Sex after open-heart surgery: How soon is too soon?

If you are planning to have or have had a traditional “open-heart” surgery, such as a coronary artery bypass procedure (CABG) or surgical heart valve replacement, then you likely have heard about the activity restrictions that are required for your sternum, or breastbone, to heal.

These surgeries require a long incision to cut through the sternal bone to reach the heart structures. Once the surgery is complete, the sternum will be brought back together and stabilized (usually with metal wires). However, it will take many weeks for the bone to completely heal, and during that time patients will be instructed to restrict or modify their activities to minimize stress on the sternum. Usually, this will include restrictions on the amount of weight you can lift or modifications in household chores.

One activity that is rarely brought up by both patients and providers alike is intimacy after cardiac surgery. Asking about sexual activity may feel embarrassing for patients, but lack of knowledge about what is safe can be a huge source of stress during your recovery. You’ve had a major operation – don’t you need to be careful about your heart and your incisions?

Luckily, the American Heart Association authored a scientific consensus on the subject that provides some general guidelines. Of course, you will need to talk to your heart surgeon and cardiologist about your specific postoperative instructions.

The guidelines recommend that sexual activity may be safely resumed six to eight weeks after surgery if the sternum is well healed. This is because movement during sex could impart considerable stress on the chest bone and compromise healing. Even after this six-to-eight-week timeframe, in the early postoperative months certain positions may still need to be avoided if they cause discomfort at the surgical site. It is also advisable that ANY physical activity is reintroduced in a gradual fashion. Sexual activity is typically equivalent to mild-moderate exercise (i.e., brisk walking, mowing the lawn or deep house cleaning). The important thing is to listen to your body and keep open communication with your partner about your level of endurance and any pain you may experience.

Bottom line: don’t be afraid to talk to your provider about sex after heart surgery and to discuss any risk factors specific to you. Your total health is our priority!

But resumption of any physical activity after heart surgery is not just dependent on the sternum healing, but also how your heart recovers. Some patients may still have decreased heart function despite surgery, and some patients may still have uncorrected cardiac blockages after CABG. Your cardiologist may require you to perform an exercise stress test prior to clearing you for sex. A good rule of thumb is if you can’t walk around the block without becoming significantly short of breath or are experiencing chest pain with exertion similar to pre-op, then hold off on sexual encounters until you are evaluated by your cardiologist. You may require changes in your heart failure medications or further interventions before it is safe to resume.

Bottom line: don’t be afraid to talk to your provider about sex after heart surgery and to discuss any risk factors specific to you. Your total health is our priority!

Regarding sexual enhancement drugs, prescription erectile dysfunction drugs are generally safe for patients with stable heart function, but you should discuss them with your provider before starting. These medications can lower your blood pressure, which when combined with other blood pressure medications could lead to symptomatic hypotension. Some also can be dangerous for patients with certain heart arrhythmias. Herbal supplements for sexual dysfunction should be avoided, as they are unregulated and may contain ingredients that interact poorly with other medications and could be dangerous for your heart.

Visit the Healthcare page to learn more about cardiothoracic procedures and treatments.

By Jana Bishop, PA-C, Ben Taub Cardiothoracic Surgery and Instructor, Baylor College of Medicine