing up with patients. But new guidance says they should, early and often, to let survivors know intimacy is often possible after a heart attack.


Discussions should involve everything from when and how to resume sex, to what position might be best for some conditions or not advised for others, according to a consensus statement released Monday by the American Heart Association and the European Society of Cardiology.


It's billed as the first scientific statement with detailed guidance on resuming sex after a heart attack, stroke or other cardiac condition and is based on a review of medical literature.


"Sexual health is an important part of the overall health of the individual," even for the oldest patients, said Elaine Steinke, a researcher and professor of nursing at Wichita State University in Kansas. Steinke was the lead author of the statement published in the heart association's Circulation journal and the European Heart Journal.


Co-author Tiny Jaarsma, a professor and heart failure researcher at Sweden's Linkoping University, said in an email that doctors and nurses "rarely discuss sex `spontaneously', but often wait until the patient brings up questions around sex. Health care providers often are afraid to upset patients or might feel embarrassed themselves."


Fears and anxieties about resuming sex are often numerous: Will it cause another heart attack? Can I use Viagra? What if my defibrillator goes off during sex? And many are too shy to ask, so heart doctors, nurses and other health care workers should take the lead and initiate the discussion with men and women patients of all ages and their partners, according to the statement.


Many heart patients can safely resume sexual intercourse after first checking with their doctors, and the answers to many questions depend on each patient's overall health, the guidance says. Patients with mild, stable chest pain face a low risk for a sex-triggered heart problem, whereas patients with advanced heart failure should postpone sex until their condition is stabilized.


General precautions listed in the statement include:


_Before resuming sex, make sure you can engage in moderate physical activity, such as walking briskly up two flights of stairs, without chest pain, breathlessness or other symptoms.



_If moderate activity is too strenuous, avoid intercourse but not intimacy: hugging and kissing may be OK.


_Have sex in a comfortable, familiar place and avoid things that could add stress to the experience, including extramarital affairs.


_Tell your doctor about any symptoms during sex, including chest pain, dizziness or insomnia afterward.


_Some positions may not be safe. Heart bypass surgery patients should avoid being on top in the missionary position, and Steinke said having sex in a more "upright position" may be easier for some heart failure patients, whose symptoms may include shortness of breath.


Ruth Westheimer, the famed 85-year-old sex therapist known as "Dr. Ruth," commented on the study Monday through her publicist from Switzerland, where she was hiking.


When hospitals have invited her to speak, she always gives the same message: "Doctors need to ask their patients about sexual functioning," even if both sides are embarrassed by the topic.


"When it comes to sex and heart issues, in my experience it's as likely to be the partner of the heart patient who is afraid of having sex because it might cause a heart attack as the patient him or herself," Westheimer said. "What I suggest is that people write down their questions and send it to the doctor in advance of their appointment. That way they'll be sure the question gets asked and the doctor will have had time to get prepared to answer it."


Dr. Vijay Divakaran, a cardiologist with Scott & White Hospital in Round Rock, Texas, said the consensus statement is important and will change practice. Cardiologists don't get formal training in discussing sexual issues with their patients but the conversations get easier, he said


"Sometimes patients don't talk about it, they just Google it, and there's a lot of misconceptions" online, Divakaran said. "Once you start asking them, you would be surprised that it almost always is an issue."


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Online:


American Heart Association: http://www.heart.org[1]


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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner[2]



Earlier on HuffPost:




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  • 1. Oysters


    Oysters have a well-established history as an aphrodisiac (just look at that suggestive shape!): Romans believed in their libido-increasing abilities and Casanova wrote that he ate 50 for breakfast in "The Story of My Life."

    Well guess what? The mollusks are packed with the feel-good hormone dopamine. Zinc -- a mineral linked to stimulating testosterone, a hormone key to sexual arousal, can also be found in oysters, <a href="a href="http://women.webmd.com/guide/food-spicier-sex-life" target="_hplink"" target="_hplink">according to WebMD</a>. A past study also suggested a link between <a href="http://www.telegraph.co.uk/news/uknews/1486054/Raw-oysters-really-are-aphrodisiacs-say-scientists-and-now-is-the-time-to-eat-them.html" target="_hplink">raw oyster consumption and sex-hormone production</a>, after researchers discovered that they contain rare amino acids previously found to stimulate testosterone and progesterone production in rats, <em>The Telegraph</em> reports.




  • 2. Peppers (And Other Hot And Spicy Food)


    The <a href="http://www.integratedsociopsychology.net/What_is_Love2/'LoveonaSuspensionBridge'-DonaldDutton&A.html" target="_hplink">"shaky bridge experiment"</a> is probably familiar to anyone who took Psych 101 in college. In the study, men were asked to walk across a tall, shaky bridge, and then asked by an attractive researcher to fill out a survey. They were more likely than those who walked across a less scary bridge to give the researcher a call later on, mistaking the physiological arousal from their fear response to the shaky bridge (increased heart rate, feeling a bit warm, breaking a sweat) for sexual attraction and arousal.

    In the absence of terrifying suspension bridges, you might try chomping down on a hot chile for the same physiological arousal. And just like hot peppers, <a href="http://www.livestrong.com/article/59801-libido-enhancers/" target="_hplink">spices like curry and cumin can also increase blood flow</a> and in turn, your libido, according to Live Strong.




  • 3. Garlic


    Another provocatively shaped food, garlic is associated with <a href="http://www.umm.edu/altmed/articles/garlic-000245.htm" target="_hplink">increased blood circulation</a>, according to the University of Maryland Medical Center. "Better blood flow to the genitals creates greater arousal for men and women," <em>Men's Health</em> reports.

    Garlic is also a traditional aphrodisiac in the Mahayana Buddhist tradition. It is one of the five pungent roots monks were told to avoid because of its effect on sexual desire (according to the Surangama sutra: <a href="http://www.buddhanet.net/pdf_file/surangama.pdf" target="_hplink">"if eaten cooked, they are aphrodisiac..."</a>).




  • 4. Alcohol


    As Shakespeare wrote in "The Tragedy of Macbeth": "Lechery, sir, it provokes, and unprovokes; it provokes the desire, but it takes away the performance..."

    In moderation, however, alcohol can lower inhibitions without the unfortunate side effect of decreased performance. A 2009 study conducted by the University of Florence also found that women who drank one to two glasses of red wine a day reported <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2009.01393.x/abstract;jsessionid=7176BC0E5E8A69E77FFEEC523925B8C2.d03t02?systemMessage=Wiley+Online+Library+will+be+disrupted+on+4+August+from+10%3A00-12%3A00+BST+%2805%3A00-07%3A00+EDT%29+for+essential+maintenance&userIsAuthenticated=false&deniedAccessCustomisedMessage=" target="_hplink">"higher...sexual desire, lubrication and overall sexual functioning."</a>




  • 5. Chocolate


    Sex isn't all about the physical act; there's a good deal of mental stimulation necessary before one is in "the mood." Taking a bite or two of chocolate can help.

    The <a href="http://fitbie.msn.com/slideshow/7-sexy-foods-boost-libido" target="_hplink">cocoa-packed treat contains a compound called phenylethylamine, which floods the body with serotonin and endorphins</a> creating that loving feeling, according to Fitbie. While a study found that a boost in sexual desire after eating chocolate was all in participants' heads, we'll take it where we can get it!