Sexual Activity and Counseling in the First Month After Acute Myocardial Infarction (AMI) Among Younger Adults in the United States and Spain: A Prospective, Observational Study | Journal Scan

Study Questions:

What is the patient experience of counseling about sexual activity after acute myocardial infarction (AMI), among young women and men with AMI?


The prospective, longitudinal VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study, conducted at 127 hospitals in the United States and Spain, was designed, in part, to evaluate gender differences in baseline sexual activity, function, and patient experience with physician counseling about sexual activity after an AMI. This study used baseline and 1-month data collected from the 2:1 sample of women (N = 2,349) and men (N = 1,152), ages 18-55 years, with AMI.


Median age was 48 years. Among those who reported discussing sexual activity with a physician in the month after AMI (12% of women, 19% of men), 68% were given restrictions: limit sex (35%), take a more passive role (26%), and/or keep the heart rate down (23%). In risk-adjusted analyses, factors associated with not discussing sexual activity with a physician included: female gender (relative risk [RR], 1.07; 95% confidence interval [CI], 1.03-1.11), age (RR, 1.05 per 10 years; 95% CI, 1.02-1.08) and sexual inactivity at baseline (RR, 1.11; 95% CI, 1.08-1.15). Among patients who received counseling, women in Spain were significantly more likely to be given restrictions than US women (RR, 1.36; 95% CI, 1.11-1.66).


The authors concluded that very few patients reported counseling for sexual activity after AMI. Those who did were commonly given restrictions not supported by evidence or guidelines.


This study suggests that US and Spanish physicians rarely counsel younger AMI patients, especially women, about resuming sexual activity even though the large majority of these patients were sexually active in the year before their event, and felt it was appropriate for physicians to initiate discussion of sexual matters in the context of AMI care. Among the few who received counseling about sexual activity, recommendations were inconsistent and only weakly related to patient characteristics. Physicians could meaningfully narrow the gap between guidelines and practice by adding recommendations for resuming sex to routine counseling about returning to work and exercise. Practical, patient-centered tools are needed to facilitate the patient–physician discussion about sexual concerns. This minor modification in practice could help improve quality of life for younger women and men with AMI.

Keywords: Coitus, Counseling, Heart Rate, Myocardial Infarction, Quality of Life, Risk, Sexual Behavior, Spain, United States

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