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Toni Brayer, M.D.Toni Brayer, M.D.Internal Medicine, Medical Advisor for MyLifeStagesCalifornia Pacific Medical Center
Toni Brayer, M.D.Internal Medicine, Medical Advisor for MyLifeStagesCalifornia Pacific Medical Center

Dr. Toni Brayer has practiced Internal Medicine in San Francisco for over 20 years. She graduated Cum laude from the University of Arizona College of Medicine and she is a Fellow in the American College of Physicians. Dr. Brayer has served as President of the San Francisco Medical Society and Chief of Staff at California Pacific Medical Center, and is currently the Regional Chief Medical Officer at Sutter Health, as well as the Medical Advisor for the MyLifeStages program . She is a known speaker and writer on a variety medical topics.

See Dr. Brayer's full profile

Question of the Week

How do I know if my heart is healthy enough for sex?

Toni Brayer, M.D. answered: This is a common question from anyone who has had a heart attack or has been diagnosed with a heart problem. The Scientific Journal, Circulation, reported on thousands of patients with coronary artery disease who had suffered a heart attack and found that the risk of a second heart attack from sexual activity was very low, if the person was physically active.

During foreplay, the blood pressure and heart rate increase mildly. The greatest increases occur during the 10-15 seconds of orgasm, with rapid return to baseline thereafter. Men and women have similar cardiac responses to sexual activity.

In a study of 5559 instances of sudden death, 34 (0.6%) reportedly occurred during sexual intercourse. Two other studies also showed low rates. Of these subjects, 82%-93% were men and the majority (75%) were having extramarital sexual activity with a younger partner, in an unfamiliar setting and/or after excessive food and alcohol consumption. The increase in absolute risk of sudden death associated with one hour of additional sexual activity per week is estimated to be <1 per 10,000 person-years.

Here is good advice:

1. If you can exercise without angina and pass an exercise stress test, you can safely have sex.

2. Increasing exercise and controlling weight, blood pressure and other risk factor for cardiac disease also help your ability to have safe sexual activity.

3. If you have had a heart attack, cardiac rehabilitation reduces further risk or complications with sexual activity.

4. Do not take any performance-enhancing medication without talking with your physician. Some of them can cause a drop in blood pressure if you are on cardiac medication.

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