Sexual function in patients with advanced heart failure

doi:10.1016/S0147-9563(96)80061-6

Heart & Lung

Volume 25, Issue 4, July–August 1996, Pages 262-270

https://doi.org/10.1016/S0147-9563(96)80061-6 Get rights and content

Objectives

To determine the effect of low ejection fraction on sexual function and the relation between alterations in sexual function and pertinent clinical, demographic, and psychosocial variables in patients with advanced heart failure.

Design

This study was descriptive and correlational in design.

Setting

The setting was an outpatient clinic of a university-affiliated hospital.

Subjects

Sixty-two male (82%) and female (18%) patients with advanced heart failure (New York Heart Association [NYHA] class III or IV) were studied.

Measures

Exercise tolerance and symptom severity were assessed by the 6-minute walk and NYHA classification. Ejection fraction was measured by echocardiography. Alterations in the patients' emotional, social, and sexual function were assessed with the self-report version of the Psychosocial Adjustment to Illness Scale.

Results

Approximately three quarters of the patients reported a marked decrease in sexual interest and in the frequency of sexual relations caused by illness, with one quarter having ceased all sexual activity. Half the patients described having experienced marked reductions, after heart failure developed, in the pleasure or satisfaction they normally experienced from sex. Few patients had arguments with their spouses about sex or reported significant marital problems as a result of their illness. A significant relation was documented between patients' sexual function and the results of the 6-minute walk (r=−0.32, p<0.005), as well as between sexual function and NYHA functional class (r=0.21, p<0.05). Sexual function was also related to the patient's social environment (r=0.59, p<0.001), psychologic distress (r=0.38, p<0.001), and domestic environment (r=0.29, p<0.05). No significant differences in sexual function were noted when patients were compared on the basis of differences in ejection fraction, medications, gender, or age.

Conclusion

Advanced heart failure results in marked changes in libido and in the ability to perform sexually. These changes do not affect the marital relationship negatively, at least in the view of the patient. As patients' symptoms of heart failure become increasingly more severe, physicians and nurses need to counsel patients and their spouses about the changes they may experience in their sexual relationships. Attention needs to focus on ways to cope with the decreasing physical status that accompanies advanced heart failure to minimize negative changes in sexual functioning.

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The prevalence of sexual dysfunction (SD) and its impact on quality of life (QOL) in adults with congenital heart disease (CHD) is not well known. The aims of this study were to: determine the prevalence of SD, evaluate the risk factors associated with SD, and determine the association between SD and QOL in adults with CHD.
This was a cross-sectional study of adults (≥ 18 years) with CHD presenting for routine follow-up at our institution. Subjects completed the CDC HRQOL-14 “Health Days Measure” to assess mental and physical health, and either the Sexual Health Inventory for Men or the Female Sexual Function Index to assess sexual function. Baseline characteristics were obtained via chart review.
105 subjects were enrolled. The mean age was 31.9 ± 11.7 years, 53 (51%) were men, 81% were NYHA Functional Class 1, and 76% had moderate or complex CHD. The rates of SD were 28% overall in the cohort, 30% in men and 25% in women. Men with SD were more likely to be taking spironolactone (p < 0.001) and digoxin (p = 0.002). Men with SD reported a greater number of days of poor mental health (p = 0.004), feeling anxious, worried or tense (p = 0.003), needing assistance (p = 0.042), and inhibited activity of daily living (p = 0.009). Women with SD were more likely to have atrial arrhythmias (p = 0.002) and to report fewer days feeling healthy and energetic (p = 0.031).
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HF was induced in Wistar rats by ligation of the left anterior descending coronary artery. Changes in the ratio of intracavernosal pressure/mean arterial pressure (ICP/MAP) after electrical stimulation of major pelvic ganglion were determined in vivo. Cavernosal and IPA contractions were induced by electric field stimulation (EFS) and phenylephrine. RhoA, Rho kinase 2 (ROCK 2) and myosin phosphatase target protein 1 (MYPT-1) protein expression and phosphorylation levels were also determined.
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Citation Excerpt :
These findings are consistent with those of Mandras et al.19 and Jaarsma et al.20 who demonstrated that sexual desire, sexual function, and intercourse are negatively affected by reduced LVEF. It is estimated that reduced EF restricts vascular congestion in the penis, ultimately leading to ED.20 The physiology underlying an erection is primarily a vascular phenomenon: increased arterial flow into the corpus cavernosum and corpus spongiosum leads to engorgement of these chambers and compression of the venous outflow tract, thereby causing penile enlargement and hardening.21
Sexual activity is an important indicator of quality of life and is significantly impaired in patients with heart failure (HF). Cardiac resynchronization therapy (CRT) has positive effects on cardiac dysfunction and endothelial dysfunction that lead to erectile dysfunction (ED). We aimed to evaluate whether CRT may improve sexual activity in patients with HF.
In total, 136 patients (mean age 61.8 ± 12.8 years) were evaluated for the study. All patients filled the Sexual Health Inventory for Men (SHIM) questionnaire for evaluation of their erectile functions before CRT device implantation. One hundred eighty days after CRT device implantation, the patients were re-evaluated with SHIM questionnaire.
In the whole study population, SHIM test scores were significantly increased after CRT (12.99 ± 3.22 vs. 18.03 ± 5.00; p<0.001). The patients were divided into two groups according to the CRT response. The increase in SHIM test scores was significantly more in the response (+) group than in the response (−) group [response (+) group: 6.94 ± 3.36; p<0.001 vs. response (−) group: 0.81 ± 1.77; p = 0.465]. A positive CRT response was found to be an independent predictor of SHIM score (p<0.001).
Our study showed that CRT had positive effects on ED of patients with HF.

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Issue in cardiovascular diseaseSexual function in patients with advanced heart failure

Objectives

Design

Setting

Subjects

Measures

Results

Conclusion

J Am Coll Cardiol

J Psychosom Res

J Psychosom Res

Am Heart J

Am Heart J

Am J Cardiol

Quality of life in patients with advanced heart failure

J Heart Lung Transplan

Symptom distress in cardiac transplantation

Heart Lung

Effect of antihypertensives on sexual function and quality of life: the TAMI study

Ann Intern Med

Sexual function after heart transplantation

J Heart Lung Transplan

Life adjustment postmyocardial infarction

Arch Intern Med

Sexual activity after myocardial infarction

Arch Phys Med Rehab

Life satisfaction following heart transplantation

J Heart Transplan

Sexual activity and the postcoronary patient

Arch Intern Med

Quality of life after orthotopic heart transplantation

J Heart Lung Transplan

Psychological aspects of heart transplantation

J Heart Transplan

Quality of life after heart transplantation in patients assigned to double- or triple-drug therapy

J Heart Lung Transplan

Sexual concerns after heart transplantation

J Heart Lung Transplan

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AHCPR Publication No. 94-061. 2

Heart transplantation may not improve quality of life for patients with stable heart failure

J Heart Lung Transplan

Two- six- and twelveminute walking test in respiratory disease

Br Med J

Issue in cardiovascular disease
Sexual function in patients with advanced heart failure