We are all familiar with the classic story of a man (or woman) who died while having sex. Inevitably, somebody comments, “At least he died happy.”

Does sex really pose a risk to the heart? Or is this simply a myth?Let’s begin to answer this question by exploring the common claim that sexual activity constitutes a strenuous physical workout that stresses the heart.

Is sex exercise?

When people posit that sexual activity may be dangerous, they worry about extreme physical exertion associated with sex. Scientists have measured the energy expenditure of sex. Their findings may surprise you.

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On average (of course, none of us wants to lay claim to being average), sex lasts for five to 15 minutes and consumes about as much energy as climbing two flights of stairs. The younger and more vigorous among us may double or even triple this figure, reaching the threshold of vigorous exercise. Alas, these people are the exception.

Sex does cause a modest cardiovascular response, with heart rates reaching 120 to 130 beats per minute and a blood pressure spike that rarely exceeds 170 mm Hg. While these numbers exceed resting levels, they are not even close to the maximum values attained during heavy exertion: shoveling snow places a far greater strain on the cardiovascular system.

Sex and the risk of heart attack

Less than 1 percent of all heart attacks are triggered by sex, compared to 5 percent that are brought on by heavy physical exertion and 3 percent by anger. A 1996 study in the Journal of the American Medical Association calculated that in healthy individuals without a history of heart disease, the chance of sexual activity causing a heart attack is about two in a million. In a person with a history of prior heart attack, the risk of experiencing another heart attack as a consequence of sex is still extremely low—about twenty in a million. This risk is even lower among heart patients who exercise regularly.

Special circumstances:

When sex increases cardiac risk

Sex is generally safe for those with coronary heart disease, carrying an extremely low risk of triggering a heart attack. But men with coronary heart disease do need to follow the rules. A German study suggests that when heart attacks do occur during or after sex, they almost always involve older men engaged in extramarital affairs with younger women. The increased excitement associated with unfamiliar partners and different settings may cause greater increases in heart rate and blood pressure, magnifying the cardiovascular risk. For these men, it would have been safer to stay at home, remain faithful to their wives, and burn off excess energy on a treadmill in the basement.

I am a heart patient. Do I need to see a doctor before sex?

Each year in the United States, more than 1 million people suffer heart attacks. Hundreds of thousands more undergo coronary artery stenting or bypass surgery to treat coronary heart disease. Although they all leave the hospital with a stack of prescriptions, few receive information about the safety (or risk) of sexual activity.A recent study from the University of Chicago demonstrated that after suffering a heart attack, only about half of men and a third of women received discharge instructions regarding sexual activity.

COLUMN: Heart Attack Differences Between Women & Men

This silence continued. In the year following a heart attack, fewer than 40 percent of men and 20 percent of women talked with their doctors about sex. But among those who did, that conversation had an impact—they were 30 to 40 percent more likely to resume sexual activity after the heart attack.

Don’t let heart disease kill your sex life. After suffering a heart attack or undergoing a cardiac procedure, ask your doctor about sex. Most people can resume sex as soon as they feel well and can walk up two flights of stairs or do moderate exercise; this is generally a week or two after a heart attack or stent, and about six weeks after heart surgery. But if you experience heart-related symptoms like chest pain or shortness of breath, see your doctor before sexual activity.

Does sex improve heart health?

While many fear that sexual activity could hurt their hearts, recent evidence suggests just the opposite. The Massachusetts Male Aging Study made headlines with the finding that men who had sex at least twice per week were less likely to develop cardiovascular disease compared with those who had sex once a month or less. While this observation does not necessarily mean that sexual activity prevents heart disease, it suggests that sex can be part of a heart-healthy lifestyle.

The bottom line—a healthy sex life correlates with a healthy heart.