Sexual function in patients with advanced heart failure

• OBJECTIVES: To determine the effect of low ejection fraction on sexual function and the relation between alterations in sexual function and pertinent clinical, demographic, and psychosocial variables in patients with advanced heart failure. DESIGN: This study was descriptive and correlational in design. SETTING: The setting was an outpatient clinic of a university-affiliated hospital. SUBJECTS: Sixty-two male (82%) and female (18%) patients with advanced heart failure (New York Heart Association [NYHA] class III or IV) were studied. MEASURES: Exercise tolerance and symptom severity were assessed by the 6-minute walk and NYHA classification. Ejection fraction was measured by echocardiography. Alterations in the patients' emotional, social, and sexual function were assessed with the self-report version of the Psychosocial Adjustment to Illness Scale. RESULTS: Approximately three quarters of the patients reported a marked decrease in sexual interest and in the frequency of sexual relations caused by illness, with one quarter having ceased all sexual activity. Half the patients described having experienced marked reductions, after heart failure developed, in the pleasure or satisfaction they normally experienced from sex. Few patients had arguments with their spouses about sex or reported significant marital problems as a result of their illness. A significant relation was documented between patients' sexual function and the results of the 6-minute walk (r = 0.32, p < 0.005), as well as between sexual function and NYHA functional class (r = 0.21, p < 0.05). Sexual function was also related to the patient's social environment (r = 0.59, p < 0.001), psychologic distress (r = 0.38, p < 0.001), and domestic environment (r = 0.29, p < 0.05). No significant differences in sexual function were noted when patients were compared on the basis of differences in ejection fraction, medications, gender, or age. CONCLUSION: Advanced heart failure results in marked changes in libido and in the ability to perform sexually. These changes do not affect the marital relationship negatively, at least in the view of the patient. As patients' symptoms of heart failure become increasingly more severe, physicians and nurses need to counsel patients and their spouses about the changes they may experience in their sexual relationships. Attention needs to focus on ways to cope with the decreasing physical status that accompanies advanced heart failure to minimize negative changes in sexual functioning.

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