SEX AFTER SIXTY AND THE HEART PATIENT

In last months column, we learned that seniors are the fastest growing segment of the U.S. population, with current estimates of 51.4 million Americans over 65 by the year 2030. Part of this fantastic growth is due to aging baby boomers.

Cardiovascular disease is and will likely remain the leading cause of death and disability in persons over the age of 65. As more individuals develop heart disease and are successfully treated for it, there will be an ever-increasing number of persons who have recovered from heart attacks, bypass operations, and angioplasties.

What kind of sex life may these individuals look forward to? To answer that question, we must look at the broader subject of sex after 60. Until recently, this topic was not discussed in most doctors' offices, let alone in public.

My, how times have changed! Seniors having sex is perfectly normal, although the idea may still seem foreign to younger people. In fact, the healthier a senior is, the more likely he/she has a healthy sex life as well, according to a recent survey by AARP. Among those with sexual partners, 25% of those 75 and older said they have sex once a week or more often, as do 60% of respondents aged 45 to 59.

Of all those with partners, 70% said they have sex at least once a month. Sixty-seven percent of the men and 57% of the women also said a satisfying sexual relationship was important to their quality of life.

According to Joane Blank, MPH, a sex educator and author of Still Doing It: Women and Men over 60 Write About Their Sexuality, "Sex is good for you. You should continue to have good sex for the same reason you should continue to get good exercise. It's taking care of yourself. Wake up your body again if it has been shut down. Do it whether you feel like it or not." Blank says, "One myth to put aside is that sex equals intercourse. Alternatives to intercourse are not just for people who don't want to get pregnant or get a disease. The most healthy thing is for people to put aside the idea that if intercourse isn't working for you, you can't be sexual. Intercourse should never be the goal. If some sexual activity is uncomfortable or doesn't work, try something different."

Communication is the key to releasing stalled sexual energy. "The worst sexual dysfunction in this country is our inability to talk about sex", Blank says. "To make the leap from not talking to talking is huge. People have to know they are not the only one who is considering being sexual. They need to know that they can do it without any risk to their health, and more importantly, with no risk to their self-esteem."

The next big hurdle to overcome is the feeling that nobody will find your older body sexy. Self-image is important to feeling attractive. If it feels more comfortable, it's okay to rekindle the sexual fires by masturbation.

Hormones have a lot to do with our sexuality and as we age, there is need to have a discussion with your doctor about hormone replacement when needed. For women, estrogen replacement affords many benefits, including healthier vaginal tissue and stronger bones. Men should have their testosterone levels measured as well. Experts estimate that there are 4-5 million U.S. men with low testosterone levels, but only 5% of these men are getting testosterone treatment. Testosterone will not only increase libido, it will enhance memory, energy levels, strength and endurance, as well as general enjoyment of life.

After a heart attack, angioplasty or bypass surgery, fear may be the biggest hurdle to an active sex life, but with a little knowledge, this obstacle can be overcome. Fear of having another heart attack is understandable, unless you know the statistics. The risk of a subsequent heart attack caused by sex is less than 1%, according to a study of nearly 2,000 men, published in the Journal of the American Medical Association in May, 1996. Regular exercise, as prescribed during cardiac rehabilitation, can reduce the risk even further.

Sexual intercourse with your partner is no more strenuous than climbing two flights of stairs, according to most experts. By enrolling in a cardiac rehabilitation program, every cardiac patient can build up the cardiovascular stamina to enjoy a safe and fulfilling sex life. This may require the help of a support group which often forms in the context of cardiac rehab. Complete recovery for heart attack patients means learning how to rekindle the flames after overcoming their fears. The lesson here is about the value of intimacy for creating a happier, healthier life for every senior.

Dr. Dennis R. Breen, MD, FACC is affiliated with the Sacramento Heart Center. For more information about the Sacramento Heart Center, visit their web site at www.sacheart.com or call (916) 830-2080 and request information be mailed to you. Please address your cardiology related questions to "Ask the Cardiologist", 500 University Avenue, Sacramento, CA 95825. Selected questions will be answered in future articles.