You may have heard rumors about sex causing a heart attack, but you rarely hear how to resume a normal sex life after you or your partner experiences a heart attack. Here’s what you need to know.

My partner just had a heart attack. Is sex too risky? This is the most common question—and myth—that I hear. After heart attack, about 25% of couples go right back to their regular sexual frequency and intensity; about 50% resume sex at reduced levels, and 25% choose to forgo sex. Some people are afraid that sex overworks a damaged heart by expending too much energy. If you or your partner have experienced heart attack, you might know the term “metabolic equivalent of energy expenditure” (METs). Sexual activity before orgasm averages two to three METs, the equivalent to walking at two to three miles per hour. During orgasm, this increases to three to four METs—compare that to the energy expenditure of jogging (eight METs) or running (16 METs). So while your heart beats faster during sex, and particularly after orgasm, it’s typically no great workout.

When can we resume sex? I had a heart attack six months ago and my husband is afraid to touch me. Although most couples are advised to wait seven to 10 days after an uncomplicated heart attack before resuming sexual activity, many people wait longer because of fear and fatigue. Folks who’ve had heart attack with complications are advised to resume sex more gradually, though typically before six months has passed. Some care providers warn people diagnosed with heart disease to avoid sex for three hours after a heavy meal, excessive alcohol intake, in extreme temperatures, or when wearing tight clothes.

I’m afraid of creating chest pain for my partner during sex. Can this happen? Chest pain during sexual activity is rare in people who don’t have pain during strenuous physical activity. If your partner now walks or gets aerobic exercise without chest pain, then sex should be free from chest pain too. Be aware that anxiety can increase the risk for chest pain, so relax and focus on sharing intimacy, which is a natural de-stressor. Chest pain is just one warning sign of overexertion. Shortness of breath, dizziness, and extreme fatigue following sexual activity are other signs to ease up. If you or your partner has had a heart attack, your health care provider can prescribe nitroglycerine for chest pain, although you should seek treatment if it doesn’t stop the pain within 15 minutes.

I heard that after my husband’s heart attack, he shouldn’t be on top when we have sex. Is this true? Experts once believed that the man-on-top (missionary) position could put additional stress on his heart, but we now know that couples can use any comfortable position. However, receptive anal intercourse can be dangerous for someone with heart disease, as stimulation in this position of the vagus nerve, one of the longest nerves in the body, can slow heart rate, which might lead to chest pain.

My husband has forgotten about sex since his heart attack—he’s just not interested, and he’s only 48 years old! Depression is common after heart attack, and one of the symptoms of depression can be lack of interest in sex. Maintain a line of communication with your partner about why he’s no longer interested. He may be concerned about chest pain or having another heart attack. Many people respond to heart attack by viewing themselves as sick or invalid, and this creates sexual dysfunction. Go with your husband to your health care provider and discuss these feelings and his health; together you can begin to rebuild your sex life.

What has happened to my husband’s erection since his heart attack? Approximately 40% of men experience erectile dysfunction (ED) after a heart attack. The most common treatments for ED are oral medications such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra). These tend to dilate blood vessels and should be used with caution in men with heart disease. If your husband is taking nitrates he shouldn’t take these medications. Some couples turn to so-called natural products to avoid the risks associated with ED drugs, but there’s little if any regulation of these remedies. Some actually contain the active ingredient found in the prescription drugs! Extreme caution should be taken when considering using these remedies. After a diagnosis of heart disease or a heart attack, it’s best to avoid any medication that has not been prescribed by a licensed health professional.

My cardiologist suggested a cardiac rehabilitation program after my husband’s heart attack. How will this help? Exercise is good medicine for the heart. Participating in a cardiac rehabilitation program with regular physical activity can reduce the cardiac work associated with sexual activity and also reduces the risk of triggering the onset of a heart attack. Exercise has also been shown to reduce depression, which commonly follows a heart attack.

I haven’t had a heart attack, but I have high blood pressure and take medication. I’m also not that interested in sex anymore. Are these things related? Many of the medications used to treat cardiac disease, such as beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, and anti-hypertensives, may reduce your drive. In men they can cause erectile difficulties and ejaculatory problems. Women might notice less lubrication and decreased orgasms. Eating a heart-healthy diet, losing weight, exercising regularly, and keeping cholesterol down can all affect your blood pressure in a positive way. Speak to your health care provider about making these lifestyle changes and working toward reducing our stopping your medications if you’re successful in lowering your blood pressure.

I think we’re “at that age” to give up sex; and after my husband’s heart attack, it just doesn’t seem that important any more. How can we remain close? First, let’s bust the myth that you’ve reached an age at which sex should just go away like teen angst. Healthy, functioning people never grow out of sexuality, although they learn to express and enjoy it in different ways throughout life. To maintain closeness, cultivate common interests and friends, spend time together, and communicate with each other about your feelings and needs. Practice “high-touch” living—touch, cuddle, caress, and express your sensual appreciation for your partner in ways other than intercourse.

Can my husband die from having sex? Ah, back to the most common rumor: Sex can kill you. Couples who stop having sex after heart attack are often afraid that the exertion of intercourse can cause a heart attack or even death. The risk of experiencing a heart attack during sexual activity is less than 1%, and the risk of dying is even lower; this applies equally to men and women. You’re safer having sex than you are driving a car or flying in a plane.