A heart attack takes a toll on all aspects of your life, including romantic relationships. But that doesn’t mean you should say goodbye to intimacy for good. In fact, sex after a heart attack is possible — and even strongly encouraged by cardiologists.

“Typically, after ‘Am I going to die?’ the second question on a patient’s mind is ‘Can I still have sex?’” says Jeremy Pollock, MD, a cardiologist at the University of Maryland St. Joseph Medical Center in Towson.

His answer is always an emphatic “yes.”

Of course, it may take time to get back into your normal routine after such a severe cardiac event.

A study published in JAMA Cardiology found that impaired sexual function — from decreased physical pleasure to disruption of regular sexual activity — was quite common following a heart attack. Notably, impaired sexual function occurred at a higher rate than the incidence of depression, even though healthcare providers rarely addressed this finding, particularly with female patients.

Dr. Pollock says that most physicians feel very uncomfortable talking about sex with their patients, and patients also feel awkward bringing it up — especially after a heart attack. As a result, patients feel afraid or hesitant to resume sexual activity, which can quickly contribute to depression following a heart attack.

The Heart Health Benefits of Sex

Sex can be one of the best ways to combat depression after a cardiac event. “Intimacy is actually a very healthy thing,” says Rachel Bond, MD, a cardiologist at Dignity Health in Chandler, Arizona. “It alleviates stress and anxiety and promotes emotional well-being — all things that contribute to a healthy heart.”

There’s research to prove it, too. Rami Kahwash, MD, a cardiologist at Ohio State University Wexner Medical Center in Columbus, points to research that found sex decreased the risks of cardiovascular disease by half.

A study published in the European Journal of Preventive Cardiology found that maintaining or increasing sexual activity within the first six months of a heart attack was associated with a 35 percent lower risk of death.

Research also shows that sex:

Reduces stress
Boosts emotional health
Lowers blood pressure

Intimacy also reestablishes normalcy, says Suzanne Steinbaum, DO, a preventive cardiologist and spokesperson for Go Red for Women, based in New York City. “Having an intimate connection between partners is an important part of quality of life and healing. Besides the serotonin and oxytocin — the ‘feel-good hormones’ — the connection and bonding between partners is part of the healing process,” Dr. Steinbaum says. And healthy relationships lead to better outcomes, she adds.

What Are the Risks of a Repeat Event?

Despite the evidence, however, after experiencing the vulnerability of a heart attack, some may still think that intimacy is too risky, out of fear that the physical exertion or stamina required for sex will provoke another attack.

But Bryant H. Nguyen, MD, a cardiologist with Sharp HealthCare who is based in San Diego, says that there are few limitations on intimacy for patients with cardiac conditions: If the patient feels well and is physically active, sexual activity does not increase their risk of heart attack or other cardiac disease.

“If a patient has just had a cardiac event, I instruct them to report any symptoms, such as shortness of breath, chest pain, or palpitations, when associated with intimacy or any other physical activity,” Dr. Nguyen says.

Some doctors will instruct patients to resume sexual activity with no limitations at all. “If they can participate in light physical activity (walking two city blocks at an easy pace), then they can resume sexual activity,” says Pollock. “I also emphasize that participating in sexual activity in no way increases their chance of a repeat cardiac event.”

Dr. Bond agrees that the risk of a heart attack or death from sexual activity is extremely low, but she also says that if patients are still worried about it, there is something they can do: “I tell my patients they may be able to further reduce this risk by improving their stamina,” she says.

Ease Into Intimacy After a Heart Attack and Talk to Your Doctor

During a heart attack, some patients suffer significant damage to the heart muscle. If that’s the case, the patient’s physical activity — including intimacy — should be severely limited, per Oyidie Igbokidi, MD, an interventional cardiologist at CHI St. Vincent Heart Institute in Hot Springs, Arkansas.

“We typically assess heart pump function after a heart attack, and if the pump function is low, then they won’t be able to engage in strenuous physical activity without risking more damage,” Dr. Igbokidi says. For those without damage to their heart muscle — for example, a patient who has a stent inserted and normal heart pumping function — Igbokidi says she typically requires that they do no physical activity for the first 48 hours after the stenting.

Ultimately, your comfort level is most important, and you should speak with your doctor about what level of activity is considered safe, says Jennifer Haythe, MD, a cardiologist at Columbia University Irving Medical Center in New York City.

Patients can certainly wait a few weeks to recover from their heart attack, but then they should feel comfortable having sex with their partner again, Dr. Haythe says.

“There are many stages of intimacy, and I advise patients to go slowly if they are nervous, demonstrating to themselves that they have no signs or symptoms of angina.”

Once you’re comfortable and confident, there’s no reason to deny yourself — or your partner — the heart health benefits of sex. “Intimacy is part of what provides joy for all of us. If you take that away, you take away joy,” says Igbokidi.

Additional reporting by Ashley Welch.