Working around health issues and sex

Studies show that regular sex is a significant health booster for men. But as men age, health issues can become a barrier.

While specific problems can affect men's sexual performance and stamina, it's how they respond to these obstacles that can pose the greatest challenge.

"The most important sex organ rests on your shoulders," says Dr. Michael O'Leary, professor of surgery at Harvard Medical School and director of Men's Health at Harvard-affiliated Brigham and Women's Faulkner Hospital. "Worrying about how conditions may cause physical limitations or possible health risks during intimacy can make sex stressful and less enjoyable."

What can you do? Here's a look at three common sex-related worries and how to counter them.

Heart disease

Men with heart disease often have one concern in the bedroom: will sex cause a heart attack?

The good news: it's highly unlikely. For men with heart disease, the odds of suffering a heart attack during sex is estimated at 1 in 50,000, according to some estimates.

"The risk is so low because the actual physical exertion from sex is quite small and lasts only a brief time," says Dr. O'Leary.

For instance, walking up two flights of stairs requires about 5.5 metabolic equivalents, or METs. (METs are one way to measure your body's energy expenditure.) Sexual activity averages between 2 and 4 METs, which is equal to brisk walking or doing housework like cleaning and sweeping.

This is why the "flights of stairs" test is used to gauge whether it's safe to have sex, especially after a heart attack. "If you can walk up two flights with no chest pain, labored breathing, lightheadedness, or extreme fatigue, you are good to have sex," says Dr. O'Leary.

Keep in mind that if you take a heart medication containing nitrates, like nitroglycerin or isosorbide dinitrate, check with your doctor before taking any erectile dysfunction drug. Combining them can make blood pressure drop dangerously low.

Arthritis

The pain and stiffness of arthritis sometimes interferes with intimacy. Trying different positions can help you work around any limitations. For example, people with arthritis in the hips, knees, or spine often find sex more comfortable when both parties lie on their sides.

Taking a pain reliever or a long, warm shower an hour before sex can ease muscle and joint stiffness. You can also place support under your joints to alleviate pain. Pillows work well, or you can get special angled wedges and cushions at medical supply stores and online.

Also, consider scheduling sexual activity when flare-ups are less likely — for instance, if pain is worse in the morning, plan on a romantic afternoon instead.

Chronic back pain

Back pain can make sex uncomfortable, and flare-ups sometimes strike at the wrong time. Here are a few ways to navigate around this problem:

• During sex, avoid bending your spine backward. Instead, try to keep it straight or bent slightly forward.
• During sex, avoid lying on your stomach or your back with your legs flat on the bed and extended straight out. If you can, try to keep your hips flexed, which can take some pressure off your lower back. Placing pillows under your thighs or knees also might help.
• Try sexual positions that are easier on your back, such as lying on your side with your hips and your knees slightly bent.
• Be reasonable and gentle. Don't aim for prolonged, vigorous lovemaking if your back is bothering you.
• Be patient and don't try to resume sex too soon after a backache. If you find that your back hurts when you continue sexual activity, wait a few days before trying again.

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