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The impact of heart failure on the sexual response cycle: A systematic review. Heart Lung 2022; 56:50-56. [PMID: 35709645 DOI: 10.1016/j.hrtlng.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Heart failure (HF) is the most prevalent disease among chronic diseases and has been associated with a high prevalence of erectile dysfunction (ED). OBJECTIVE this study aims to analyze research that has as its object of study the sexual activity of patients with HF. METHODS A high-sensitivity search was performed in databases (PUBMED via MEDLINE, Cochrane, EMBASE, Web of Science, SCOPUS AND CINAHL) using descriptors linked to sexuality and heart failure. RESULTS Fifteen studies from 7 countries with a total sample of 6244 participants were included. CONCLUSION It was identified that patients with HF have alterations in their sexual activities, which are more common in males. Among men, it was noticed that the most reported sexual disorder was erectile dysfunction.
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Silva FH, Veiga FJR, Mora AG, Heck RS, De Oliveira CC, Gambero A, Franco-Penteado CF, Antunes E, Gardner JD, Priviero FBM, Claudino MA. A novel experimental model of erectile dysfunction in rats with heart failure using volume overload. PLoS One 2017; 12:e0187083. [PMID: 29095897 PMCID: PMC5667775 DOI: 10.1371/journal.pone.0187083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/15/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients with heart failure (HF) display erectile dysfunction (ED). However, the pathophysiology of ED during HF remains poorly investigated. OBJECTIVE This study aimed to characterize the aortocaval fistula (ACF) rat model associated with HF as a novel experimental model of ED. We have undertaken molecular and functional studies to evaluate the alterations of the nitric oxide (NO) pathway, autonomic nervous system and oxidative stress in the penis. METHODS Male rats were submitted to ACF for HF induction. Intracavernosal pressure in anesthetized rats was evaluated. Concentration-response curves to contractile (phenylephrine) and relaxant agents (sodium nitroprusside; SNP), as well as to electrical field stimulation (EFS), were obtained in the cavernosal smooth muscle (CSM) strips from sham and HF rats. Protein expression of endothelial NO synthase (eNOS) and neuronal NO synthase (nNOS) and phosphodiestarese-5 in CSM were evaluated, as well as NOX2 (gp91phox) and superoxide dismutase (SOD) mRNA expression. SOD activity and thiobarbituric acid reactive substances (TBARs) were also performed in plasma. RESULTS HF rats display erectile dysfunction represented by decreased ICP responses compared to sham rats. The neurogenic contractile responses elicited by EFS were greater in CSM from the HF group. Likewise, phenylephrine-induced contractions were greater in CSM from HF rats. Nitrergic response induced by EFS were decreased in the cavernosal tissue, along with lower eNOS, nNOS and phosphodiestarese-5 protein expressions. An increase of NOX2 and SOD mRNA expression in CSM and plasma TBARs of HF group were detected. Plasma SOD activity was decreased in HF rats. CONCLUSION ED in HF rats is associated with decreased NO bioavailability in erectile tissue due to eNOS/nNOS dowregulation and NOX2 upregulation, as well as hypercontractility of the penis. This rat model of ACF could be a useful tool to evaluate the molecular alterations of ED associated with HF.
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Affiliation(s)
- Fábio Henrique Silva
- Hematology and Hemotherapy Center, University of Campinas, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Frederico José Reis Veiga
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - Aline Gonçalves Mora
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - Rodrigo Sader Heck
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - Caroline Candida De Oliveira
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - Alessandra Gambero
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - Carla Fernanda Franco-Penteado
- Hematology and Hemotherapy Center, University of Campinas, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Edson Antunes
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Jason D. Gardner
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA, United States of America
| | | | - Mário Angelo Claudino
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
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Danel DP, Siennicka AE, Fedurek P, Frackowiak T, Sorokowski P, Jankowska EA, Pawlowski B. Men With a Terminal Illness Relax Their Criteria for Facial Attractiveness. Am J Mens Health 2017. [PMID: 28625113 PMCID: PMC5675349 DOI: 10.1177/1557988317692504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
According to the life history paradigm, in life-threatening conditions, sexual selection criteria are relaxed in order to increase the probability of a last resort reproduction, ultimately contributing to reproductive success. This should be reflected in loosened mating preferences — a process observed in nonhuman animals. Studies investigating this aspect in humans, however, are scarce. This study explored the aesthetic preferences towards facial and nonfacial stimuli in terminally ill patients with heart failure (HF) and their healthy, same-sex peers. The aim was to examine if these two groups of men demonstrate different patterns of aesthetic judgments. Using a 7-point scale, 65 male patients with HF and 143 healthy men evaluated the perceived attractiveness of 15 photographs (five adult male faces, five adult female faces, and five nonfacial pictures). A mixed-design analysis of variance was run to assess group differences in aesthetic preferences. Compared to healthy controls, stimuli. HF patients rated the pictures using significantly higher scores, but this applied only to male and female, but not nonfacial, stimuli. We propose that lower criteria for facial attractiveness in HF patients are linked to relaxation of mate preferences as a result of a life-threatening conditions, and that this process can be an adaptive mating strategy from an ultimate, evolutionary perspective. However, other mechanisms (e.g., seeking social support) may be also responsible for the observed patterns.
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Affiliation(s)
- Dariusz P Danel
- 1 Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, PAS, Wrocław, Poland
| | - Agnieszka E Siennicka
- 2 Wrocław Medical University, Wrocław, Poland.,3 Clinical Military Hospital, Wrocław, Poland
| | - Pawel Fedurek
- 4 Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | | | | | - Ewa A Jankowska
- 1 Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, PAS, Wrocław, Poland.,2 Wrocław Medical University, Wrocław, Poland.,3 Clinical Military Hospital, Wrocław, Poland
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4
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Fischer S, Bekelman D. Gender Differences in Sexual Interest or Activity among Adults with Symptomatic Heart Failure. J Palliat Med 2017; 20:890-894. [PMID: 28318353 DOI: 10.1089/jpm.2016.0476] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
CONTEXT Problems with sexual function can have a detrimental effect on quality of life. Symptomatic heart failure has been associated with problems with sexual function, although the majority of reports are focused on men and erectile dysfunction. Understanding women's perception of and gender differences in problems with sexual function in heart failure could yield new insights. OBJECTIVES To determine the gender differences in reporting and bothersomeness of problems with sexual function, defined as sexual interest or activity. METHODS Observational, cross-sectional study of adults with symptomatic heart failure from three health systems participating in a clinical trial. Eligible participants completed baseline surveys of symptom prevalence and bothersomeness. Logistic regression modeling was used to identify patient-level factors associated with problems with sexual interest or activity. RESULTS Among 314 patients with heart failure, we found large differences in reporting a problem with sexual function or interest in men (62.4%, n = 154/247) compared with women (37.9%, n = 25/66, p = 0.0004). When the symptom was reported, both men and women found it equally bothersome; 73.4% of men and 64.0% of women responded that this problem bothered them quite a bit or very much (p = 0.33). After adjusting for age, marital status, and income, men relative to women were still more likely to report problems with sexual function (OR 3.5, 95% CI 1.8-6.8). CONCLUSION While men more commonly reported problems with sexual function, both genders were similarly highly bothered by this problem. These findings support the need for further research to assess and manage this symptom in both men and women with heart failure.
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Affiliation(s)
- Stacy Fischer
- 1 Division of General Internal Medicine, Anschutz Medical Campus, University of Colorado School of Medicine , Aurora, Colorado
| | - David Bekelman
- 1 Division of General Internal Medicine, Anschutz Medical Campus, University of Colorado School of Medicine , Aurora, Colorado.,2 Department of Veterans Affairs, Eastern Colorado Health Care System , Denver, Colorado
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Abstract
Sexual problems can affect quality of life of patients with advanced heart failure. At this moment sexual problems in patients with heart failure are described in a few studies, however, no data are available on a European sample. The objective of this study was to report on the occurrence of sexual problems in patients with advanced heart failure and to study the relationship of sexual problems with demographic and clinical variables and overall quality of life. Data of 73 patients with heart failure, (mean age 70 years, 80% male), living with a spouse, collected at 3 points in time were analysed. It was found that symptoms of heart failure do effect the sexual relationships. Patients report marked changes in sexual function as a result of their disease. Even in a recovery period of 9 months after discharge patients report considerable changes in frequency of sexual activity, sexual interest, satisfaction and sexual performance as a result of heart failure. Most patients did not report problems in their relationship as a result of heart failure or as a result of sexual problems. Sexual adjustment was related to functional status, number of co-morbidities and age. Better sexual adjustment was also related to a higher quality of life.
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Affiliation(s)
- Tiny Jaarsma
- Netherlands Heart Foundation, P.O. Box 300, 2500 CH, The Hague, The Netherlands.
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6
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Abstract
Aim: The aim of this literature review was to review and discuss the differences between men and women with heart failure with regard to epidemiology, aetiology, diagnostics, prognosis, pharmacological and non-pharmacological treatment, and the impact of heart failure on psychosocial factors and healthcare utilisation. Method: Two primary health care resources, MEDLINE and CINAHL, were selected to review the current literature. In MEDLINE, 234 abstracts dealing with heart failure and gender/sex were found and in CINAHL, 20 abstracts. Conclusion: Men have a higher incidence of heart failure, but the overall prevalence rate is similar in both sexes, since women survive longer after the onset of heart failure. Women tend to be older when diagnosed with heart failure and more often have diastolic dysfunction than men. The extent of sex differences in treatment, hospital cost and quality of care can partly be explained by age differences. The life situations for men and women with heart failure are different. Physical and social restrictions affecting daily life activities are experienced as most bothersome for men, whereas restrictions affecting the possibility to support family and friends are most difficult to accept for women. Women with heart failure ascribe more positive meanings to their illness. Despite this, women seem to experience a lower overall quality of life than men. The known gender differences in patients with heart failure need to be highlighted in guidelines as well as implemented in standard care.
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Affiliation(s)
- Anna Strömberg
- Department of Cardiology, Heart Centre, Linköping University Hospital, S-581 85 Linköping, Sweden.
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7
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Jaarsma T. Sexual function of patients with heart failure: facts and numbers. ESC Heart Fail 2016; 4:3-7. [PMID: 28217306 PMCID: PMC5292636 DOI: 10.1002/ehf2.12108] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 07/08/2016] [Accepted: 07/19/2016] [Indexed: 12/27/2022] Open
Abstract
Approximately 60% to 87% of patients with heart failure (HF) report sexual problems, and numbers as low as 31% of HF patients younger than 70 have normal sexual function. When compared with healthy elders, the amount of perceived sexual dysfunction might be similar (around 56%), but patients with HF are reporting more erectile dysfunction (ED) and also perceive that their HF symptoms (20%) or HF medication (10%) is the cause for their problems. The prevalence of ED is highly prevalent in men with cardiac disease and reported in up to 81% of cardiac patients, compared with 50% in the general older population. In total 25-76% of women with HF report sexual problems or concerns. The physical effort related to sexual activity in cardiac patients can be compared to mild to moderate physical activity. The related energy expenditure of sexual activity falls in the range of three to five metabolic units (METs), which can be compared to the energy needed to climb three flights of stairs, general housework, or gardening. Information about sexual activity is often overlooked by health care professionals treating HF patients. Advice and counselling about this subject are needed to decrease worries of patients and partners, avoid skipping medication because of fear for side effects, or prevent inappropriate use of potency enhancing drugs or herbs.
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Affiliation(s)
- Tiny Jaarsma
- Department of Social and Welfare Studies, Division of NursingLinköping UniversityLinköpingSweden; Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneVic.Australia
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Steinke EE, Jaarsma T. Sexual counseling and cardiovascular disease: practical approaches. Asian J Androl 2016; 17:32-9. [PMID: 25219908 PMCID: PMC4291873 DOI: 10.4103/1008-682x.135982] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patients with cardiovascular disease and their partners expect health care providers to provide sexual counseling to assist them in maintaining sexual quality of life. Evidence suggests however, that there is a gap in integrating evidence into practice and that relatively few cardiac patients receive sexual counseling. This can result in negative psychological, physical, and quality of life outcomes for couples who may needlessly decide sexual activity is too risky and cease all sexual activity. Two scientific statements now exist that provide ample guidance to health care providers in discussing this important topic. Using a team approach that includes physicians, nurses, physical therapists, rehabilitation staff, and others is important to ensure that sexual counseling occurs throughout recovery. In addition, several trials using interventional approaches for sexual counseling provide insight into successful approaches for sexual counseling in practice. This article provides practical strategies and evidence-based approaches for assessment and sexual counseling for all cardiac patients and their partners, and specific counseling for those with ischemic conditions, heart failure, and implanted devices.
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Affiliation(s)
- Elaine E Steinke
- School of Nursing, Wichita State University, 1845 Fairmount, Wichita, Kansas, USA
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Alves da Silva V, Dantas Cavalcanti AC, Oliveira de Souza R, De Andrade Martins W, Corrêa da Rosa JM. Estudio observacional de validación clínica del diagnóstico de enfermería de disfunción sexual en pacientes con insuficiencia cardíaca crónica. AVANCES EN ENFERMERÍA 2014. [DOI: 10.15446/av.enferm.v32n2.46229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Johansen PP, Zwisler AD, Hastrup-Svendsen J, Frederiksen M, Lindschou J, Winkel P, Gluud C, Giraldi A, Steinke E, Jaarsma T, Berg SK. The CopenHeartSF trial--comprehensive sexual rehabilitation programme for male patients with implantable cardioverter defibrillator or ischaemic heart disease and impaired sexual function: protocol of a randomised clinical trial. BMJ Open 2013; 3:e003967. [PMID: 24282249 PMCID: PMC3845056 DOI: 10.1136/bmjopen-2013-003967] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Sexuality is an important part of people's physical and mental health. Patients with heart disease often suffer from sexual dysfunction. Sexual dysfunction has a negative impact on quality of life and well-being in persons with heart disease, and sexual dysfunction is associated with anxiety and depression. Treatment and care possibilities seem to be lacking. Studies indicate that non-pharmacological interventions such as exercise training and psychoeducation possess the potential of reducing sexual dysfunction in patients with heart disease. The CopenHeartSF trial will investigate the effect of a comprehensive sexual rehabilitation programme versus usual care. METHODS AND ANALYSIS CopenHeartSF is an investigator-initiated randomised clinical superiority trial with blinded outcome assessment, with 1:1 central randomisation to sexual rehabilitation plus usual care versus usual care alone. Based on sample size calculations, 154 male patients with impaired sexual function due to implantable cardioverter defibrillator or ischaemic heart disease will be included from two university hospitals in Denmark. All patients receive usual care and patients allocated to the experimental intervention group follow a 12-week sexual rehabilitation programme consisting of an individualised exercise programme and psychoeducative consultation with a specially trained nurse. The primary outcome is sexual function measured by the International Index of Erectile Function. The secondary outcome measure is psychosocial adjustment to illness by the Psychosocial Adjustment to Illness Scale, sexual domain. A number of explorative analyses will also be conducted. ETHICS AND DISSEMINATION CopenHeartSF is approved by the regional ethics committee (no H-4-2012-168) and the Danish Data Protection Agency (no 2007-58-0015) and is performed in accordance with good clinical practice and the Declaration of Helsinki in its latest form. REGISTRATION Clinicaltrials.gov identifier: NCT01796353.
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Affiliation(s)
- Pernille Palm Johansen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ann-Dorthe Zwisler
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Jesper Hastrup-Svendsen
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health Science, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Frederiksen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jane Lindschou
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Per Winkel
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Gluud
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Center Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
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Verschuren JEA, Zhdanova MA, Geertzen JHB, Enzlin P, Dijkstra PU, Dekker R. Let's talk about sex: lower limb amputation, sexual functioning and sexual well-being: a qualitative study of the partner's perspective. J Clin Nurs 2013; 22:3557-67. [DOI: 10.1111/jocn.12433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Jesse EA Verschuren
- Department of Rehabilitation Medicine; Center for Rehabilitation; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Mariya A Zhdanova
- Department of Rehabilitation Medicine; Center for Rehabilitation; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Jan HB Geertzen
- Department of Rehabilitation Medicine; Center for Rehabilitation; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Paul Enzlin
- Department of Development and Regeneration; Institute for Family and Sexuality Studies; KU Leuven Belgium
- Department of Psychiatry; Context - Center for Couple, Family and Sex Therapy; UPC KU Leuven Belgium
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine; Center for Rehabilitation; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- Department of Oral and Maxillofacial Surgery; University Medical Center Groningen; Groningen The Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine; Center for Rehabilitation; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
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Steinke EE, Jaarsma T, Barnason SA, Byrne M, Doherty S, Dougherty CM, Fridlund B, Kautz DD, Mårtensson J, Mosack V, Moser DK. Sexual counselling for individuals with cardiovascular disease and their partners: a consensus document from the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP). Eur Heart J 2013; 34:3217-35. [PMID: 23900695 DOI: 10.1093/eurheartj/eht270] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
After a cardiovascular event, patients and their families often cope with numerous changes in their lives, including dealing with consequences of the disease or its treatment on their daily lives and functioning. Coping poorly with both physical and psychological challenges may lead to impaired quality of life. Sexuality is one aspect of quality of life that is important for many patients and partners that may be adversely affected by a cardiac event. The World Health Organization defines sexual health as '… a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences ….'(1(p4)) The safety and timing of return to sexual activity after a cardiac event have been well addressed in an American Heart Association scientific statement, and decreased sexual activity among cardiac patients is frequently reported.(2) Rates of erectile dysfunction (ED) among men with cardiovascular disease (CVD) are twice as high as those in the general population, with similar rates of sexual dysfunction in females with CVD.(3) ED and vaginal dryness may also be presenting signs of heart disease and may appear 1-3 years before the onset of angina pectoris. Estimates reflect that only a small percentage of those with sexual dysfunction seek medical care;(4) therefore, routine assessment of sexual problems and sexual counselling may be of benefit as part of effective management by physicians, nurses, and other healthcare providers.
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Steinke EE. How Can Heart Failure Patients and Their Partners Be Counseled on Sexual Activity? Curr Heart Fail Rep 2013; 10:262-9. [DOI: 10.1007/s11897-013-0138-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Driel AGV, de Hosson MJJ, Gamel C. Sexuality of patients with chronic heart failure and their spouses and the need for information regarding sexuality. Eur J Cardiovasc Nurs 2013; 13:227-34. [PMID: 23575920 DOI: 10.1177/1474515113485521] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Psychological and physiological effects of chronic heart failure (CHF) can influence sexuality. Both CHF patients and their partners may experience changes and have questions about sexuality. Despite this, healthcare professionals give little information regarding sexuality. This may be due to the paucity of literature describing patients' concerns and questions about sexuality and CHF. AIMS The aims of this study were to describe the sexuality of patients and their partners and to describe their needs for information regarding sexuality. METHODS A prospective, descriptive cross-sectional design was used. A convenience sample was obtained in three hospitals (Belgian and the Netherlands). Patients and partners completed two questionnaires: Sexual Adjustment Scale (SAS) and the Needs of Sexual Counseling Scale for Chronic Heart Failure (NSCS-CHF). RESULTS There were 52 patients and 32 partners who participated in the study. No or slight disturbance was seen in sexual discussions and intimacy. Marked or serious disturbance was reported in sexual activity. A mixed profile was seen in sexual performance, sexual interest and sexual pleasure. The majority of patients with CHF and their partners want information regarding sexuality. The NSCS-CHF clearly identified the information needs of patients and partners and most needs concerned the areas of symptoms, the relationship and relaxation. CONCLUSION The questionnaires were easy to complete and changes in sexuality and information needs were identified. The NSCS-CHF needs further validation as a research instrument. Healthcare professionals can use both questionnaires to bring up the topic of sexuality and to identify topics that require further discussion or counselling with patients and partners.
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Hoekstra T, Lesman-Leegte I, Couperus MF, Sanderman R, Jaarsma T. What keeps nurses from the sexual counseling of patients with heart failure? Heart Lung 2012; 41:492-9. [DOI: 10.1016/j.hrtlng.2012.04.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 04/10/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
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Hoekstra T, Jaarsma T, Sanderman R, van Veldhuisen DJ, Lesman-Leegte I. Perceived sexual difficulties and associated factors in patients with heart failure. Am Heart J 2012; 163:246-51. [PMID: 22305843 DOI: 10.1016/j.ahj.2011.10.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 10/26/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sexual dysfunction is a common problem of increasing incidence in patients with heart failure (HF). However, there is no knowledge on which demographic, clinical, and quality of life (QoL) aspects are related to difficulties in sexual activity nor on the course of sexual difficulties in patients with HF. METHODS Data on sexual difficulties were collected at 1 and 18 months after an HF hospitalization (n = 792, mean age 69 ± 12 years, 35% female, mean left ventricular ejection fraction 33% ± 14%) by the question on sexuality of the Minnesota living with HF questionnaire. Demographic and clinical factors were assessed from medical records and QoL by Minnesota living with HF questionnaire, Medical Outcome Study 36-item General Health Survey, and Ladder of Life. RESULTS In total, 48% (n = 380) of the patients perceive difficulties in sexual activity at 1 month after discharge, and 70% continued to perceive this at 18 months. Furthermore, 27% of the patients without difficulties at 1 month developed them during follow-up. Living with a partner (OR 3.76, 95% CI 2.58-5.48), younger age (OR 0.96, 95% CI 0.94-0.97)), male gender (OR 3.08, 95% CI 2.10-4.43), overall well-being (OR 1.13, 95% CI 1.00-1.27), and physical (OR 1.06, 95% CI 1.06-1.08) and emotional (OR 1.07, 95% CI 1.03-1.10) QoL were independently associated with perceived difficulties in sexual activity. CONCLUSIONS Perceived difficulties in sexual activity are common in patients with HF, particularly in younger and male patients and continue over time. Patients who perceive difficulties in sexual activity report a significant lower QoL and overall well-being than those who do not.
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Affiliation(s)
- Tialda Hoekstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands.
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Reese JB, Shelby RA, Taylor KL. Sexual quality of life in patients undergoing coronary artery bypass graft surgery. Psychol Health 2011; 27:721-36. [PMID: 22149897 DOI: 10.1080/08870446.2011.623781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Despite improvements in many domains of functioning, sexual quality of life often remains impaired following coronary artery bypass graft (CABG) surgery. This study examined associations among sexual quality of life, fear of sexual activity and receiving information from providers about sexual activity in CABG patients. METHODS Participants completed a survey assessing sexual activity, mental health and physical health at baseline (3-5-day post-surgery; n=60) and 2-month post-surgery (n=42). RESULTS Sexual quality of life showed moderate difficulties at baseline and did not improve by follow-up (p values≥0.09). At follow-up, greater patient fear was associated with lower sexual quality of life in some domains; receiving information was related to lower fear (p values≤0.03) and greater sexual satisfaction and interest (p values≤0.04). Suggestive of mediation, there was a significant indirect effect of information on patient fear and of patient fear on sexual interest (p=0.05). CONCLUSIONS Though data were cross-sectional, findings suggest that fears of sexual activity may play a role in lowering CABG patients' motivation for sexual activity and that receiving information from a medical provider may assist in hastening sexual rehabilitation. Prospective and intervention studies are needed to support findings.
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Affiliation(s)
- Jennifer Barsky Reese
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins University, 5510 Nathan Shock Dr. Suite 100, Baltimore, MD 21224, USA.
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Goossens E, Norekvål TM, Faerch J, Hody L, Olsen SS, Darmer MR, Jaarsma T, Moons P. Sexual counselling of cardiac patients in Europe: culture matters. Int J Clin Pract 2011; 65:1092-9. [PMID: 21923848 DOI: 10.1111/j.1742-1241.2011.02756.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Sexual problems are common amongst cardiac patients, and concerns may arise when resuming sexual activities after a cardiac event. Sexual counselling is therefore indispensible. Culture is an identified barrier to talking about sex, but research is lacking on whether and how culture influences nurses in providing sexual counselling. DESIGN This cross-sectional descriptive study assessed four areas related to sexual counselling provided by cardiovascular nurses. We investigated the impact of culture on these areas by surveying cardiovascular nurses living in Denmark, Norway and two regions of Belgium - Flanders, Dutch-speaking region and Wallonia, French-speaking region. METHODS Overall, 819 participants were recruited as they attended cardiovascular nursing congresses in Denmark, Norway and Belgium. Subjects completed the Undertaking Nursing Interventions Throughout Europe (UNITE) sexual counselling questionnaire, measuring practice, responsibility, confidence and perceived comfort of patients. Controlling for demographic, educational and professional covariates, we performed multiple linear regression analysis to determine the impact of culture on sexual counselling. RESULTS All four subscale scores were independently associated with culture. Danish nurses counselled patients significantly more often, reported feeling more responsibility and confidence and estimated more comfort in patients than Norwegian, Flemish and Walloon nurses. CONCLUSIONS This study showed that culture matters with respect to sexual counselling for cardiac patients. Interventions should be developed improving sexual counselling of cardiac patients. Educational courses and training of healthcare professionals on sexual counselling should be more sensitive to sociocultural differences. Cross-cultural perspectives may bias attitudes of professionals as they deal with concerns of cardiac patients about resuming sexual activity.
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Affiliation(s)
- E Goossens
- Centre for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium
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Dalteg T, Benzein E, Fridlund B, Malm D. Cardiac Disease and Its Consequences on the Partner Relationship: A Systematic Review. Eur J Cardiovasc Nurs 2011; 10:140-9. [DOI: 10.1016/j.ejcnurse.2011.01.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 01/21/2011] [Accepted: 01/21/2011] [Indexed: 11/27/2022]
Affiliation(s)
- Tomas Dalteg
- School of Health and Caring Sciences, Linneaus University, Kalmar, Sweden
- Department of Emergency Care, Emergency Ward, County Hospital Ryhov, Jönköping, Sweden
| | - Eva Benzein
- School of Health and Caring Sciences, Linneaus University, Kalmar, Sweden
| | - Bengt Fridlund
- Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Dan Malm
- Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden
- Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
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Mosack V, Steinke EE, Wright DW, Walker C, Medina M, Moser DK, Chung ML. Effects of Depression on Sexual Activity and Sexual Satisfaction in Heart Failure. Dimens Crit Care Nurs 2011; 30:218-25. [DOI: 10.1097/dcc.0b013e31821b7f63] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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22
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Winter MM, Reisma C, Kedde H, Bouma BJ, Vis JC, Luijendijk P, de Witte P, Zwinderman AH, Vliegen HW, Pieper PG, van Dijk APJ, Mulder BJM. Sexuality in adult patients with congenital heart disease and their partners. Am J Cardiol 2010; 106:1163-8, 1168.e1-8. [PMID: 20920658 DOI: 10.1016/j.amjcard.2010.06.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 06/05/2010] [Accepted: 06/05/2010] [Indexed: 11/17/2022]
Abstract
Data on relational and sexuality issues in adult patients with congenital heart disease (CHD) are scarce. The present study aimed to evaluate relational and sexual behaviors, satisfaction, and functioning in a representative sample of patients with CHD and their partners. In addition, we aimed to evaluate the relation between sexuality parameters and quality of life. Relational and sexuality issues were assessed using a sexuality questionnaire in 133 patients (52% men, 37 ± 13 years old) with CHD (43 with coarctation of the aorta, 42 with transposition of great arteries, 36 with Marfan syndrome, and 12 with Eisenmenger syndrome), and 74 partners. Quality of life was assessed using the Dutch translation of the Medical Outcomes Study Short Form 36-Item Health Survey. Data were compared to an age- and gender-matched control group (n = 3,642). Seventy-one percent of patients with CHD were involved in a relationship, which was significantly less compared to controls (79%, p < 0.05). Nonetheless, patients perceived their relationship as more satisfactory compared to controls (p < 0.05). Overall, sexual satisfaction was equal in patients compared to controls, although they perceived lower body esteem (p < 0.001), decreased sexual esteem (p < 0.05), and more distress during sex (p < 0.001). Patients reported no more erectile and lubrication problems compared to partners and to controls. We found significant associations between most relational and sexual parameters and quality of life. In conclusion, many aspects of sexuality are affected in adult patients with CHD, whereas their partners remain relatively unaffected. Moreover, sexuality is an important aspect of quality of life in these patients. We advise physicians to be receptive to discuss sexuality issues and provide patients with adequate therapy.
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Affiliation(s)
- Michiel M Winter
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
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23
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Abstract
It is increasingly realized that discussing sexuality is an important issue in the holistic care for cardiac patients. In this review article, the conditions of a good assessment of sexual problems are identified such as creating an appropriate environment, ensuring confidentiality, and using appropriate language. Second, we present different styles and approaches that can be used to start the assessment, differing between settings, persons, or disciplines. The PLISSIT (permission, limited information, specific suggestion, and intensive therapy) model can be helpful to initiate discussion about sexuality with the cardiac patient and his/her partner. This model is a stepwise approach using various levels of discussion or treatment. Open-ended question can facilitate discussion about sexual concerns, and validated questionnaires or diaries can be used to assess sexual problems. Patients with sexual concerns and problems should be counseled and/or treated appropriately, and adequate follow-up is needed. Additional training and research are needed to further improve the quality of sexual assessment and counseling in cardiac patients.
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Lindau ST, Gavrilova N. Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of ageing. BMJ 2010; 340:c810. [PMID: 20215365 PMCID: PMC2835854 DOI: 10.1136/bmj.c810] [Citation(s) in RCA: 272] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2009] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To examine the relation between health and several dimensions of sexuality and to estimate years of sexually active life across sex and health groups in middle aged and older adults. DESIGN Cross sectional study. SETTING Two samples representative of the US population: MIDUS (the national survey of midlife development in the United States, 1995-6) and NSHAP (the national social life, health and ageing project, 2005-6). PARTICIPANTS 3032 adults aged 25 to 74 (1561 women, 1471 men) from the midlife cohort (MIDUS) and 3005 adults aged 57 to 85 (1550 women, 1455 men) from the later life cohort (NSHAP). MAIN OUTCOME MEASURES Sexual activity, quality of sexual life, interest in sex, and average remaining years of sexually active life, referred to as sexually active life expectancy. RESULTS Overall, men were more likely than women to be sexually active, report a good quality sex life, and be interested in sex. These gender differences increased with age and were greatest among the 75 to 85 year old group: 38.9% of men compared with 16.8% of women were sexually active, 70.8% versus 50.9% of those who were sexually active had a good quality sex life, and 41.2% versus 11.4% were interested in sex. Men and women reporting very good or excellent health were more likely to be sexually active compared with their peers in poor or fair health: age adjusted odds ratio 2.2 (P<0.01) for men and 1.6 (P<0.05) for women in the midlife study and 4.6 (P<0.001) for men and 2.8 (P<0.001) for women in the later life study. Among sexually active people, good health was also significantly associated with frequent sex (once or more weekly) in men (adjusted odds ratio 1.6 to 2.1), with a good quality sex life among men and women in the midlife cohort (adjusted odds ratio 1.7), and with interest in sex. People in very good or excellent health were 1.5 to 1.8 times more likely to report an interest in sex than those in poorer health. At age 30, sexually active life expectancy was 34.7 years for men and 30.7 years for women compared with 14.9 to 15.3 years for men and 10.6 years for women at age 55. This gender disparity attenuated for people with a spouse or other intimate partner. At age 55, men in very good or excellent health on average gained 5-7 years of sexually active life compared with their peers in poor or fair health. Women in very good or excellent health gained 3-6 years compared with women in poor or fair health. CONCLUSION Sexual activity, good quality sexual life, and interest in sex were higher for men than for women and this gender gap widened with age. Sexual activity, quality of sexual life, and interest in sex were positively associated with health in middle age and later life. Sexually active life expectancy was longer for men, but men lost more years of sexually active life as a result of poor health than women.
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Affiliation(s)
- Stacy Tessler Lindau
- Department of Obstetrics and Gynaecology, University of Chicago, 5841 S Maryland Avenue, MC2050, Chicago, IL 60637, USA.
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25
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Medina M, Walker C, Steinke EE, Wright DW, Mosack V, Farhoud MH. Sexual Concerns and Sexual Counseling in Heart Failure. ACTA ACUST UNITED AC 2009; 24:141-8. [DOI: 10.1111/j.1751-7117.2009.00052.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Apostolo A, Vignati C, Brusoni D, Cattadori G, Contini M, Veglia F, Magrì D, Palermo P, Tedesco C, Doria E, Fiorentini C, Montorsi P, Agostoni P. ORIGINAL RESEARCH—ERECTILE DYSFUNCTION: Erectile Dysfunction in Heart Failure: Correlation with Severity, Exercise Performance, Comorbidities, and Heart Failure Treatment. J Sex Med 2009; 6:2795-805. [PMID: 19674255 DOI: 10.1111/j.1743-6109.2009.01416.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Anna Apostolo
- Istituto di Scienze Cardiovascolari, Università di Milano-Centro Cardiologico Monzino, IRCCS, Milan 20138, Italy
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28
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Gustavsson A, Bränholm IB. Experienced Health, Life Satisfaction, Sense of Coherence, and Coping Resources in Individuals Living with Heart Failure. Scand J Occup Ther 2009; 10:138-43. [DOI: 10.1080/11038120310016120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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29
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Steinke EE, Mosack V, Wright DW, Chung ML, Moser DK. Risk Factors as Predictors of Sexual Activity in Heart Failure. Dimens Crit Care Nurs 2009; 28:123-9; quiz 130-1. [DOI: 10.1097/dcc.0b013e31819af08d] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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30
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Sexual self-concept, anxiety, and self-efficacy predict sexual activity in heart failure and healthy elders. Heart Lung 2008; 37:323-33. [DOI: 10.1016/j.hrtlng.2007.09.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 09/15/2007] [Accepted: 09/17/2007] [Indexed: 11/22/2022]
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Abstract
Little has been published about sexual function in chronic heart failure (CHF) and knowledge among clinicians in this regard is sparse. To review data regarding sexual function and dysfunction in patients with CHF, 2 of the authors (S.A.M. and P.A.U.) independently conducted a literature search using the MEDLINE database. English-language articles and cited bibliographies published between January 1996 and November 2006 were reviewed. Search terms included heart failure or CHF or ventricular dysfunction or heart disease in conjunction with sexual activity, erectile dysfunction, impotence, or sex. Articles were selected for inclusion if they had a primary focus on CHF and sexual function or dysfunction. Critical reviews of the literature, observational studies using self-reported patient surveys, and prospective, blinded, randomized, placebo-controlled trials were included. Articles were not excluded on the basis of patient sample size but were excluded if the article concerned a broad aspect of cardiovascular disease rather than CHF. When properly screened and treated, most patients with CHF can safely engage in sexual activity and be treated for erectile dysfunction with sildenafil, provided that they do not have active ischemia and do not require treatment with nitrates. Clinicians should know the physiological requirements of sexual activity and the impact CHF has on sexual performance. Fear of a cardiac event during intercourse can interfere with patients' ability to perform and enjoy sex, and so it is important that the physician be able to counsel patients with CHF about sexual activity.
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Affiliation(s)
- Stacy A Mandras
- Division of Cardiology, Washington University in Saint Louis, St Louis, MO, USA
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32
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Schwarz ER, Kapur V, Bionat S, Rastogi S, Gupta R, Rosanio S. The prevalence and clinical relevance of sexual dysfunction in women and men with chronic heart failure. Int J Impot Res 2007; 20:85-91. [PMID: 17882230 DOI: 10.1038/sj.ijir.3901613] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Sexual dysfunction is a common problem of increasing incidence that is associated with multiple co-morbid conditions and chronic diseases. In heart failure, however, exact numbers are unknown, in part secondary to under-reporting and under-interrogating by health care providers. A gender-specific questionnaire was modified from established sexual dysfunction questionnaires to correspond to a non-randomized outpatient heart failure population, to assess the prevalence and demographic distribution of sexual dysfunction and potential treatments expectations. One-hundred patients in a stable hemodynamic condition in New York Heart Association classes I-III participated. Eighty-seven percent of women were diagnosed with female sexual dysfunction compared to 84% of men with erectile dysfunction. Eighty percent of women reported reduced lubrication, which resulted in frequent unsuccessful intercourse in 76%. Thirty-six percent of patients thought that sexual activity could harm their current cardiac condition; 75% of females and 60% of men stated that no physicians ever asked about potential sexual problems. Fifty-two percent of men considered sexual activity in their current condition as an essential aspect of quality of life and 61% were interested in treatment to improve sexual function. Sexual dysfunction appears to be high in prevalence in both men and women with chronic compensated heart failure and represents a reduction in quality of life for most. Despite the fact that most patients are interested in receiving therapy to improve sexual dysfunction, treatment options are rarely discussed or initiated.
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Affiliation(s)
- E R Schwarz
- Division of Cardiology, Department of Medicine, Cedars Sinai Medical Center and University of California Los Angeles (UCLA), Los Angeles, CA 90048, USA.
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34
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Schwarz ER, Rastogi S, Kapur V, Sulemanjee N, Rodriguez JJ. Erectile Dysfunction in Heart Failure Patients. J Am Coll Cardiol 2006; 48:1111-9. [PMID: 16978992 DOI: 10.1016/j.jacc.2006.05.052] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 04/26/2006] [Accepted: 05/01/2006] [Indexed: 11/17/2022]
Abstract
Chronic heart failure (HF) and erectile dysfunction (ED) are 2 highly prevalent disorders that frequently occur concomitantly. Coronary artery disease, HF, and ED share several common risk factors, including diabetes mellitus, hypertension, smoking, and dyslipidemia. Additionally, the distinct physiologic sequelae of HF create unique organic and psychologic factors contributing to ED in this patient population. Standard HF therapy with beta-receptor blockers, digoxin and thiazide diuretics may worsen sexual dysfunction owing to medication side effects. This may, in turn, lead to noncompliance in misguided efforts to retain satisfactory sexual activity, with secondary worsening of cardiac capacity. This review describes the unique aspects of ED in the HF population.
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Affiliation(s)
- Ernst R Schwarz
- Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
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35
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Rastogi S, Rodriguez JJ, Kapur V, Schwarz ER. Why do patients with heart failure suffer from erectile dysfunction? A critical review and suggestions on how to approach this problem. Int J Impot Res 2006; 17 Suppl 1:S25-36. [PMID: 16391540 DOI: 10.1038/sj.ijir.3901426] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic heart failure (HF) is an increasingly common cardiovascular disorder. The goal of health-care providers is to optimize quality of life in this population, including sexual health. Up to 75% of patients with HF report erectile dysfunction (ED). As HF is a condition with distinct physiologic sequelae, some unique organic and psychological factors contributing to ED in this patient population have been identified, along with risk factors common to the development of coronary artery disease, HF and ED. This review describes contributing factors to ED in the setting of HF and highlights treatment considerations for this distinct patient population.
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Affiliation(s)
- S Rastogi
- Department of Internal Medicine, Division of Cardiology, The University of Texas Medical Branch (UTMB), Galveston, 77555, USA
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36
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Abstract
Erectile dysfunction (ED) is highly prevalent in patients with chronic heart failure (CHF) and is among the most distressing symptoms in this patient population. Although the safety and efficacy of phosphodiesterase 5 (PDE5) inhibitors in the management of ED have been evaluated in many cardiovascular disease populations, scant data are available in patients with CHF. In published studies, the short-term safety and efficacy of sildenafil in patients with stable mild-to-moderate CHF with ED appears to be comparable to that observed in other populations with cardiovascular disease. Evidence is not available on the effects of vardenafil or tadalafil in CHF. In addition to their benefits in the treatment of ED, preliminary studies suggest that PDE5 inhibitors enhance endothelial function in patients with CHF and have beneficial effects on pulmonary hemodynamics and exercise capacity in patients with pulmonary hypertension. Additional studies are needed to determine the therapeutic potential of this class of agents in these disease states.
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Affiliation(s)
- Milan D Patel
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut 06510, USA
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37
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Molloy GJ, Johnston DW, Witham MD. Family caregiving and congestive heart failure. Review and analysis. Eur J Heart Fail 2005; 7:592-603. [PMID: 15921800 DOI: 10.1016/j.ejheart.2004.07.008] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2003] [Revised: 06/26/2004] [Accepted: 07/12/2004] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is increasing evidence that discharge planning and post-discharge support for CHF patients can contribute greatly to the medical management of heart failure (CHF) in the community and that the quality of the CHF patient's close personal relationships can influence outcome in CHF. However, there has been little research on the impact of CHF on the family or the role of the family in the management of the condition. In this paper, we provide a review and analysis of studies that have explicitly investigated these issues in the informal carers of CHF patients. RESULTS OF THE REVIEW Sixteen papers were identified that examined the role and/or impact of informal caregiving for CHF patients. Our main findings were: demands specific to CHF caregiving were identified, e.g., monitoring complex medical and self-care regimen, disturbed sleep and frequent hospitalisation of patients. Relatively high levels of emotional distress were identified in CHF caregivers. Few studies explicitly investigated the role of informal carers in the management of CHF. Studies were limited in number, scope and quality. CONCLUSION Caring for a family member with CHF can affect the well-being of those responsible for care, which may have consequences for the CHF patient's health. Further studies are needed to clarify these issues and to examine the role of informal caregivers in the management of CHF in the community.
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Affiliation(s)
- Gerard J Molloy
- School of Psychology, University of St. Andrews, St. Andrews KY16 9JU, Scotland.
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38
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Steinke EE. INTIMACY NEEDS AND CHRONIC ILLNESS: Strategies for Sexual Counseling and Self-Management. J Gerontol Nurs 2005; 31:40-50. [PMID: 15916202 DOI: 10.3928/0098-9134-20050501-08] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Individuals experiencing a chronic illness have many needs and concerns. One area frequently overlooked is that of intimacy. Those experiencing cardiovascular illnesses have concerns about the strain of sexual activity on their heart. Individuals with lung diseases may perceive that sexual activity is no longer possible because of breathing difficulties. Accurate information and strategies for self-management are needed to address the intimacy needs and concerns of these individuals. The purpose of this article is to identify intimacy needs and strategies for sexual counseling for individuals with cardiovascular illnesses such as myocardial infarction, heart failure, implantable defibrillators, hypertension, and for chronic lung problems.
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Affiliation(s)
- Elaine E Steinke
- School of Nursing, Wichita State University, Kansas 67260-0041, USA
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39
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Abstract
The incidence of heart failure is increasing because of the progressive aging of the population and improved survival from cardiovascular disease. This article synthesizes the state of the science of nurse sensitive outcomes in heart failure treated medically or surgically and provides recommendations for building the science. Outcomes studied include mortality, morbidity, resource use, quality of life, symptoms, physical function, return to work, and self-care and compliance behavior. Gaps in the literature are identified and recommendations for future research are provided.
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Affiliation(s)
- Christi Deaton
- School of Nursing, Midwifery and Health Visiting, University of Manchester, Manchester, United Kingdom.
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Abstract
OBJECTIVE The purpose of this study was to gain insight from the patient's perspective into how it is to live with moderate chronic heart failure (HF). METHODS Twenty men with moderate chronic HF in New York Heart Association classes II to III, aged 43 to 73 years, were interviewed with open-ended questions. The interviews were analyzed using qualitative inductive content analysis as a method. RESULTS Both the consequences of the illness and how the patients adjusted to them were described in the narratives. The consequences were physical, emotional, cognitive, social, and vocational and included thoughts about death. Adjusting to the illness involved changing one's lifestyle, being aware of one's physical ability and disability, developing psychologic strategies, and adjusting to medication. CONCLUSIONS The findings of this study demonstrate a wider range of disabilities as a consequence of moderate chronic HF and show several more ways of adjusting to the illness than previously reported in men.
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Affiliation(s)
- Eeva Europe
- Department of Physical Therapy, Karolinska University Hospital Huddinge, Stoockholm, Sweden
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41
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Abstract
Disease is commonly associated with sexual dysfunction in both men and women. In many cases, effective treatments are available that can improve libido, erectile dysfunction, and vaginal dryness. Sexual problems in older persons with disease often lead to anxiety, marital discord, and withdrawal. It is the responsibility of all health care professionals to inquire about sexuality in all patients, no matter what the patient's age, and to be aware that frailty [79-81] is not, in itself, a barrier to sexuality. Health professionals need to give education, support, and counseling on sexuality for patients with disease.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, GRECC, VA Medical Center, St. Louis, MO, USA.
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42
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Katz SD. Potential role of type 5 phosphodiesterase inhibition in the treatment of congestive heart failure. CONGESTIVE HEART FAILURE (GREENWICH, CONN.) 2003; 9:9-15. [PMID: 12556672 DOI: 10.1111/j.1527-5299.2002.00288.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Endothelial dysfunction is associated with impairment of aerobic capacity in patients with heart failure and may play a role in the progression of disease. Impaired endothelium-dependent vasodilation in patients with heart failure can be attributed to decreased bioavailability of nitric oxide and attenuated responses to nitric oxide in vascular smooth muscle. Impaired vasodilation in response to nitric oxide derived from vascular endothelium or organic nitrates in vascular smooth muscle may be related in part to increased degradation of the second messenger cyclic guanosine monophosphate by type 5 phosphodiesterase. Sildenafil, a specific type 5 phosphodiesterase inhibitor currently approved for the treatment of erectile dysfunction, has been shown to acutely enhance endothelium-dependent vasodilation in patients with heart failure. Further studies are warranted to characterize the safety and efficacy of type 5 phosphodiesterase inhibition in the treatment of chronic heart failure.
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MESH Headings
- 3',5'-Cyclic-GMP Phosphodiesterases
- Cyclic GMP/metabolism
- Cyclic Nucleotide Phosphodiesterases, Type 5
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/physiopathology
- Enzyme Activation/drug effects
- Enzyme Activation/physiology
- Guanylate Cyclase/drug effects
- Guanylate Cyclase/physiology
- Heart Failure/drug therapy
- Heart Failure/metabolism
- Heart Failure/physiopathology
- Humans
- Muscle, Smooth, Vascular/blood supply
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/physiopathology
- Nitric Oxide/antagonists & inhibitors
- Nitric Oxide/metabolism
- Nitric Oxide/therapeutic use
- Phosphoric Diester Hydrolases/drug effects
- Phosphoric Diester Hydrolases/physiology
- Vasodilation/drug effects
- Vasodilation/physiology
- Vasomotor System/drug effects
- Vasomotor System/metabolism
- Vasomotor System/physiopathology
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Affiliation(s)
- S D Katz
- Yale University School of Medicine, Heart Failure Center, Yale University, 135 College Street, Suite 201, New Haven, CT 06510, USA.
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43
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Evangelista LS, Kagawa-Singer M, Dracup K. Gender differences in health perceptions and meaning in persons living with heart failure. Heart Lung 2001; 30:167-76. [PMID: 11343002 DOI: 10.1067/mhl.2001.114893] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The goal of this study was to determine whether gender differences exist in health perceptions, psychosocial adjustment to illness, and concerns related to illness in patients with heart failure (HF). DESIGN Thirty-two patients (50% women) from a single outpatient HF clinic were asked to complete standardized tools to assess health perceptions and psychosocial adjustment to illness. Open-ended questions were used to obtain data on concerns related to HF. RESULTS The women had higher health perceptions than men did; they also demonstrated better psychosocial adjustment to illness. The qualitative data further suggest that women ascribed more positive meanings to their illness than men did. CONCLUSION The current study underscored the importance of gender differences in health perceptions related to HF. Patient teaching and counseling can be tailored to address the gender-specific concerns of men and women suffering with this condition to improve patient outcomes.
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Affiliation(s)
- L S Evangelista
- California State University, Los Angeles, Department of Nursing, California 91321, USA
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