Sexual Activity and Cardiac Safety

Energy Expenditure and Cardiac Risk

The American Heart Association and European Society of Cardiology guidelines indicate that sexual activities requiring less than 3 METs pose minimal cardiac risk, making masturbation the safest option for those with cardiovascular concerns 1, 2, 3
Non-coital sexual activities represent the lowest-risk category for cardiac patients, followed by masturbation 3

Low-risk patients, such as those with successfully revascularized individuals, controlled hypertension, mild valvular disease, or heart failure NYHA class I-II, can safely engage in masturbation or other sexual activities without additional cardiac evaluation 4, 5
Intermediate-risk patients, such as those with mild-to-moderate stable angina, recent MI, or heart failure NYHA class III, require exercise stress testing before resuming any sexual activity to ensure they can achieve 3-5 METs without ischemia 3, 4, 5
High-risk patients, such as those with unstable/refractory angina, uncontrolled hypertension, or recent MI, should defer sexual activity until their condition is stabilized and optimally managed 2, 4, 5, 6

The European Society of Cardiology recommends being well-rested before sexual activity to minimize cardiac strain 1, 2, 6
The American Heart Association advises stopping immediately if experiencing shortness of breath, chest pain, or other cardiac symptoms during sexual activity 1, 2, 6
Phosphodiesterase-5 inhibitors are safe and effective for achieving erections during masturbation in cardiac patients, provided they are not taking nitrates 4, 5, 7

For patients with heart failure, the European Society of Cardiology recommends adjusting timing of diuretics and using comfortable positioning to minimize exertion 1, 2, 6
For patients with ICDs, sexual activity including masturbation is generally safe if moderate physical activity does not precipitate arrhythmias 1, 2
The European Association of Urology advises against combining PDE5 inhibitors with nitrates or nicorandil due to life-threatening hypotensive risk 4, 5
The American Heart Association recommends avoiding prolonged application of topical anesthetics, as this can cause penile numbness and loss of erection 8