P2985Twelve weeks of a sexual rehabilitation program improves sexual function in patients with either ischaemic heart disease or patients with implantable cardioverter defibrillator and sexual dysfunction

Abstract

Background: Sexual dysfunction is common in patients with ischaemic heart disease or in patients with implantable cardioverter defibrillator and has a negative impact on quality of life and overall well-being. Non-pharmacological treatment options are lacking. Purpose: To assess the effect of sexual rehabilitation versus usual care for male patients with either ischaemic heart disease or implantable cardioverter defibrillator and sexual dysfunction. Methods: The participants were randomised 1:1 to a 12 weeks sexual rehabilitation program consisting of physical exercise training including pelvic floor exercise plus psychoeducational consultations with a specially trained nurse plus usual care (the intervention group) or usual care alone (the control group). Inclusion criteria: Sexual dysfunction defined by the International Index of Erectile Function (IIEF) questionnaires cut off score below 25, and coronary angiography verified ischaemic heart disease or implanted cardioverter defibrillator, and having a partner. Exclusion criteria: High risk patients in relation to cardiovascular status according to the Princeton group, diseases in the urinary tract, intense exercise more than three times a week, and neurological deficit preventing exercise. The primary outcome was sexual function measured by the IIEF. Secondary outcome were sexual adjustment to illness measured by the Psycho-social Adjustment to Illness Scales, Sexual Relationship Domain (PAIS-SR). Exploratory outcomes included pelvic floor strength, endurance, and exercise capacity which were obtained through manual digital examination of the pelvic floor and cardiopulmonary exercise testing, by VO2 peak and Watt max. Self-reported health and anxiety and depression were measured by the Short Form-36 (SF-36) and Hospital Anxiety and Depression Score (HADS). Results: A total of 154 male patients were included in accordance with our sample-size calculation. The mean age was 61.6 (SD: 6).Sexual rehabilitation compared with usual care had a beneficial effect on sexual function with a mean difference IIEF score on 6.6 (SD: 19), p<0.0005 16 weeks after randomisation, and results persisted after 6 months: mean difference IIEF score on 6.7 (SD: 19), p<0.0002. No statistically significant differences were seen on the secondary outcome. Regarding physical exercise we found a statistically significant mean difference between groups on Watt max on: 10.3 (SD: 49), p<0.003, however, no difference was seen on VO2 peak. On the pelvic floor strength we found a statistically significant difference, p<0.01 between intervention and control; however, no differences was seen on pelvic floor endurance, SF-36, and HADS. One serious adverse reaction occurred in the intervention group (hospital admission due to angina during exercise training). Conclusion: Sexual rehabilitation compared with usual care improves sexual function and physical capacity, but has no effect on mental health and health status.