DRHOOK- Different strokes: Exercise your way to better sex

the handsome doctor John Hong of Charlottesville

Sex after marriage is something we've all heard about– and most have ignored. Sex after heart attack? Now that's a million dollar question. 

In The Wrestler, Mickey Rourke has a massive heart attack. (I still can't believe that's the same actor who seduced Kim Basinger in Nine ½ Weeks. It's like he entered a witness protection program! He looks completely different!) Rourke's character is truly affected by this heart attack, and his doctor tells him he can't "throw down" anymore. 

Can sex really give you a heart attack?

The answer is yes– well possibly. Sex is work– not in the prostitution or porn industry sense. Sex is equivalent to normal exercise when it comes to raising blood pressure and heart rate. I find this very interesting: people are studied having sex in the laboratory. Talk about test tube babies!

One study showed that during orgasm, heart rates increase to 140-180 bpm, and blood pressure increases by 80/50 points. Breathing rate also increases to the equivalent of doing moderate to severe physical exertion. (Though if you fake it, is it more like sitting on your couch, eating bonbons, and watching an aerobics video?)

Married couples at home, though, were found to have heart rates more around 117 bpm during orgasm, which is lower than while doing normal daily activities. So most likely blood pressure and heart rate during intercourse and orgasm are equivalent to mowing the lawn or carrying things up and down the stairs. 

For people with chronic stable angina (heart disease is under control, but chest pains occur with exertion), about 65 percent experience angina that interrupts sex. "Not tonight honey; you're giving me angina.")

Heart attack usually occurs within the first two hours of orgasm (which is a big reason smoking after sex is a no-no). However, overall, the increased risk of a sex-induced heart attack is pretty tiny, maybe less than one percent. Anger, stress, and physical exertion are the main causes of acute heart attack.

 Studies do show sedentary people (with or without known heart disease) are more likely to have a heart attack after sex than those who exercise regularly. The more often a person exercises a week, the less likely a sex-induced heart attack will occur. 

High-risk patients are most susceptible to heart attack after sex. Having had a heart attack in the previous two weeks, unstable angina, uncontrolled hypertension, bad congestive heart failure, high risk arrhythmias, hypertrophic cardiomyopathy (something that affects younger people), and significant heart valve disease all fall under high risk for sex-induced heart attack.

Within six weeks of having had a heart attack, the cardiologist usually does heart studies. Based on these results, the cardiologist can tell the patient if making whoopee will be yippee or not.

Regular, consistent exercise does improve sexual performance and endurance, besides decreasing the chances of angina during sex or heart attack afterwards. Think about this using the MET, the standard medical measure of metabolic oxygen.

One MET is how much oxygen you use in a sitting position. 3-4 METS is walking 2-4 mph on a level surface. Sex is about 2-3 METS, and orgasm is 3-4 METS. So, the longer and faster you are able to walk, the more energy you will have during sex.

I can't tell you how many of my overweight, inactive patients tell me they poop out during sex. And just lying there doesn't improve anything. Studies have shown lying on the back doesn't decrease heart rate or blood pressure during intercourse or orgasm. (Though Joan Rivers joked she watches QVC during sex, so maybe she's the exception to the rule.)

So a person who gets wiped out during sex and has a hard time getting through it might want to see a doctor. A heart attack could be looming, and that person would never see it coming.