High blood pressure and sex: Overcome the challenges

High blood pressure often has no signs or symptoms. But the impact on your sex life may be obvious. Although sexual activity is unlikely to pose an immediate threat to your health — such as a heart attack — high blood pressure can affect your overall satisfaction with sex.

A link between high blood pressure and sexual problems has been proved in men. For women who have decreased sexual satisfaction, it's not yet been proved that high blood pressure is to blame.

Challenges for men

Over time, high blood pressure damages the lining of the blood vessels and causes arteries to harden and narrow (atherosclerosis), limiting blood flow. This means that less blood flows to the penis.

For some men, the decreased blood flow makes it difficult to achieve and maintain erections. This problem is called erectile dysfunction. It's fairly common.

Even a single episode of erectile dysfunction can cause anxiety. Fears that it will happen again might lead men to avoid sex, which can affect the relationship with their sexual partners.

High blood pressure can also interfere with ejaculation and reduce sexual desire. Some blood pressure medications may cause similar effects.

Men should discuss any concerns with their doctors.

Challenges for women

High blood pressure's effect on sexual problems in women isn't well understood. But it's possible that high blood pressure could affect women's sex lives.

High blood pressure can reduce blood flow to the vagina and may lower levels of nitric oxide, a chemical that helps smooth muscles relax. In some women, this may cause:

• Lowered sex drive or arousal
• Difficulty achieving orgasm
• Vaginal dryness

Using lubrication and learning ways to improve arousal can help.

Like men, women can have anxiety and relationship issues due to sexual dysfunction. Women should talk to their doctors if they are having any problems or concerns.

Sexual side effects of high blood pressure medications

Some high blood pressure medications may affect sex drive or sexual function.

• Water pills (diuretics). Diuretics can decrease forceful blood flow to the penis, making it difficult to achieve an erection. They can also deplete the body of zinc, which is necessary to make the sex hormone testosterone.
• Beta blockers. These medications, especially older generation beta blockers such as propranolol (Inderal, Innopran XL), are commonly associated with sexual dysfunction.

Taking medications exactly as prescribed can help lower the risk of side effects, including sexual problems. If that doesn't work, talk to your doctor about other possible medications that may have fewer side effects.

Medications less likely to cause sexual side effects

If you are taking blood pressure medication and having sexual side effects, talk to your doctor about your options. Some high blood pressure medications are less likely to cause problems with sex drive and sexual function. For example, switching to a newer type of beta blocker improves symptoms in some men and women.

If your doctor says it's OK, you may be able to stop taking blood pressure medications for a short while to see if any sexual symptoms improve. During this time, you may need to frequently take blood pressure readings at home to make sure your blood pressure remains in a safe range.

Be sure to tell your doctor about every medication you take, including herbal supplements and all over-the-counter drugs. Sometimes supplements or a particular combination of medications or supplements can lead to sexual problems.

Erectile dysfunction drugs and high blood pressure

Men considering medications for erectile dysfunction should check with their doctors first. Erectile dysfunction drugs include sildenafil (Viagra), vardenafil (Levitra, Staxyn) and tadalafil (Cialis). The pill forms are generally considered safe for men with high blood pressure who are in otherwise good health.

Erectile dysfunction drugs aren't recommended for men with severe cardiovascular disease or for men with high blood pressure who have difficulties with urination or have other lower urinary tract problems. Never take erectile dysfunction drugs with nitrates, which are used to treat chest pain. Doing so can cause a dangerous drop in blood pressure.

Be honest with your doctor

Living with high blood pressure doesn't usually mean giving up a satisfying sex life. Talking openly and honestly with your doctor can help better manage your treatment and help you overcome any sexual challenges. Be prepared to answer questions your doctor may ask, such as:

• What medications do you take?
• Has your relationship with your sexual partner changed recently?
• Are you sad or depressed?
• Have you been under a lot of stress lately?

Promote overall health

Living a healthy lifestyle can lower your blood pressure and potentially improve your sex life. Try these healthy-lifestyle choices:

• Do not smoke or use tobacco.
• Eat healthy foods.
• Limit the amount of alcohol you drink.
• Reduce the amount of salt in your diet.
• Get regular exercise.
• Lose extra pounds.

A healthy and fit body can boost your confidence and help you feel more attractive, which could also improve your sex life.

Set the stage for satisfying sex

How you feel about your partner and where you have sex may affect your sexual response. To encourage satisfying sex, initiate sex when you and your partner are feeling relaxed. Explore various ways to be physically intimate, such as massage or warm soaks in the tub.

Share with each other the types of sexual activity you enjoy most. You may find that open communication is the best way to achieve sexual satisfaction. And studies have shown that a healthy, pleasurable sex life is good for the heart.