Chest Pain During Sexual Intercourse
If you experience chest pain during sex, stop the activity immediately, sit down, and if you have been prescribed nitroglycerin, take one tablet under your tongue; if the pain does not resolve after 3 tablets taken 5 minutes apart (total 15 minutes), or if the pain feels different than usual, seek emergency medical assistance immediately. 1
Immediate Actions When Chest Pain Occurs
Stop sexual activity immediately and sit or lie down to prevent falls from lightheadedness or dizziness. 1, 2
If you have prescribed nitroglycerin:
- Place one tablet under your tongue (do not chew, crush, or swallow) 2
- Wait approximately 5 minutes 2
- If pain persists, take a second tablet 2
- Wait another 5 minutes 2
- If pain still persists, take a third tablet 2
- If chest pain continues after 3 tablets over 15 minutes total, or if the pain is different from your typical angina, call emergency services immediately 1, 2
Warning Signs Requiring Emergency Care
Seek immediate medical attention if you experience: 1
- Chest pain that does not resolve with nitroglycerin (if prescribed)
- Shortness of breath or excessive difficulty breathing
- Rapid or irregular heart rate
- Dizziness or fainting
- Cold sweats, nausea, or vomiting
- Pain that interrupts normal activity or feels severe
- Anxiety or sense of impending doom
These symptoms may indicate a heart attack, unstable angina, or other life-threatening cardiac conditions requiring immediate hospital evaluation. 3, 4
Understanding Your Risk
Sexual activity typically requires 3-5 METs (metabolic equivalents) of energy expenditure, equivalent to walking 3-4 miles per hour on a treadmill or climbing 2 flights of stairs at a brisk pace. 1
Cardiovascular symptoms during sex rarely occur in patients who do not experience similar symptoms during exercise testing at equivalent levels. 1 This means if you can walk briskly or climb stairs without chest pain, sexual activity is likely safe for you.
The actual cardiovascular risk of sexual activity is low for most patients with stable heart disease, but symptoms should never be ignored. 1
Follow-Up Medical Evaluation
Report any chest pain during sexual activity to your physician, even if it resolved with nitroglycerin. 1 Your doctor needs to:
- Assess whether your cardiac condition is optimally controlled 1
- Determine if you can safely exercise at 5 METs without angina, excessive shortness of breath, ischemic ECG changes, or dangerous blood pressure responses 1, 5
- Consider exercise stress testing if your cardiovascular risk is unclear or intermediate 1, 5
- Optimize your cardiac medications 1
Preventive Strategies
If you tend to experience chest pain with sexual activity: 1
- Take nitroglycerin prophylactically 5-10 minutes before sexual activity (if prescribed) 1, 2
- Consider less physically demanding forms of intimacy (hugging, kissing, fondling) as alternatives or as a gradual progression 1
- Use familiar, comfortable positions that require less exertion 1
- Engage in regular exercise and cardiac rehabilitation, which decreases peak heart rate during sex and reduces risk of sexual activity-triggered heart attacks 1, 5
Critical Medication Warning
Never take medications for erectile dysfunction (sildenafil/Viagra, tadalafil/Cialis, vardenafil/Levitra) if you use nitroglycerin or any nitrate medications, as this combination can cause life-threatening drops in blood pressure. 1, 2 This prohibition applies to oral, sublingual, and topical nitrate preparations. 6
When Sexual Activity Should Be Avoided
Defer sexual activity if you have: 1
- Unstable or refractory angina (chest pain at rest or with minimal exertion)
- Recent heart attack (timing of resumption should be discussed with your cardiologist)
- Severe heart failure symptoms
- Uncontrolled arrhythmias
- Inability to exercise at 3-5 METs without symptoms
Patients with these high-risk features should have their cardiac condition optimally managed and stabilized before resuming sexual activity. 1
Important Considerations
Pain severity alone is a poor predictor of cardiac complications - even mild chest pain during sex warrants medical evaluation. 3, 4
Fatigue the day after sexual activity or insomnia following sexual activity should also be reported to your physician, as these may indicate your heart is working too hard. 1
If you use supplemental oxygen for cardiac or pulmonary conditions, continue using it during sexual activity. 1
Regular physical exercise is strongly recommended as it increases your exercise capacity, decreases your heart rate response during sex, and reduces the overall risk of cardiac events triggered by sexual activity. 1, 5