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Contempo Updates | Clinician's Corner

Sexual Activity in Patients With Angina

Robert F. DeBusk, MD
JAMA. 2003;290(23):3129-3132. doi:10.1001/jama.290.23.3129.
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Coital angina is angina that occurs during the minutes or hours following sexual activity. More than 6 million individuals in the United States experience angina pectoris.1 Coital angina appears to represent less than 5% of all anginal attacks. For various reasons, fewer middle aged or older women engage in sexual activity than age-matched men.2 Accordingly, the prevalence of coital angina is higher in men than in women. The comparative physical demands of sexual activity in men and women are unknown. Frequency of coitus diminishes with age in both women and men,2 especially after the onset of coronary artery disease, which occurs some 10 years later in women than in men.1

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Figure 1. Stepwise Risk Stratification and Patient Management
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Adapted with permission from DeBusk et al.11 Stratification of risk is a 2-step process: clinical evaluation permits identification of low- and high-risk individuals; specialized cardiovascular assessment permits individuals at intermediate clinical risk to be restratified into low- or high-risk categories. Low-risk patients identified at either step can initiate or resume sexual activity or be treated for sexual dysfunction. High-risk patients identified at either step should defer sexual activity until the cardiac condition is stabilized.
Figure 2. Management of Coital Angina
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Individuals with coital angina who have taken a phosphodiesterase-5 (PDE-5) inhibitor prior to sexual activity should avoid nitrates and call for emergency assistance. Patients who have not taken a PDE-5 inhibitor can take nitroglycerin according to American Heart Association guidelines.15 Patients whose coital angina persists despite nitroglycerin should call for emergency assistance.

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