Management of sexual dysfunction in patients with cardiovascular disease: Recommendations of the Princeton Consensus Panel

Sexual dysfunction is highly prevalent in both sexes and adversely effects patients' quality of life and well being. Given the frequent association be tween sexual dysfunction and cardiovascular disease, in addition to the pot ential cardiac risk of sexual activity itself, a consensus panel was conven ed to develop recommendations for clinical management of sexual dysfunction in patients with cardiovascular disease. Based upon a review of the resear ch and presentations by invited experts, a classification system was develo ped for stratification of patients into high, low, and intermediate categor ies of cardiac risk. The large majority of patients are in the low-risk cat egory, which includes patients with (1) controlled hypertension; (2) mild, stable angina; (3) successful coronary revascularization; (4) a history of uncomplicated myocardial infarction (MI); (5) mild valvular disease; and (6 ) no symptoms and <3 cardiovascular risk factors. These patients con be saf ely encouraged to initiate or resume sexual activity or to receive treatmen t for sexual dysfunction. An important exception is the use of sildenafil i n patients taking nitrates in any form. patients in the intermediate-risk c ategory include those with (1) moderate angina; (2) a recent MI (<6 weeks); (3) left ventricular dysfunction and/or class II congestive heart failure; (4) nonsustained low-risk arrhythmias; and (5) greater than or equal to 3 risk factors for coronary artery disease. These patients should receive fur ther cardiologic evaluation before restratification into the low- or high-r isk category. Finally, patients in the high-risk category include those wit h (1) unstable or refractory angina; (2) uncontrolled hypertension; (3) con gestive heart failure (class III or IV); (4) very recent MI (<2 weeks); (5) highrisk arrhythmias; (6) obstructive cardiomyopathies; and (7) moderate-t o-severe valvular disease. These patients should be stabilized by specific treatment for their cardiac condition before resuming sexual activity or be ing treated for sexual dysfunction. A simple algorithm is provided for guid ing physicians in the management of sexual dysfunction in patients with var ying degrees of cardiac risk. (C) 2000 by Excerpta Medica, Inc.