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How risky is sexual activity for people with coronary heart disease?

This is a question best asked of your personal physician so you can get advice that is specific for you. If you have symptoms during sexual activity, talk to your doctor.

In general, the American Heart Association says that people who are able to do moderate-intensity physical activity (such as walking 3 miles per hour, bowling, dancing, golfing, and hunting) without symptoms are at very low risk of a heart attack during or immediately after sexual activity.

If you’ve had a recent heart attack or heart surgery, start slowly with activities that are less strenuous than sexual intercourse, such as kissing, hugging, fondling, mutual masturbation, and oral sex. If you have no chest pain, shortness of breath, rapid or irregular heart beat, or dizziness during or after these activities or fatigue the next day, then it’s probably okay to engage in intercourse. If you are unsure, check with your doctor.

People who have mild, stable chest pain are at low risk for heart events triggered by sex. Being physically active will help lower your risk even more. On the other hand, people who have unstable angina or chest pain that is difficult to treat are at high risk and should not engage in sex until their condition is stable and they get the okay from their doctor.

If you’re having trouble resuming sexual activity, see your doctor. Difficulties are commonly caused by medications, depression or anxiety, and fear of causing a heart attack. Many of these issues can be successfully addressed with help from your physician or a sexuality counselor.

(Source: Steinke EE, et al. Sexual counseling for individuals with cardiovascular disease and their partners: A consensus document from the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions [CCNAP]. Circulation. 2013;128:2075-2096.

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Is there sex after a heart attack?

Yes, there is. And after a stent, angioplasty, and bypass surgery, too. But it’s not something you want to rush into right after leaving the hospital. To be safe, you should wait until your doctor gives the go-ahead before you have sex.

But even after they get the okay from their doctor, many people are fearful about resuming sex. Sometimes it’s the patient who’s afraid and sometimes it’s the partner. Common questions include: Is it too stressful for my heart? What if I get chest pain while having sex or afterward? Will my medications have any effect on my sex life?

Often the fear is so strong that it affects a couple’s sexual functioning and quality of life. Men may develop erectile dysfunction (ED) and women may have difficulty with desire, lubrication, or orgasm. Sometimes these problems are associated with anxiety or depression, which are more common among heart patients and sometimes their partners.

It’s best to get clear guidance from your health care provider about when you can resume sex and what to watch out for. You may find that you’ll need to make some changes depending on your diagnosis, procedure, or medication, in such things as positions.

If you find that resuming sex isn’t going smoothly, discuss it with your doctor. If your physician isn’t knowledgeable or doesn’t feel comfortable counseling about sex you might want to ask for a referral to a sexuality counselor or sex therapist. Counseling is generally short-term and practical.






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Can ADHD Medications Make You a Different Person?

Can ADHD medications change who you are? Do stimulants alter your personality so you think and do things you otherwise wouldn’t?  Do they make it so you no longer take responsibility for your actions?

Researchers in the United States and United Kingdom were interested in finding out how children diagnosed with ADHD experienced having the condition and what it was like to take medication for it. So they started the ADHD VOICES study to look at “the ethical concerns about authenticity, moral agency, and personal responsibility” as well as issues around behavioral norms and academic pressures (

The study was funded by the Wellcome Trust and the researchers interviewed children aged 9 to 14, some with the diagnosis and others without it, and some with ADHD who were on medication and some who weren’t. The purpose of the study was not to support or attack the use of ADHD medications, but to find out whether the people using them found them beneficial or harmful.

The researchers concluded that ADHD medications help children stop and think before acting, support their moral development, and help them take responsibility for their actions–good and bad. They emphasize that stimulants are not for all people with ADHD and they don’t solve all the problems that people with ADHD have. They are just a tool that may or may not be used. And they’re not a substitute for good communication among the patient, parents, teachers, and health care providers.

For more information, see the video made from interviews of children in the study:

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An Alternative to ADHD Medication

Medications often are remarkably effective for adults with ADHD. Some of my patients have told me that taking appropriate medication has helped them get a job promotion or switch careers, improve their marriage, and make a positive impression on their professors.

But as effective as ADHD medications can be, they’re not a cure and will not make symptoms completely disappear. Fortunately, though, it’s possible to retrain your brain.

Studies have shown that cognitive-behavioral therapy (CBT) for ADHD can be effective in helping improve focus, attention, and organizational skills. By learning and practicing techniques specific for people with ADHD, lifelong patterns can be altered.

Some people learn these techniques in addition to taking medication, while others choose to forgo medications completely. In either case, the course of treatment is about 10 counseling sessions. A lot of emphasis is put on learning simple skills that can improve attention and practicing them daily so they eventually become a habit.

Patients are usually pleasantly surprised at how effective CBT can be for their ADHD.


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