While the analysis found great sex is risky for men in the survey, those who had sex one to three times a month and rated it less pleasurable had no increased risk for heart concerns.
For their female partners, however, results were different. Women who said they had frequent, extremely satisfying sex had a lower risk of hypertension, a common precursor to heart disease.
Mediocre sex better for heart health?
“These findings challenge the widely held assumption that sex brings uniform health benefits to everyone,” Liu said. “I think it is important for older people to understand the potential risks and benefits of sex.”
“I tell my patients a month after they have a heart attack or open heart surgery if they can walk a flight of steps without getting chest pain or shortness of breath,” said Campbell, “then they are fine to resume sexual activity.”
Surprising results for men
“The results for men were surprising,” said Lui, agreeing they run counter to decades of research that shows a positive health effect from sexual behavior for men, including better prostate health.
One reason for the unusual findings, she said, could be in the design of the study. She said while other research has tended to focus on younger age groups, this survey was on a nationally representative sample of older adults across the United States.
“It’s a survey, not a gold-standard, randomized, clinically controlled trial,” countered Campbell, also highlighting that the study was conducted in 2005, with a follow-up in 2010. “Is it really relevant now that most everyone is on a statin and our treatment of cardiovascular disease has continued to improve?” he asked.
Another reason for her findings, Lui said, might lie in the use of erectile dysfunction supplements by many older men, or the level of stress created by the act of sex itself.
“Older men may have more difficulties reaching an orgasm for medical or emotional reasons,” Lui said. “Therefore, they may exert themselves to a greater degree of exhaustion and create relatively more stress on their cardiovascular system in order to achieve a climax, which may hurt health.”
That could possibly be true, Campbell said, if the man is suffering from an unknown cardiovascular blockage or if he is using certain medications for existing heart disease.
“If they are taking any type of nitroglycerin, it can cause a dramatic drop in blood pressure with any of the erectile dysfunction drugs,” Campbell said. “That needs to be monitored very carefully.”
She added, “So men should be sure they are physically able to have sex, and then it’s about being careful and understanding the risk factors.”
Lastly, said Lui, having a high frequency of sex may indicate problems of “sexual addiction, sexual compulsivity or sexual impulsivity” for men, and could be related to “psychological states such as anxiety or depression, which may lead to negative cardiovascular health.”
A win-win for women
Women, however, have good news. “Good sexual quality may protect older women from cardiovascular risk in later life,” Lui said.
That makes sense, said Berman, because of the way that women view their sexual relationships.
“It’s not so much the number of orgasms or how vigorous the sexual experience that predicts a woman’s sexual satisfaction,” Berman said. “It’s how close she feels to the person she is having sex with, through kissing and cuddling as well as orgasms. That is the key to her emotional and physical well-being, which benefits her health and her heart, and everything else.”
Men, however, are different.
“The way men feel emotionally close to their partner is through the physical act of sex,” Berman said. “They benefit from an emotional connection, but in their minds, they don’t need it as much and don’t get as stressed, anxious, depressed as a woman will. They will feel that way if they are not getting sex, but they won’t see isolation as such a loss.”
She added, “If a man is in a relationship, no matter what sort, he will live longer, but if a woman is in a bad relationship she will live less long.”
The takeaway for older couples
So what’s an older couple to do when it comes to sex and the risk of heart disease?
“We need to weigh the cost-benefit analysis and allow the older sexual relationship to progress, because we’re living longer in our society and we have to deal with this,” Berman advised. “I still believe that for the majority of older adults, the physical and emotion benefits outweigh the risk factors.”
Campbell, the cardiologist, said, “Here’s the bottom line. Patients need to talk about sex with their doctors, regularly, and on each office visit, so we can diagnose and address any concerns before they escalate.”
“All of this gets back to our inability or ability to communicate about sex and pleasure and health,” she said. “It’s not surprising that an older population might have some discomfort about speaking up, but the conversation of sex and aging is one that we should have been having for years.”