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J Sex Med. 2014 Jul;11(7):1709-16. doi: 10.1111/jsm.12459. Epub 2014 Mar 3.

Intercourse avoidance among women with coronary artery disease.

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Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA; Center for Research on Ethnicity, Culture, and Health (CRECH), University of Michigan School of Public Health, Ann Arbor, MI, USA.



Avoidance of sexual intercourse has not been frequently studied among patients with chronic medical conditions and patients with coronary artery disease (CAD) are not exception.


We aimed to (i) compare intercourse avoidance during the past 2 weeks among women with CAD and healthy controls; and (ii) to determine factors associated with intercourse avoidance during the past 2 weeks among women with CAD.


This study was conducted in an outpatient cardiology clinic in Tehran, Iran. The study included 152 married women with CAD and 50 controls. Socio-demographic and clinical data including the severity of angina (WHO Rose Questionnaire), risk factors (cigarette smoking, hyperlipidemia, diabetes, and obesity), fatigue, physical function (visual analogue scale [VAS]) and somatic comorbidities [Ifudu index], symptoms of anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), and dyadic adjustment (Revised-Dyadic Adjustment Scale [R-DAS]) were considered as independent variables. Logistic regression was used to determine predictors of sexual avoidance during the past 2 weeks.


The main outcome was intercourse avoidance over a 2-week period, measured by the Relation and Sexuality Scale (RSS).


Avoidance of intercourse during the past 2 weeks was higher among women with CAD than controls (73.0% vs. 56%, P = 0.024). According to the logistic regression, intercourse avoidance was positively associated with age (Odds ratio [OR] = 1.127, 95% confidence interval [CI] = 1.073, 1.185), somatic comorbidities (OR = 1.137, 95% CI = 1.061, 1.218) and depressive symptoms (OR = 1.150, 95% CI = 1.022, 1.293).


Our study suggests that among women with CAD, age, depressive symptoms and somatic comorbidities are associated with avoidance of intercourse. As having intercourse is safe among patients with stable CAD, all health professionals should discuss sexual behaviors with their female CAD patients, especially those that are older, with higher depressive symptoms or multiple comorbidities so as to allay fears about sexual functioning.


Avoidance of Sexual Intercourse; Coronary Artery Disease; Dyadic Adjustment; Heart Disease; Psychological Status; Sexual Function; Sexual Intercourse; Somatic Comorbidities

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