Is sexual activity safe in men with cardiovascular disease?

Cardiac disease and erectile dysfunction frequently  coexist. Sexual activity, being physical  activity, carries a potential cardiac risk for  those patients with pre-existing cardiac disease.  This risk may include the triggering of a myocardial  infarction due to the increase in cardiac  workload associated with sexual activity. Therefore,  it is generally considered unwise for any  patient with unstable cardiovascular disease to  engage in sexual activity, regardless of whether  they have taken a PDE5 inhibitor. Unstable  cardiovascular disease is defined as: unstable  or refractory angina; uncontrolled hypertension;  congestive heart failure (Class III or IV);  very recent MI (<2 weeks); high-risk arrhythmias;  obstructive cardiomyopathies; moderateto-  severe valvular disease [52]. Sexual intercourse  requires 3 to 4 METS (Metabolic Equivalent  of the Tasks) of energy expenditure. This  energy requirement is approximately equivalent  to walking at a rate of 3 MPH (or one mile  in 20 minutes on level ground) [53].  Accordingly, the physical demands of intercourse  can generally be considered safe for a  patient who can walk comfortably one mile in  20 minutes without notable symptoms.