A study published ahead of print in the Journal of the American College of Cardiology indicates that following implantation of a left ventricular assist device (LVAD), sexual function does not improve and may even worsen—with LVAD equipment frequently cited as an obstacle to sexual function.
Peter Eckman, Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, USA, and others wrote that impaired sexual function was common in patients with heart failure and patients who have undergone a cardiac transplant. However, they added that data for sexual functioning following LVAD implantation was limited. Eckman et al reported: “This study examines the prevalence and the types of sexual dysfunction among LVAD recipients. A secondary aim was to evaluate the changes in sexual function following LVAD, though a self-recall questionnaire.”
The investigators surveyed (anonymously) 301 LVAD patients, at seven centres, using the “Changes in sexual function questionnaire-14” and a self-recall questionnaire that compared four domains of sexual function (desire, arousal, orgasm, and pain) before and after LVAD implantation. They commented: “Sexual dysfunction was defined by a total score of ≤41 in males and ≤47 in females.”
Of the 59 responses received (24% female), 71% of men and 79% of women met the criteria for sexual dysfunction. Eckman et al reported that following LVAD implantation, there were significant decreases in arousal scores for both genders. They added: “Orgasm scores decreased in men post-implant but were unchanged in women. More than half of patients reported worsening in desire, arousal and orgasm post LVAD.”
According to the authors, it is not clear whether the lack of change or worsening in sexual functioning following LVAD implantation reported by respondents was driven “by physiologic changes or the myriad other factors that impact sexual health.” They added that, in the study, women “were more likely to rate the impact of body image highly, mirroring findings in healthy people”, which might account for the higher prominence of sexual dysfunction in females. Eckman et al concluded: “Equipment was frequently cited as an obstacle [to sexual function]; along with the fear of damaging the LVAD, it appears the improvements to external components may have a favourable impact on sexual function. Willingness to address concerns about sexual function may foster discussion regarding to the safety of and barrier to sexual activity.”
Eckman told Cardiovascular News: “Our study established that many patients who have LVAD experience sexual dysfunction. Some of their concerns can be easily addressed by their care team, such as reassurance about the safety of sexual activity in the presence of an LVAD. We would encourage physicians to ask their patients if they have any questions about this aspect of their lives both before and after implant.”