First comes the heart attack. Then comes the fear of sex. Never mind that it's groundless, never mind that it's irrational. For all too many people who have suffered the trauma of a heart attack, the fear barrier is very re-al. A sense of terrible, lonely fragility holds them back from the healing warmth of sex. What could be more frightening than the thought that you might have another heart attack, or even die, during intercourse?
That's why so many people-between 50 ,and 75 percent, by some estimates either curtail their sex lives or completely draw the curtains on sex after a heart attack. (Often it's the spouse, not the patient, who's most reluctant to resume sex, studies have shown.)

It doesn't help that there's often a major communication gap between cardiologist and patient on the subject of the patient's sexuality, says Chris Papadopoulos, M.D., chief of cardiology at South Baltimore General Hospital. Cardiologists just haven't been very good at giving patients specific, practical advice about sex during recovery, and patients haven't been very good at asking for it. Part of the problem, says Dr. Papadopoulos, is that cardiologists tend to be as uncomfortable talking about sex as anybody else. And even though many patients view them as experts on sex, often they're really not terribly well informed. The result: One survey showed that of 135 postcoronary patients, almost half got no information at all about how soon it was safe to resume sex after surgery.

Still, because of recent research into the matter, a good deal is now known about the sexual aftermath of heart attacks and heart surgery-and much of it is reassuring.