RECLAIMING MENTAL AND SEXUAL HEALTH AFTER A CARDIAC INCIDENT

1. RECLAIMING MENTAL AND SEXUAL HEALTH AFTER A CARDIAC INCIDENT Dr Marelize Swart Psychologist and Sex Therapist HelderbergMedi-Clinic

2. WELCOME HELDERBERG CARDIAC SUPPORT GROUP!

4. How do I reclaim my sexual self after a cardiac incident? • Sexual activity is a major quality of life issue for men and women with cardiovascular disease and their partners. • Sexuality, including sexual function and the psychological aspects of sexual health, are affected in almost everyone who has had a cardiac incident. • Expect that your body’s response to arousal and stimulation will have changed.

5. How do I reclaim my sexual self after a cardiac incident? • Sexual activity frequency and satisfaction often decline because of anxiety on the part of the patient or partner that sexual activity will worsen the underlying cardiac condition or cause death. • Changes in sexual activity after a cardiac event may impair the patient's quality of life, negatively affect psychological health, and strain marital or other important intimate relationships, which in turn may lead to depression and anxiety. • The resultant depression may be an important contributing cause of ED in men and of female sexual problems, including decreased libido, difficulty with arousal and orgasm, and dyspareunia.

6. How do I reclaim my sexual self after a cardiac incident? • After a diagnosis of cardiovascular disease, it is reasonable for patients to be evaluated by their physician or healthcare provider before resuming sexual activity. • Patients should be assessed to see if their sexual dysfunction is related to underlying vascular or cardiac disease, anxiety, depression or other factors.

7. RECLAIMING SEXUAL HEALTH (cont) • Patients with severe heart disease who have symptoms with minimal activity or while at rest should not be sexually active until their cardiovascular disease symptoms are stabilized with appropriate treatment.

8. SEX AND INTIMACY AFTER CARDIAC INCIDENT • The insecurity, fear and doubt that can arise from this can throw even the most open and loving couples into a tangled web of conflicting emotions. • The most common concern for survivors and caregivers alike is fear of causing another cardiac incident. • Experts agreed that research indicates that it is very unlikely that lovemaking will cause another cardiac incident.

9. RECLAIMING SEXUAL HEALTH (cont) • The absolute rate of cardiovascular events during sexual activity, such as heart attacks or chest pain caused by heart disease, is miniscule because sexual activity is usually for a short time.

10. RECLAIMING SEXUAL HEALTH (cont) • It is often the partner of the person who had a myocardial infarction who is worried about having sex and causing another MI.  

11. RECLAIMING SEXUAL HEALTH - Decreased sexual activity and function are common in patients with cardiac incidents and are often interrelated to anxiety and depression.

12. Cardiovascular events — such as heart attacks or chest pain caused by heart disease – rarely occur during sexual activity, because sexual activity is usually for a short time. • Some patients will postpone sexual activity when it is actually relatively safe for them to engage in it. • On the other hand, there are some patients for whom it may be reasonable to defer sexual activity until they’re assessed and stabilized.

13. RECLAIMING SEXUAL HEALTH (cont) • As long as someone can walk two flights of stairs and has the okay from the doctor they are good to go for having sex. • Men and women with stable CVD who have no or minimal symptoms during routine activities can engage in sexual activity.

14. SEXUALITY • According to a new scientific statement issued by the American Heart Association, it is probably safe to have sex if your cardiovascular disease has stabilized.

15. SEX AND INTIMACY AFTER CARDIAC INCIDENT • Sex is a sensitive subject amongst cardiac patients and their partners as it can cause big changes in the lives of couples who are sexually active. • Cardiac related physiological and psychological changes may affect both sexual desire and performance. • When to have sex? Neither partner should force the issue. You will know when you are ready.

16. WHAT HAPPENED TO DESIRE • Many survivors find that they don’t have much desire for sex because they are so involved in their recovery process. • Or erection difficulties. A number of anti-depressants and blood pressure medicines can reduce libido (sexual desire) and performance (ED).

17. WHAT ABOUT DEPRESSION • Depression often reduces libido, and drugs for depression may also reduce libido. • Careful grooming and attractive clothes can help you feel good about yourself. While this may take extra effort at first, you’ll feel attractive.

18. THE IMPORTANCE OF INTIMACY • Intimacy is very important and we need to get away from the model of heterocentric penis-vagina penetration. • Men with heart problems may have difficulty with erections both due to problems like artherosclerosis and high blood pressure, and the meds used to treat them. • They need to hear that they can still be intimate and not to get discouraged if they are having difficulty with erections.  It's common, talk to doctor.

19. Grieve changes as often as you need to • You will want to take time and grieve: 1) changes in how your body feels & functions, 2) changes in your energy, and 3) changes in your desire, arousal and sensation. • Let go of how you were, and embrace how you are now - a “new normal”.

20. Re-Connect with your Body • Get a manicure or pedicure • Get a full body massage • Move breathe and eat mindfully, noticing every sensation • Connect consciously with the things you love about your body • Find clothing or lingerie that is comfortable and makes you feel sexy and attractive • Learn what feels good now and what kind of touch works best for you. • Do something physical (yoga, walking, sitting in the sunshine and focus on how your body feels as you do it.

21. Communicate with your partner • Sometimes it takes something as life-altering as a cardiac incident to help one realize how important it is to have clear and loving communication in order to keep intimate relationships healthy.

22. FATIGUE • Fatigue is a common problem for survivors and partners. The best time for sex may be after resting or in the early morning. • Perhaps, just to reestablish the relationship, couples should spend time together cuddling and sleeping quietly.

23. “Die Burger” front page article today • A survey by Pharma Dynamics in South Africa reported that the average man in SA has sex 52 times per year versus 100 in other countries. • 22% of the men reported that they only had sex every 3 months. • 16% reported that they were in a sexless (no sex) relationship. • The majority of the men that took part in this survey stated that they had experienced erectile disorder for the previous 5 years without getting treatment for it. ED can be a sign of cardiac problems, high blood pressure, diabetes, etc.

24. YOU HAVE A CHOICE TO BE MORE INTIMATE THAN EVER BEFORE--

25. MOVING FORWARD: INTIMACY TIPS • Take the time and do some work to make sure that you’re both fully communicating with each other: talk, listen, and intentionally move through life together as a team. • Grieve the changes together. • Help your partner get to know your body as it is now as s/he might be afraid too ask.

26. MOVING FORWARD: INTIMACY TIPS • Get to know each other again • Ask what s/he loves about you, mind, body and spirit. • Move forward together and further develop your sense of being a team in this life. • Make time for intimate closeness even if you don’t have the energy for sex.

27. MOVING FORWARD: INTIMACY TIPS • Take some time with your partner to cuddle, touch, and be close in intimate, but not necessarily sexual, ways when you don’t have energy for sex. • This will keep your bond strong, and provide healing touch and comfort for both of you.

28. Permission for self-pleasure • If you are feeling less sexual than your partner, it’s important to give your partner permission to enjoy self-pleasure as part of him or her life. • It is not your responsibility to provide sexual opportunities or release for your partner but is is helpful for to to explicitly give permission for her or him to maintain their own wellness through orgasm and self-pleasure

29. Permission for self-pleasure • One way to provide this kind of permission is to give your partner a pleasure toy, or an erotic book or DVD, with instructions to “PS Enjoy yourself, with love.” • There will be a time when you will want to explore you own pleasure, alone, as you learn how your body has changed and what feels good now, so setting the stage early for healthy self-pleasure can make that more comfortable when it’s your turn.

30. Get to know your sexual “new normal” • Because a cardiac incident can change how your body responds to touch and stimulation, once you feel reunited with your body, it is time for you to explore to see how it works, what feels good, what is not-so-pleasurable, and what kind of touch and mental stimulation work best for sexual arousal and sensation.

31. Be Loving • As a couple you need to be patient, loving and keep humour in the relationship. It is good to set aside a special time for intimacy and sex. Do things that make both of you feel sexy and attractive. Create a loving atmosphere with music, soft lights, candles and by giving compliments to each other. • Having sex is not just about vaginal penetration as much as touching, caressing, kissing, and just showing appreciation for your mate.

32. TALK WITH EACH OTHER • When do you have the energy for sex? • If you have pain or discomfort, what do you need to accommodate that? • What does it take to have an orgasm now? • Take time to explore with yourself so you can share what you learn with your partner. • Create a pleasure map for your partner (and have him/her do the same for you) showing what kind of touch you like and where, and showing where the “no go” zones are now.

33. Practice communicating and negotiating around sex • It’s always a good idea to be able to communicate explicitly about what you like and want; but after a cardiac incident it is even more important to do so. • Practice asking for what you want, planning together to enjoy intimacy at times when you have the most energy and interest. • Make conscious “sex dates” so intimate play doesn’t get left out of your life altogether.

34. Explore new ways to make love • It won’t be the same as it was before, and with some creativity and learning, it can be even better and more intimate than before the cancer. • Pleasure each other without having intercourse. • In stead, become accustomed to Outercourse. Enjoy the sensations. Take your time. Be less goal-oriented.Get creative and experiment with new positions and places.

35. Use tools and enhancements when you need them  • Lubricant • Vibrator for helping with arousal, sensation and orgasm • Vibrating massage wand for vaginal health and renewal • Kegel exercises to help keep your pelvic floor strong and flexible • Penile rehabilitation devices for erectile dysfunction

36. Facts about Intercourse • Cultural attitudes have led most people to think of intercourse -- ending in orgasms for all parties -- as the be-all-and-end-all of sexual activity, in spite of the fact that most women can’t orgasm through that method alone. • This leaves many people who are unable to participate in that activity feeling cheated or downright defective because they cannot provide what is viewed by many as the ultimate act of love and pleasure. It also negates the intimacy non-penetrative acts provide.

37. Outercourse • Fortunately, for couples who cannot have intercourse, whether it’s caused by health issues, like erectile dysfunction or painful sex, , there are plenty of alternative activities that simulate the feel and closeness of intercourse. • We call that Outercourse.

38. Outercourse -- What is it? • Outercourse is creative sex play that is not limited to, or focused on intercourse. It can include any sexual activities you and your partner enjoy, and can lead to anything you both agree to. It can be “the first course,” “the last course,” “the main course,” or “the only course!”

39. Outercourse: a good choice if you or your partner… • has trouble maintaining an erection • has pain with penetration, or do not enjoy penetration • has trouble reaching orgasm/ejaculating during intercourse • has performance anxiety • want to postpone intercourse, and still enjoy intimate play together .

40. GETTING STARTED • Start slowly, perhaps just be being close and cuddling. Explore what feels good to you now. Tell your mate what pleases you – he or she cannot read your mind. • Intercourse may not happen at first, so just relax and focus on the intimacy that you are building together • Add intercourse only if and when you both feel ready.

41. A playful attitude and adventurous spirit are the best assets you have when it comes to sex, second only to a genuine affection for your partner. The right attitude can make any activity or technique full of pleasure and fun.

42. Sex can easily become serious business if you see it as a race to the finish line, or a performance that must play out in a particular way each time. • We all experience busy or stressful times, illnesses, and other circumstances that force changes in intimacy or physical response. • Flexibility and a sense of humor can help you weather these changes.

43. Broadening your idea of what good sex consists of, and exploring ways to create as much pleasure as possible for you and your partner, will take the focus off of what you can’t, or choose not to do.

44. Instead you can keep your attention on creating pleasure and deepening your intimate connection with each other. As an added benefit, expanding your sexual repertoire will increase the fun you can enjoy during sex play.

45. Getting Started and Building Anticipation • Agree that neither of you will aim for orgasm; your only goals will be giving/receiving pleasure and having fun together. • You can decide some activities are off-limits, or set no limits, but DON’T set orgasm as the end point. • One or both of you may have an orgasm, but it’s not required. This can relieve performance pressure while allowing you to explore activities you might have otherwise missed, If you enjoy this, you can make try it whenever you want to build your connection and anticipation.

46. Getting Started and Building Anticipation • Make out during a movie with no pressure to go any further, or skip the movie and revisit heavy petting on the couch. • Keep your clothes on much longer than you want to, or keep them on all evening. • See how much fun you can have undressing slowly when the time comes, or touching each other through your clothing.

47. Add some more advanced communication skills • Try asking your partner for permission before every action or touch. Only touch when and where your partner allows. • After asking "may I touch your...?”Follow it up with “Did you like that? Would you like me to do it some more?" If so, try “May I kiss your...?".

48. Hand or Foot Massage • Another version is to give a hand or foot massage but only touch in the exact manner your partner requests. Your goal is that you are both able to ask for specific kinds of touch in specific places. Then you’re ready to move on to other erogenous zones.

49. Communicate more about intimacy • Practice talking about intimate play more often, explicitly asking for what you want as well as asking your partner what she or he would enjoy doing.

50. By improving your non-sexual intimacy – hugging, laughing, having fun – can really improve your sexual intimacy • It is important to focus on what you have, not what you have lost.