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HEART ILLNESS AND INTIMACY: SEX AND HEART ILLNESS

One of the many psychological dramas involved in coping with heart disease may surprise you: from the earliest moments following a heart attack, many patients begin worrying about future effects on their sexual abilities. That's right, many people—both men and women—lie on that emergency room bed with a pain in their chest and tears in their eyes and wonder if they will still be able to do "it" like they used to.
Research has suggested that somewhere between 20 percent and 40 percent of heart patients may experience periods of impaired sexual functioning. Research further suggests that an even higher percentage of spouses of heart patients experience anxiety about sex. Many cardiac couples undergo long-term sexual adjustment struggles. Lessened sexual drive for both males and females, impaired ability to get or maintain erections for men, and diminished sexual arousal for women are but a few of the sexual difficulties that can plague couples following heart illness.
But citing data is unnecessary in discussing sexual aspects of cardiac rehabilitation. The fact is that intimacy is our most basic psychological need, and marital intimacy is directly related to sexual intimacy in many ways. Most cardiac patients and their spouses have questions about sex after heart illness. I hope to answer these questions here.
The self-questioning and fears that inevitably come with facing heart disease can seriously erode the many "flavors" of intimacy in your marriage, especially the wonderful flavor of sexual relating. Add to this the fact that much of self-concept is tied to sexuality, and the importance of this topic is obvious.
We are taught from our earliest days to define ourselves as sexual beings. I am not referring to genital sexual experience; I will get to that topic soon. Here, I am referring to our most basic sense of us as being male or female persons. We are taught to value and to evaluate ourselves from this perspective of sexuality. We think of and speak of ourselves and of each other in such terms as, "He's a man's man," or "She's a sexy woman," or "He has those bedroom eyes," or "She has a beautifully feminine figure."
The confusing irony is that, although we are so obviously taught to value ourselves as being sexual, we are taught virtually nothing about how to understand and enhance our sexual functioning. This lack of accurate information about what to expect of ourselves and of each other within the sexual realm is the major cause of the two culprits that typically underlie sexual performance difficulties: performance anxiety and relationship tensions.
I have often counseled couples who have endured years of marital tension and self-doubt because they had mistaken assumptions about what is normal versus abnormal sexual behavior. I have also noticed that sexual miseducation is not necessarily correlated with formal educational level. Many otherwise well-educated people are simply misinformed, or not at all informed, about medical sexual facts.
Our relative ignorance about sex is understandable when you realize that courses in human sexuality were not taught in medical schools until relatively recent years. In fact, extensive education in human sexual functioning is still not part of most medical school curricula. We have all been doing "it" in the dark in more ways than one. It seems par for the course of rehabilitation that heart patients and their spouses grapple with concerns about their sex life in silence and confusion. Heart patients are notorious for going to their doctors and remaining quiet about their sexual concerns. They then interpret thedoctor's silence on this issue as confirmation of their worst fear: that pleasurable lovemaking has to be given up now that heart illness has arrived.
This is simply not the case. Often, doctors are merely unaware of the patients' sexual concerns. Perhaps they do not give the go-ahead because they are not asked. So it is time to get some facts straight. The first important fact to remember is that heart illness does not have to end full and enjoyable sexual functioning. More than 80 percent of heart patients are capable of full sexual functioning without any particular physical risks or cardiovascular complications. The other 20 percent of heart patients can also enjoy active sex lives; they may simply need to adjust their lovemaking styles because of physical changes caused by illness, medication, or aging. The question, of course, is what can be done to continue—or perhaps to create for the first time—a comfortable sexual relationship? The following pages will answer this question.
First, I discuss the problem of differences in levels of sexual drive that plague many couples. Then I outline the various types of sexual dysfunctions that can occur in the normal course of any marriage. Finally, I discuss in detail the critical factors for enjoying your sex life now that you are undergoing cardiac rehabilitation.
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EPILEPSY AND PREGNANCY

Women with epilepsy are quite often concerned about getting pregnant. There appear to be five reasons for this concern. They wish to know:
if they are likely to hand their epilepsy on to their children;
whether their fits will get worse during pregnancy;
whether it is safe for the baby that the mother should take anticonvulsants drugs during pregnancy;
if there will be any problems in the newborn baby from these drugs;
if they can safely breast feed the baby.
With regard to handing on epilepsy to one’s children – as mentioned earlier, if one parent has epilepsy, the chances of one of the children having epilepsy are no greater than in the population at large. If both parents have epilepsy, it would appear that the risk of a child having epilepsy is about 10 per cent. So in fact the chance of a child inheriting epilepsy, particularly idiopathic epilepsy, is negligible.
As far as seizures during pregnancy are concerned, the situation is not as clear as it might be. There is evidence that for some women, seizure control may deteriorate, while for others there may in fact be no change or even an improvement. A patient told me recently that “she would like to remain pregnant forever” as she had not had a single fit during her pregnancy, compared with six fits in the preceding nine months!
As a general working rule, it is suggested that people who have more than one grand mal fit a month are those who are most likely to have a deterioration in seizure control during pregnancy. The deterioration, if it occurs, is most likely during the first three months of pregnancy. There are a number of theories why this may happen, but none has been proved. It may be of value to check the blood anticonvulsant levels during pregnancy, especially if there is a deterioration in seizure control. The blood levels may fall, necessitating an increase in dosage during the pregnancy.
The main concern for parents is whether the anticonvulsants can harm the unborn baby (foetus). It is known by most people with epilepsy that this is a potential hazard. The effects include physical abnormalities in the baby, a process known as teratogenesis. Abnormalities have been reported in the offspring of mothers on all the commonly used anticonvulsants with the exception of carbamazepine. This is particularly applicable to phenytoin, barbiturates and sodium valproate. Babies born to mothers who have been on carbamazepine have not been shown to have any physical abnormalities, but have a smaller head size than other babies. This has not been shown to be any handicap to the babies who have been followed up for five years.
The risk of abnormalities in the baby is difficult to assess, but it seems to be most common in mothers on polytherapy (receiving numerous drugs), especially if they are on three or more anticonvulsants. The risk in mothers on phenytoin, with or without other medications, appears to be about a 10% chance of the baby showing features of the ‘foetal hydantoin’ syndrome. This syndrome consists of cleft palate, abnormalities of the fingers, possible heart abnormalities and mild mental retardation. Thus, at present, if it is possible, it would seem wise to try to change patients over to carbamazepine before conception. This may not be possible in all patients and, of course, many women will first visit their doctor when already pregnant, at which time there is no purpose in making the change.
Anticonvulsants taken by the mother during pregnancy may have some effects on the baby immediately after birth, as they are transmitted to the baby across the placenta. These include the possibility of a mild bleeding tendency and some drowsiness. In mothers who have been taking barbiturates, the infant may occasionally show features of a withdrawal reaction with irritability, jitteriness and poor sucking. None of these features is [...]

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