Answering Questions About Heart Disease & Sex

 Today, Norm Goldman, Publisher & Editor of Bookpleasures.com is honored to have as our guest, Dr. Eduardo Chapunoff, M.D., F.A.C.P., F.A.C.C. author of Answering Your Questions About Heart Disease & Sex.

Dr. Chapunoff is a Diplomate of the American Board of Internal Medicine and the American Board of Cardiovascular Disease, a Fellow of the American College of Physicians and the American College of Cardiology. Good day Dr. Chapunoff and thanks for participating in our interview. Dr. Chapunoff was a Clinical Associate Professor at the University of Miami from 1985 to 1997.

I am just curious, with your busy medical practice as well as being a Clinical Associate Professor of Medicine at the University of Miami School of Medicine, how did you find the time to author Answering Your Questions About Heart Disease & Sex. And, as a follow up, what motivated you to write a book?

Dr. Chapunoff:

Norm, before I answer your questions, I want to tell you that I consider a great privilege to be interviewed by a person of your intellect and prestige. I'm also very appreciative of your recent review of my book. This kind of recognition by people of your caliber is what encourages an author to pursue additional projects.

And now, my answer to your first question: It's true that I'm very busy but I'm very focused and organized. I also happen to be very fortunate working for the Greater Fort Lauderdale Heart Group where I'm provided with technical assistance and an infrastructure that makes my job extremely comfortable and stress-free. I'm also blessed with a very happy marriage. You know how important that is. No individual, regardless of how capable he/she is, can go too far without that kind of love and support.

I've also educated myself to think positive and avoid, as much as possible, negative ideas or attitudes. These are upsetting and intrusive and take a lot of a person's time.

With respect to what motivated me to write the book: In 1991 I published Sex and the Cardiac Patient. Today, this book only has a historical value for me, but that was the time when I became concerned about the widespread ignorance about the effects of sex on heart disease and about the possible consequences of cardiac illness on sexual functioning.

 Norm:

In your book you make mention that when you started to investigate the topic there was very little information pertaining to sex and the cardiac patient. How has this changed and why do you believe there is more research and concern today?

Dr. Chapunoff::

I believe that the new awareness about sex and heart disease that we've seen in the past several years has nothing to do with changes in people's perception or redefinition of sexual behavioral patterns. In my personal opinion, patients are as shy and reserved about discussing sexual issues as they were in the past.

What really changed – and changed a lot – is technology. In 1998, Viagra appeared in the market and it was followed by Levitra and Cialis. These drugs made a substantial difference and improved lots of erections although 30% of men do not respond to them. Incidentally, these medications are being studied for a possible beneficial effect in women's excitement phase of the sexual cycle. Penile prosthesis improved their designs and efficiency.

There are new modalities of treatment for cardiovascular disorders, e.g., balloon angioplastly of coronary arteries, stents, more experience with coronary bypass surgery, valve replacement or repair, ablation for some arrhythmias, intra-cardiac defibrillators, and cardiac transplantation. There are new and better antidepressants, psychotherapists deploy quicker and more effective treatments, more attention is being paid to women's vulvar and vaginal pain during intercourse, and so forth.

The new challenge is to discover a drug that will increase sexual desire. Millions are currently being spent in research to discover that magic pill. Viagra and similar medications have no aphrodisiac properties whatsoever. They are useful to increase excitement, not desire. These are two different things

Norm:

What should someone watch out for after he or she resumes sex (i.e. upon the advice of his or her doctor) after suffering a heart attack?

 Dr. Chapunoff:

There are 3 essential points that patients should be aware of, and the health-care practitioner should be specific about them.

1.       Appropriate timing for resumption of sexual activity

2.       What precautions are necessary?

3.       What are the risks involved (of having a heart attack or dying during intercourse (low, high, intermediate)

1.       Timing: It varies for each patient since there are heart attacks of very different severity, different associated medical conditions, diabetes, hypertension, liver or kidney disease, lung disease, cancer, etc. The patients' age is also different and so are their psychological dysfunctions, the quality of the relationship, and the patient and his/her mate's sexual abilities and compatibilities.

2.       Precautions: The patient should watch for symptoms (e.g., chest pains, shortness of breath, fainting, palpitations) and obtain medical advice before engaging in sexual activity and know what to do if symptoms develop during intercourse. A little angina may just require sublingual nitroglycerin. Severe chest pains may require a 911 call.

Medications should be taken on time. For example, the omission of a beta-blocker prior to intimacy may be hazardous. Palpitations and chest pains may occur when they could have been avoided.

3.       Risks: It is important to classify the patient into risk categories: Recovery following a mild heart attack may carry low risk and no prohibition of sex. On the other hand, someone who recently had severe congestive heart failure may not be able to have sex for an undetermined period of time.

Norm:

I have read that one should avoid sexual intercourse for at least 2-3 hours after eating or after consuming alcohol. Do you agree and why?

Dr. Chapunoff:  

The cardiac patient may prevent a heart event by waiting about 3 hours to have sex after eating. This is the reason: Food in the stomach means an active digestive process. This requires more blood. To provide that blood the cardiac muscle has to work harder, contracts harder, and beats more strongly. In doing so, it requires more fuel. That fuel is provided by blood delivered to the heart muscle by the coronary arteries. If these are diseased, that needed amount of blood can not be supplied to the heart and heart failure or a myocardial infarction may develop.

Alcohol causes cardiac rhythm disturbances (arrhythmias) and an abnormal heart doesn't graciously accept an additional burden. 

Norm:

Is it true that men with chronic heart failure can have active sex lives? 

Dr. Chapunoff: 

Yes, many (not all) of them are able to have sexual activity. However, this kind of patient needs special medical attention and special marital attention. 

The management of congestive heart failure has remarkably improved in the past several years. There are new medications and methods to deal with this condition. The cardiologist should provide the maximally effective therapy. When heart failure is severe, an intracardiac defibrillator or special pacemaker may be required.

Patients with heart failure should generally avoid lying down flat during intercourse. The reason is that fluid tends to accumulate in the lungs while the patient holds this position. It's better to use the kneeling position since the thorax will be positioned vertically. 

Those who enjoy oral genital sex and suffer from a chronically weak heart (man or a woman) will feel more comfortable using this position: While the sexual partner lies in bed, he/she gets close to the end of the bed. The patient is kneeling on the floor placing one or two pillows under the knees to avoid their irritation. The patient's arms, at the same time, should be resting comfortably in bed. The sexual partner gets closer to the edge of bed so the patient can embrace his/her hips and proceed with oral genital contact.

Norm:  

Whom do you think will benefit from reading your book? Why do you think this is an important book at  this time? What are your hopes for this book?

Dr. Chapunoff: 

We must keep in mind that health-care practitioners only have a few minutes to examine their patients. Under those circumstances talking about sex becomes a luxury.

I believe that cardiac patients and their sexual partners would benefit the most from reading this book.  That's why I strongly recommend to those who are interested in becoming familiar with the problems of sex and the cardiac patient to read the book. By doing so, they'll have answers for questions they had for a long time, and nobody ever addressed them.

Physicians, nurses, psychotherapists, sex therapists, and undergraduates of these disciplines would hopefully benefit from it.  This work should also be useful for cardiac rehabilitation centers.

Norm:

Can you explain some of your research techniques, and how you found sources for your book? 

Dr. Chapunoff: 

During the past decade, various authors contributed to a better understanding of cardiac disease and sexual dysfunction. Still, the field suffers from chronic academic neglect. The best Cardiology textbooks barely mention a few lines on the matter. Sex remains a restricted subject. Lots of people, doctors included, prefer to talk about something else. 

The best sources for the book were definitely my patients, but always a selected group of them. Most patients, I insist, are evasive.

Norm:

Psychologically, how important is it to resume sexual activity after one suffers from heart failure? 

Dr. Chapunoff: 

This depends upon several important factors and there's great variability in the way patients react to heart failure. As one would expect, more severe cardiac compromise affects emotionally a person more significantly.

The management of heart failure has improved so much lately that an affected person should try to adopt a positive attitude and be hopeful that the current technology will help him/her a lot. I have a number of patients who suffered from various causes of heart failure and following appropriate treatment, the disturbance became history.

Norm:  

Are there any particular sex positions one should avoid if one suffers from chronic heart failure?

 Dr. Chapunoff:  

I discussed part of this issue in an earlier question and I mentioned that lying flat is not good for these patients  because the lungs get congested and that translates into shortness of breath. I also described a comfortable way to perform oral-genital sex.

Weight matters: A heavy sexual partner who gets on top of a cardiac patient (typical "missionary" position) and presses his/her chest will induce a "choking" sensation on the patient.

Now, if the patient (a male) is using that same position, ("missionary"), will have a tendency to place both of his hands stretched on the bed. This represents a physical effort because both hands will practically support the rest of the body. This can be minimized by placing both hands and forearms on the mattress.

Norm:

How can readers find out more about you? 

Dr. Chapunoff: 

 I suggest readers to visit my website: www.dreduardochapunoff.com 

Norm:

Is there anything else you wish to add that we have not covered and what is next for Dr. Eduardo Chapunoff? 

Dr. Chapunoff: 

Norm, the subject of sex and heart disease is extensive and it's impossible to cover the issues during one interview. You've asked extremely important and pertinent questions and I hope the answers are adequate.

As far as what's next for me, the answer is writing more books.  

I want to add this: I have no words to express my deepest appreciation to you for the enormous privilege of this interview. I wish you the best of health and happiness and continued success.

Norm:  

Thanks once again and good luck with all of your future endeavors.

 To read Norm's Review of Answering Your Questions About Heart Disease & Sex CLICK HERE