High blood pressure and sex: Overcome the challenges

If you have high blood pressure, having sex is unlikely to cause immediate health dangers — such as having a heart attack. But high blood pressure may affect your satisfaction with sex.

A link between a history of high blood pressure and sexual dysfunction 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

High blood pressure often has no symptoms. But over time, high blood pressure damages the lining of the blood vessels. It also causes arteries to harden and narrow, a condition known as atherosclerosis. The condition limits blood flow. This means that less blood flows to the penis.

For some men, less blood flow makes it difficult to get and keep erections. This fairly common condition is called erectile dysfunction.

Having erectile dysfunction even once can cause anxiety. Fears that it will happen again might lead men to avoid sex.

High blood pressure also can affect ejaculation. Some blood pressure medicines may lower sex drive.

Men should discuss any concerns with their healthcare team.

Challenges for women

How high blood pressure affects women sexually isn't well understood. But it's possible that high blood pressure can reduce blood flow to the vagina. It also might lower levels of nitric oxide, which helps smooth muscles relax. In some women, this may cause:

• Lowered sex drive or arousal.
• Difficulty having an 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 healthcare team if they are having any concerns.

Sexual side effects of high blood pressure medications

Some high blood pressure medicines can affect sex drive or the quality of sex.

• Water pills. Also known as diuretics, water pills can decrease blood flow to the penis. This can make it difficult to get an erection. They also can empty the body of zinc. Zinc is needed to make the sex hormone testosterone.
• Beta blockers. These medicines, especially older beta blockers such as propranolol (Inderal LA, Innopran XL) are often linked with sexual problems.

To lower the risk of side effects, take medicines exactly as told. If that doesn't work, ask your healthcare professional about other medicines that may have fewer side effects.

Medicines less likely to cause sexual side effects

If your blood pressure medicine is causing sexual side effects, talk with your healthcare professional about your options. Some high blood pressure medicines are less likely to cause sexual side effects. For example, switching to a newer type of beta blocker improves symptoms in some people. Ask your healthcare professional what types of beta blockers are best for you.

If your healthcare professional says it's OK, you may be able to stop taking blood pressure medicines for a short time to see if sexual symptoms improve. During this time, you may need to take blood pressure readings at home often to make sure your blood pressure stays in a safe range.

Be sure to tell your healthcare team about every medicine you take, including herbal supplements and medicines you get without a prescription.

Erectile dysfunction medicines and high blood pressure

If you're thinking of using medicines to help with erections, it's a good idea to check with your healthcare team first. These medicines include sildenafil (Revatio, Viagra), vardenafil, avanafil (Stendra) and tadalafil (Adcirca, Cialis, others). The pill forms generally are thought to be safe for men with high blood pressure who are otherwise in good health.

These medicines aren't for men with severe heart disease. They're also not for men with high blood pressure who have trouble urinating or have other urinary tract conditions. Never take these medicines with nitrates, which are used to treat chest pain. Doing so can cause a dangerous drop in blood pressure.

Be honest with your healthcare team

Living with high blood pressure doesn't usually mean giving up a good sex life. Talking openly and honestly with your healthcare team can help you manage your treatment and solve any concerns. Be ready to answer questions your healthcare team may ask, such as:

• What medicines 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 blood pressure. Keeping the heart healthy may prevent erectile dysfunction and other sex-related conditions over time. Try these healthy lifestyle choices:

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

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

Set the stage for satisfying sex

How you feel about your partner and when you have sex may affect your sexual response. For more fulfilling sex, have sex when you and your partner feel relaxed. Try various ways to be physically close, such as massaging each other or soaking in a warm tub.

Tell each other what you enjoy sexually. Talking openly might be the best way to enjoy sex more. And studies have shown that a healthy, pleasurable sex life is good for the heart.