[Cardiac rehabilitation and resuming sexual activity]

Sexual function is an important component of cardiac patients' quality of life and subjective well being. Patients, however, are often uninformed regarding the question of resuming sexual activity after a cardiac event. Recent epidemiologic data reveal that sexual problems are widespread and adversely affect mood, well-being, and interpersonal functioning Erectile dysfunction (ED) is the most commonly recognized and treated sexual dysfunction. It affects > 30% of men 40 to 70 years of age and its prevalence in patients with cardiovascular disease is higher than in the general population. International Guidelines has faced the problem of resuming sexual activity after a cardiac event and of the eventual suitability to the use of sildenafil or other selective inhibitor of cGMP-specific phosphodiesterase type 5 (5-PDE) for the therapy of ED in these patients. The clinical judgment should be based on the integration of clinical and instrumental data, on the evaluation of the compatibility with the foreseen energetic cost of the effort connected to sexual activity and, in case of prescription of 5-PDE inhibitors, on the eventual incompatibility with the therapy undertaken (in particular with nitrates). In the review the main reference points of literature are supplied in order to have the chance of giving motivated technical advice. Finally it is extremely important to face the problem of resuming sexual activity systematically within the cardiac rehabilitation program, with educational sessions, individual or couple conversations, and with the aid of information pamphlets.