Sex and PAH

PAH coupleMy patients ask me all sorts of questions– how am I doing, is my PAH getting better, what activities can I do and what should I avoid.  In more than 14 years of caring for PAH patients I can remember only one patient asking about sexual activity.  There is a paucity of published information and patients are often embarrassed or shy when it comes to asking.  Nonetheless, just about all of my patients are curious, scared and desperate for accurate information.As a result over the years I have come to include a discussion about sex in my standard educational talks with my patients.  Let’s face it, sex is an important part of life and having a chronic illness does not change that.

The Basics

Rule number one:  Women with pulmonary hypertension should not get pregnant.  Some studies have reported up to 50% maternal mortality in patients with severe PAH.  So any discussion about sex must start with defining effective contraception.  All female patients of child bearing potential (that means if you have a uterus and are less than 55) must use reliable contraception.  In general we prefer to avoid estrogen containing pills.  Depot-Provera is a great choice.  Condoms when used from start to finish not just prevent pregnancy but also prevent sexually transmitted diseases.  An IUD (this is a small device the gynecologist inserts through the vagina and cervix into the uterus and remains in place for 5- 10 years) is a great option for women in long-term relationships.

Rule number two:  Listen to your body.  During sex your heart rate increases, your blood pressure increases, and blood flow is redirected.  The magnitude of these changes depends on how “athletic” you and your partner are, and very importantly whether you are with a new partner or someone you have been with for years.    A good strategy is to go slow.  If you feel light headed, short of breath or develop chest pain, take a break.  In the beginning let your partner do more of the “work”.

How do I know if I am well enough for sex?

First, chronic illness reduces your libido.  So as you start regaining an interest in sex it generally means that your PAH is improving.  In general if you can walk through the grocery store, take a shower and get dressed without having to stop then you are probably ok.  Patients with marked shortness of breath or symptoms with minimal activity should wait.

Do PAH medications affect a man’s ability to father a child?

Most of the PAH medications don’t affect sperm counts or sperm motility.  However, the endothelin receptor antagonists such as  Bosentan (Tracleer) and Ambrisentan (Letairis) may reduce sperm counts.

Are there things that I should avoid?

In general patients with PAH tolerate having their head below their heart poorly.  So keep this in mind as you choose your positions.  Combining alcohol with PAH medications is never a good idea.

My goal in caring for patients with PAH is to restore them to the best health I can and to give them the best quality of life.  Part of a good quality of life is a healthy sex life.  Ask your PAH team questions about sex and don’t be shy in discussing birth control/contraception with your team.


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