Men's Health: Sexual Life Guidance for Patients with Coronary Heart Disease and Diabetes—Safety Principles and Rehabilitation Suggestions

Sexual Life of Patients with Chronic Diseases

Many chronic diseases can lead to disability. For example, diabetic retinopathy can cause blindness, diabetic neuropathy can cause lower limb paralysis, and diabetic gangrene can cause limb amputation. Hypertensive patients may experience hemiplegia or aphasia due to cerebral hemorrhage or thrombosis. Rheumatic heart disease can cause embolisms in any part of the body, such as cerebral infarction or limb arterial embolism. All these diseases and complications can affect quality of life to varying degrees. Besides physiological and anatomical dysfunctions, complex psychosocial problems can also arise. These can directly and indirectly affect sexual function, even leading to sexual dysfunction. For example, diabetic patients may experience erectile dysfunction due to pathological changes in nerves and blood vessels. Joint diseases often restrict sexual activity due to limitations in posture and movement, while cardiovascular diseases can cause significant psychological burden, leading to reluctance to engage in sexual activity. Furthermore, many medications are required for disease treatment, some of which can significantly affect sexual function, causing decreased libido and erectile dysfunction.

1. Coronary Artery Disease (CAD)

CAD is short for coronary artery disease. It refers to a series of abnormal clinical manifestations related to cardiac function caused by myocardial ischemia and hypoxia due to coronary artery sclerosis. Because of coronary artery occlusion and interruption of blood flow, myocardial ischemia and even necrosis occur, this pathological change severely affects cardiac function and can even lead to unexpected heart failure or sudden cardiac arrest and death at any time. This situation is a powerful psychological stimulus for patients. Under the influence of these adverse factors, patients are anxious and restless. Even after their cardiac function returns to normal, they cannot shake off the shadow of the malignant stimulation of the disease, fearing that sexual arousal and activity will trigger a recurrence of myocardial infarction, or even lead to sudden death. Therefore, most patients experience a significant decrease in libido and sexual interest after recovery. Some statistics show that approximately 60% to 75% of male CAD patients experience a significant reduction in sexual activity, less than half the frequency before the disease, and avoid sexual activity as much as possible due to perceived physical weakness and discomfort. This is a self-protective psychological state after recovering from illness. However, this state is not entirely normal. These patients worry that sexual activity will increase the burden on the heart and the body's oxygen consumption, but there is no evidence of this in hemodynamic studies. Some studies have concluded that for middle-aged men, the physical exertion of sexual activity between spouses is equivalent to a relatively small physiological expenditure in a resting state, with oxygen consumption equivalent to climbing four flights of stairs, similar to a light walk. However, sexual activity between non-spouses may generate higher levels of tension and greater oxygen consumption, which can have a more serious impact on the recurrence of heart disease.

Due to differences in patients' physical condition, disease severity, treatment history, personality traits, marital relationship, and sexual activity style, post-recovery sexual activity will also vary. It is generally believed that, without complex complications, patients can gradually return to their pre-illness level of sexual activity during the recovery process. Patients who, through gradually increasing physical exercise, do not experience tachycardia or palpitations, have a good chance of returning to their pre-illness level of sexual activity. Of course, after recovering from a myocardial infarction, due to limitations imposed by the disease and physical strength, sexual activity must be moderate. Avoid strenuous movements and extreme excitement, and limit the duration; it should be gradual and slow. Change positions that require effort from both partners. Generally, the side-lying position is considered less strenuous and suitable for recovered patients. Furthermore, choose an appropriate time for sexual activity, avoiding situations such as after a large meal, drinking alcohol, or fatigue, as these increase risk factors. If chest tightness or discomfort occurs during sexual activity, stop immediately and seek medical attention promptly.

In addition, clinically, it is frequently observed that many patients with erectile dysfunction develop myocardial infarction or are diagnosed with coronary heart disease on electrocardiograms shortly after experiencing sexual dysfunction. Many patients with coronary heart disease and myocardial infarction also have a history of erectile dysfunction or complete inability to achieve an erection several months prior to the infarction. Why is this? Many people find it difficult to understand. In fact, the simultaneous or sequential occurrence of these two clinical phenomena is entirely theoretically sound. Every organ in the human body requires sufficient blood to deliver adequate oxygen and nutrients during its physiological processes; otherwise, it cannot maintain normal function. When the blood vessels supplying a particular organ undergo pathological changes, such as hardening, decreased diastolic tension, or occlusion, resulting in insufficient blood supply, it will cause a decline in the organ's function and lead to serious abnormalities. Coronary heart disease is caused by narrowing, hardening, blockage, or interruption of blood flow in the blood vessels supplying the myocardium on the surface of the heart, leading to myocardial ischemia.

Erectile dysfunction has many causes, but decreased vascular function is one of the important factors. When the arteries supplying the penis undergo pathological changes, such as hardening or occlusion, insufficient blood supply can occur when an erection is needed, resulting in insufficient filling of the corpora cavernosa and inability to achieve an erection. Therefore, the pathogenesis of both coronary heart disease and vascular erectile dysfunction involves problems with blood supply. Whether coronary heart disease or erectile dysfunction occurs first depends on the severity of the vascular lesions supplying these two organs. If the penile artery pathology is severe, erectile dysfunction will occur first. Then, after a certain period, when the pathological changes in the coronary arteries reach a level sufficient to affect cardiac function, symptoms of coronary heart disease will appear. Therefore, for middle-aged and elderly people, if they experience erectile dysfunction or poor erection, it is best to proactively consult a doctor and, if necessary, have an electrocardiogram (ECG) to detect problems early and receive timely treatment, avoiding delays in heart disease management.

2. Diabetes

Diabetes is a common endocrine disease with a genetic predisposition. It is caused by absolute or relative insulin deficiency, characterized by impaired glucose metabolism, clinically presenting with symptoms such as polyuria, polydipsia, polyphagia, and weight loss. In severe cases, ketoacidosis can occur.

Diabetes can cause various sexual dysfunctions. The main reason is that long-term glucose metabolism disorders lead to lipid metabolism disorders, causing functional changes in nerves and blood vessels. Nerve conduction disorders and lipid deposition in blood vessels narrow the lumen, resulting in insufficient local blood supply. These are the main pathological changes causing erectile dysfunction in diabetes. Erectile dysfunction associated with diabetes can occur at any age, mainly depending on the degree of impact of the metabolic disorders caused by diabetes on local nerves and blood vessels. The more severe the impact, the earlier the onset and the more obvious the symptoms of erectile dysfunction. According to literature, the incidence of erectile dysfunction in diabetic patients aged 20-30 is 25%-30%; in patients over 50, the incidence is 50%-70%; and in patients over 60, 75% experience erectile dysfunction. Of course, the higher the age, the higher the incidence, which is also related to the decline in gonadal function with age. Most patients develop erectile dysfunction several years after the onset of diabetes. Initially, it manifests as decreased penile erection hardness and shorter duration, but sexual intercourse can still be completed. Later, erectile dysfunction gradually develops, making sexual intercourse impossible. However, some people experience sudden erectile dysfunction, which is mostly caused by sudden occlusion of local blood vessels or blockage of nerve conduction due to disease.

Mild erectile dysfunction caused by diabetes can be treated with vasodilators, aphrodisiacs, physical therapy, and psychological counseling to restore sexual function. If necessary, pudendal artery angiography can be performed to identify the location and degree of vascular stenosis, and local catheter dilation can be used if possible. We encountered a diabetic patient who came to the hospital for treatment due to pain in the left lower limb. We suspected it was caused by insufficient blood supply to the left lower limb arteries. Iliac artery angiography showed that the patient had stenosis of the left common iliac artery, resulting in insufficient blood supply to both the left lower limb arteries and the pudendal artery. Catheter dilation was immediately performed to restore the stenotic area to normal width, ensuring smooth blood flow. After the dilation treatment, the pain in the left lower limb disappeared. The patient reported that after more than a year without erection, his penis regained erectile function. This is a typical case of erectile dysfunction caused by insufficient blood supply; after the stenosis was relieved and blood flow was restored, erectile function also recovered.

3. The Impact of Other Chronic Diseases on Sexual Life

Chronic diseases and their treatment can both affect the sexual function of some patients to varying degrees. Aside from physiological and anatomical issues, most sexual dysfunctions in patients are caused by psychological factors. Lack of medical knowledge, being bound by traditional beliefs and prejudices, and not receiving necessary psychological comfort and encouragement are important reasons why some people are unable to resume normal sexual activity for a long time after recovery. Many patients recovering from life-threatening illnesses, along with their partners, often fear that sexual activity will cause or worsen their condition, thus developing a fear of sex. This situation often exists not only during illness but also after the disease is cured and recovered. Patients with chronic diseases and those in the recovery period should understand that appropriate sexual activity can be beneficial to recovery. To alleviate psychological fear and stress, appropriate sexual activity is permissible as long as it does not affect health and disease treatment. The key is to maintain the standard of "moderation."