Don’t Panic: Sex with a Pacemaker is Completely Safe

Editor's note: Some of the names in this article have been changed to protect the medical privacy of our sources.

When men and women show signs of a heart problem, a pacemaker or implantable cardioverter defibrillator (ICD) may be the answer. But the idea of an implanted device sending electric impulses can make them cautious about having sex.

If a pacemaker is in your future or a partner's, you might wonder if your sex life will change forever. Here's what you should know.

Roughly 3 million people wear a pacemaker to help with a slow heartbeat, or bradycardia. A pacemaker sends electrical impulses to the heart to help speed up the heart rate. Putting in a pacemaker doesn't count as open heart surgery and, generally, is minimally invasive.

Most people recover and head home within 24 hours of surgery.

Implantable cardioverter defibrillators (ICD) are different. They have special coils on the wires that deliver a shock for defibrillating the heart to prevent cardiac arrest. According to the Mayo Clinic, it is considered a more invasive procedure, although it does not require open heart surgery.

Instead, the procedure requires minimally invasive surgical implantation of the electric device underneath the skin in the chest wall. The wires are placed endovascularly with catheters often by a specialized cardiologist and sometimes cardiac surgeons..

A subcutaneous ICD (S-ICD) is implanted under the skin and attached to an electrode that follows along the breastbone.

More than 70 percent of people with a pacemaker are at least 65 years old. But that isn't always the case, as Amber, 30, learned when she received an ICD at age 28.

Amber was treated for long QT syndrome, a heart signaling disorder causing fast, chaotic heartbeats, also known as arrhythmias. Long QT syndrome can cause fainting, seizures and, in young people, increase the likelihood of sudden death.

While the disorder can be treated through lifestyle changes and medication, some people, like Amber, need to undergo minimally invasive surgery to have a pacemaker or implantable cardioverter defibrillator (ICD) fitted, which can help to monitor and control heart rate.

Post-operation, Amber was scared of anything that could raise her heart rate, including exercise, doing anything exciting or thrilling, like riding a rollercoaster, and of course, sexual intercourse.

Why do you feel anxious about having sexual experiences?

"I had a lot of anxiety about having sex afterward," she said. "I waited a few months and only had sex a few times over the next six months out of fear of being shocked."

ICDs—unlike pacemakers—work by delivering a shock in order to slow down a fatally abnormal heart rhythm, and these shocks can be painful, both physically and emotionally.

"At the time, I was single, and it made me incredibly nervous to start dating again or hook up with anyone," Amber said.

So, Amber put her sexual relationships on hold, despite her doctor telling her it was unlikely she would receive a shock during sex. Her heart rate would have to cross the 200 beats per minute (BPM) mark.

Her quality of life took a dive until she found a helpful solution. Amber purchased a smartwatch to monitor her heart rate. It gave her a bit more reassurance and peace of mind.

"It's scary to feel like you have a bomb inside you," she said.

While Amber's concerns are normal, it's very rare to get a shock from an ICD during sex, according to the British Heart Foundation website. This is because the devices are set to expect a normal increase in heart rate that would occur during moderate physical activity.

Plus, as Neil Srinivasan, MBChB, consultant cardiologist specializing in the management of heart rhythm problems, said, there's about a one in a million chance that sex would lead to a heart attack.

A small 2020 study of 80 men suggested the implantation of a pacemaker had a positive effect on sexual functioning for all participants.

"Most of the time, [having a pacemaker fitted] actually improves patients’ exercise tolerance," Srinivasan said. "There's no reason why someone who has a pacemaker should think that they can't engage in sexual activity. In fact, it may be that the presence of the pacemaker has made it safer for them to do so." For some people, it may increase intimacy.

However, he advised that you should speak to your doctor about any activity you plan to undertake.

Whether you get a pacemaker or an ICD will affect your recovery time. If you’ve had invasive surgery, you’ll typically get the go-ahead on sex when you feel good and healed. Follow your doctor's guidelines.

There is important advice to note. Srinivasan said the general advice is to have sex like normal but to take care in the first four to six weeks of your recovery to avoid positions that "place a pressure on the arms and chest" because there is a risk of the pacemaker lead moving out of place.

After an initial pacemaker check has been performed at around weeks four to six, and the pacemaker has had time to bed in, he said, you’re good to go.

"There's no reason you can't continue to have a good sex life after having a pacemaker implanted and you're feeling better," Srinivasan added.

The advice doesn't change over time.

"Once a pacemaker is in, it stays there for life, normally," Srinivasan said. "Occasionally, the battery needs to be replaced via a small operation, but this doesn't change long-term advice."

Although for Amber, the fear of being shocked during sex still lingers, it's encouraging to know it is highly unlikely. Sex with a pacemaker or ICD is completely safe. Cardiovascular interventions and treatments don't have to ruin your sex life.

Consult your doctor if you have questions after your pacemaker or ICD implantation. You may need to watch certain positions when it's time to have sex that places pressure on your arms and chest during the four to six weeks after surgery. Typically, you’re okay to experience sexual pleasure when you feel ready and recovered from the procedure.

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