For people with implantable cardioverter defibrillators, the life-saving device may come at a cost: Fear of it firing a shock to the heart during sex drives some to avoid lovemaking altogether.
Implantable cardioverter defibrillators (ICD) are small devices placed in the chest or abdomen that shoot off electrical pulses when they detect potentially life-threatening, irregular heartbeats.
But shock-related anxiety can impede sexual performance, according to new research scheduled for presentation at the American Heart Association annual meeting in Orlando, Fla.
These fears are warranted, said study author Dr. Steven Cook, director of adult congenital heart disease at Children's Hospital of Pittsburgh. "It's a huge deal that no one talks about sexual function with these patients," Cook said.
ICDs can fire during sex or any other time that they sense a dangerous arrhythmia, Cook added. And the jolt can be frightening. He said that patients tell him the shock feels like "someone kicked you in the chest. It is a pretty intense sensation."
The new study included 151 men and women who had congenital heart disease, meaning a heart abnormality since birth of these, 41 had ICDs and an average age of 37.
Those without an ICD averaged 32 years. Study participants rated their sexual function and depression via standardised tools, which included questions about confidence, satisfaction and arousal. Those individuals with ICDs also completed the Florida Shock Anxiety Scale, which measures fears about ICD-related shock.
Men with ICDs had sexual function scores similar to the ratings of men with mild erectile dysfunction (the inability to achieve or maintain an erection sufficient for sexual intercourse).
Men more affected
The sexual function scores of women with and without ICDs showed little difference, suggesting men might be more affected by shock-related anxiety.
Many people with congenital heart disease may be depressed, which could affect their sexual function, but depression scores were in the normal range for all of the study participants – those with and without ICDs, the study showed.
Men and women who reported high levels of shock-related anxiety had lower sexual function scores compared with their counterparts who were not anxious about their device firing.
It didn't matter if these individuals were single or in committed relationships. Some may have experienced a shock in the past, while others might just fear experiencing one in the future, Cook said.
Communication between patients and their doctors is critical to allay any fears, Cook said. Anyone shocked in the past who dreads another jolt should try to figure out why the device fired in the first place, Cook said.
Solutions exist, based on whether the ICD fired appropriately or inappropriately. Doctors can tweak your medication regimen to help control the underlying heart problem or reprogram the device, he said.
In the future, it may help to have doctors screen people for shock-related anxiety before implanting the device, he said.
This is a real issue, said Dr Joshua M. Hare, the Louis Lemberg Professor of Medicine at the University of Miami Miller School of Medicine. "It is an interesting dilemma because the same device that can save your life also has side effects," he said.
"It's the right treatment, but there is the risk that it could happen at the wrong time," he said. "If you don't have the device, you are at risk for a potentially fatal event, but having the device can be anxiety-provoking and create psychosocial issues."
"You have to pick your poison," he said.
Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.
(HealthDay, Denise Mann, November 2011)
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