Many heart attack patients worry about being intimate with partners
Heart attack survivors are highly likely to avoid sex, fearing it could kill them, US researchers say.
The team told an American Heart Association meeting that those whose doctors failed to talk to them about sex were most likely to avoid it.
Dr Stacy Tessler Lindau, who led the study of 1,700 people, said the chance of dying during sex was "really small".
The British Heart Foundation backed her call for doctors to discuss sex with their patients to allay their fears.
Experts say it is safe for heart attack survivors to start having sex again once they are capable of moderate exercise, such as climbing a few flights of stairs.
The study of 1,184 men and 576 women who had experienced heart attacks were asked about their sexual activity prior to and after having a heart attack.
They were assessed one month after their heart attacks, and then again after a year.
The men, who had an average age of 59, were more likely to be married than the women, who had an average age was 61.
The men were also more likely to be sexually active prior to the heart attack.
But even after adjusting for these differences, patients who had been given instructions about resuming sexual activity when they were discharged from hospital were more likely to have sex in the following year.
Less than half of the men and about a third of the women had talked about their sex lives with their doctors.
And less than 40% of men and 20% of women talked to their doctors about sex in the 12 months after their heart attack.
One year on, more than two thirds of the men reported some sexual activity as did about 40% of women.
But men were 30% and women 40% more likely to report having less sex a year on, compared with before their heart attack, if they had not been given information on resuming sexual activity.
'Healthy sex life'
Dr Lindau said: "Most heart attack patients are sexually active. But for the most part, physicians just aren't discussing this topic with their patients after a heart attack."
She said that even when sex was discussed, there was nothing to show what the patients were being told - and whether the information was consistent.
But Dr Lindau stressed: "The likelihood of dying during sexual intercourse, even among people who have had a heart attack, is really small."
She said sex should not be dismissed as an issue simply because a patient was older or married.
"You can't predict by looking at someone if they are sexually active. Patients regard sex as an important part of their life, and they think it's appropriate for doctors to raise it as an issue."
Cathy Ross, a cardiac nurse at the British Heart Foundation, said patients should be given information about resuming their sex lives when they were discharged.
"Some people are scared of having sex after a heart attack in case the exertion causes another one. But this is extremely unlikely.
"You can still enjoy a happy and healthy sex life, even if you have a heart condition.
"As with any other type of exercise, sexual activity can bring on symptoms if you've a heart condition so keep medication like your GTN spray or tablets nearby.
"Caressing and being intimate is a good way to start resuming sexual relationships and increase your confidence."