June 26, 2000 -- Albert and Mary Zarlengo of Denver, Colo., both 61, always counted their sex life as one of the pluses of their marriage.

Then came Albert's heart attack and his bypass surgery. The otherwise loving couple, scared of inducing another attack, quit having sex. It got worse. Albert, a trial lawyer who was in his early 50s when the attack occurred, became so obsessed with counting fat grams and minutes of exercise that he started to neglect Mary.

They grew apart because of his heart attack, says Mary. "Everything was for him -- his diet, his exercise, his problems. I heard constantly about his heart attack and the surgery. I gave him support, but I started to feel left out."

The Zarlengos' story is a common one. Fear of a heart attack is one of the biggest obstacles that comes between a heart patient and an active sex life, according to Wayne Sotile, PhD, a Winston-Salem, N.C., sex therapist and author of Heart Illness and Intimacy. The topic was also discussed in depth at the European Society of Cardiology Conference in Barcelona, Spain, in late 1999.

Fears of having another heart attack are understandable, especially when you don't know the statistics. There you are, in the middle of a passionate moment: What if your heart starts to act up? You can imagine all sorts of embarrassing scenarios with paramedics rushing into your bedroom. Then there's the emotional trauma you'd cause your spouse if you were to die in the middle of sex.

The Facts

But excessive fear is unfounded. The risk of a subsequent heart attack caused by sex is less than 1%, according to a study of nearly 2,000 men published in the Journal of the American Medical Association in May 1996. Regular exercise (as prescribed during cardiac rehabilitation) can reduce the risk even further, the study found.

Despite the increased heart rate that accompanies sex, it is often only as strenuous as gardening, experts say. If you can climb two flights of stairs, you will probably be cleared by your doctor to have sex with your spouse, according to Robert Kloner, MD, PhD, a University of Southern California professor and director of the Good Samaritan Hospital Heart Institute, Los Angeles.

The Importance of Sex

Understandably, survival is the first order of business for someone who has had a heart attack. After that, other aspects of life need attention, too. "Sex is one of the first things that should be addressed after a person has a heart attack," says Dean Ornish, MD, author of Love and Survival: Eight Pathways to Intimacy and Health, and founder of the Preventive Medicine Research Institute in San Francisco.

Many doctors don't address sexual issues for several reasons, says Ornish. "Sexuality isn't valued in our culture," he says. "Doctors weren't trained to deal with sexual issues, and they often don't have the time to talk about it."

Getting the Help You Need

In a perfect world, doctors would sit down and discuss the patient's concerns thoroughly. But in reality, it's often up to patients or their loved ones to press their doctors for information.