Affairs of the heart (God’s LOVE) faith, hop, joy and believe

A physical connection with your romantic partner is often an important part of a fulfilling relationship. But when it comes to matters of the heart, the health of your heart matters.

“A satisfying sex life depends on physical health, psychological well-being, and the quality of the relationship,” says Dr. Jan Shifren, who directs the Massachusetts General Hospital Midlife Women’s Health Center. Heart disease and related conditions can influence all three of those factors in both men and women. Here’s a look at the range of those effects and some possible solutions.

The male perspective

Problems with blood circulation (the hallmark of cardiovascular disease) can affect not just the heart but the entire body, including the sex organs. In men, this can manifest as erectile dysfunction (ED) — trouble getting or keeping an erection.

Sometimes drugs used to treat high blood pressure cause erection problems. Beta blockers and diuretics appear more likely to cause ED, while ACE inhibitors and calcium-channel blockers seem less likely to do so. (For a list of common examples of these drugs, see www.health.harvard.edu/heart-meds/blood-pressure.) Men who develop ED after starting a blood pressure drug can ask the physician who prescribed the drug about switching to an alternative.

If that’s not the issue, drugs to treat ED are an option. For the most part, they’re safe for men with heart disease. The drugs, which include sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis), are known as PDE5 inhibitors. They help relax blood vessels and increase blood flow to the penis.

The one precaution: Men need to avoid nitrate-containing medicines for 24 to 48 hours after using a PDE5 inhibitor. Nitrates, which are used to treat chest pain (angina) caused by heart disease, also widen blood vessels. Taking these drugs together can lead to a potentially dangerous drop in blood pressure, says Dr. Michael O’Leary, professor of surgery at Harvard Medical School and director of the Men’s Health Center at Brigham and Women’s Hospital.

Some physicians prescribe sublingual (under-the-tongue) nitroglycerin tablets to people who’ve had heart attacks, just in case they develop angina. “If another doctor later prescribes Viagra, that will get flagged as a dangerous drug interaction, and the pharmacist may not fill it,” Dr. O’Leary says. But many heart attack survivors never end up needing or taking nitrate drugs. And even those who do can safely use PDE5 inhibitors as long as they follow the precautions, he adds.

The female perspective

Because ED drugs have been on the market for decades, talking about sexual problems is less taboo than in the past. But while cardiologists may ask their male patients about ED, they may not be asking their female patients about related problems, says Dr. Shifren. It’s possible that cardiovascular disease may affect the blood flow needed for vaginal arousal and lubrication.

Viagra was tested as a treatment for sexual dysfunction in women, but it wasn’t FDA-approved because it failed to show a benefit. In recent years, however, two drugs have been approved for low sexual desire in women. One, flibanserin (Addyi), can cause low blood pressure. The other, bremelanotide (Vyleesi), can cause high blood pressure and isn’t recommended for women at risk for heart disease. However, both were tested and approved only for premenopausal women, in whom heart disease is not common. So even though those side effects are concerning for only a small percentage of women, they should be aware of them, says Dr. Shifren.

The drop in estrogen levels that follows menopause can cause vaginal dryness, which can make intercourse painful. One effective treatment is low-dose vaginal estrogen therapy, available as a cream, suppository, or ring. “These products are really effective, so women with these symptoms should be encouraged to try them,” says Dr. Shifren. Higher doses of estrogen taken via pill or skin patch to treat hot flashes may increase cardiovascular risk. But these risks are not seen with low doses in the vagina.

Emotional and relationship issues

A heart attack or diagnosis of heart disease can bring up intense emotions, both for the patient and his or her partner. Sometimes the role of the partner shifts from being an intimate companion to a caregiver, and it’s often hard for couples to shift back to their original roles, says Dr. Shifren. Anxiety and depression are common and may disrupt a couple’s attempts at intimacy. And certain antidepressants — namely, drugs known as SSRIs, such as fluoxetine (Prozac) and citalopram (Celexa) — sometimes cause sexual side effects, including ED and — for both sexes — low libido and difficulty having an orgasm. Another common concern is that sex might trigger heart-related symptoms, but those fears are largely unfounded (see “How stressful is sex on the heart?”).

How stressful is sex on the heart?It’s normal to feel anxious about your ability to make love after having a heart attack. In young, healthy people, the physical demands of intercourse are equivalent to those of climbing two flights of stairs. In people who have heart disease or are older, the effort may require greater exertion. Nevertheless, at any age, the greatest increase in heart rate and blood pressure occurs for only 10 to 15 seconds during orgasm, after which these levels quickly return to baseline.”If you’re healthy enough to be active outside the bedroom, you should feel confident that you’re healthy enough to be active inside the bedroom,” says Harvard Medical School professor Dr. Jan Shifren.

Your physician may be able to help by adjusting your medications or referring you to a counselor, which could be for individual or couples therapy, or a certified sex therapist. But having an open, honest discussion with your partner about your feelings and concerns is probably the most important first step.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

Acts 4:18-31 And when they had summoned them, they commanded them not to speak or teach at all in the name of Jesus. But Peter and John answered and said to them, “Whether it is right in the sight of God to give heed to you rather than to God, you be the judge; for we cannot stop speaking about what we have seen and heard.”     

2 Chronicles 25:19 “You said, ‘Behold, you have defeated Edom.’ And your heart has become proud in boasting. Now stay at home; for why should you provoke trouble so that you, even you, would fall and Judah with you?”

1 Samuel 2:3 “Boast no more so very proudly, Do not let arrogance come out of your mouth; For the LORD is a God of knowledge, And with Him actions are weighed.

Proverbs 11:2 When pride comes, then comes dishonor, But with the humble is wisdom.

Proverbs 16:5 Everyone who is proud in heart is an abomination to the LORD; Assuredly, he will not be unpunished.

Micah 2:3 Therefore thus says the LORD, “Behold, I am planning against this family a calamity From which you cannot remove your necks; And you will not walk haughtily, For it will be an evil time.

Recommended contacts for prayer request and Bible study

www.agapetemplesda.com

www.adventistontario.org

https://www.hopechannel.com/au/learn/courses

breathoflife.tv/

https://3abn.org/all-streams/3abn.html

http://www.nadadventist.org/article/15/contact-us

https://www.adventist.org/en/utility/contact/

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