Exclusion Criteria

  • Intermediate or High risk for cardiovascular disease
  • Inability to exercise
  • Cardiac symptoms such as angina, orthostatic hypotension, untreated arrhythmias


Intermediate Risk:  Patients who are intermediate risk should undergo further testing like a stress test before engaging in sexual activity.


  • Mild or moderate stable angina
  • A recent myocardial infarction (more than two weeks but less than eight weeks) without intervention. In patients who have not undergone revascularization, the risk can be assessed with stress testing.
  • A myocardial infarction more than six to eight weeks previously
  • Asymptomatic left ventricular dysfunction with left ventricular ejection fraction <40 percent or NYHA class III heart failure
  • Noncardiac manifestations of atherosclerotic disease, such as peripheral vascular disease or prior stroke, or transient ischemic attack


High Risk: Patients need to be stabilized with appropriate treatment before engaging in sexual activity.


  • Unstable or refractory angina
  • Uncontrolled hypertension
  • NYHA class IV heart failure
  • An MI within the past two weeks
  • High-risk arrhythmias
  • Obstructive hypertrophic cardiomyopathy with severe symptoms
  • Moderate to severe valvular disease, particularly aortic stenosis
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