Beyond silos: Why women’s sexual health and heart health belong in the same conversation

Sexual health is an important part of our overall health and well-being, but it is not always treated that way. Health care has traditionally organized the body into separate systems, with different specialists focusing on different parts of our health. Increasingly, however, research and health care are recognizing the importance of looking at the whole person, rather than treating individual systems in isolation. 

This is particularly important in women’s health, where cardiovascular health, reproductive health and sexual health are often discussed separately. 

Sexual health does not exist in a vacuum; it can be affected by our physical health, mental health, relationships, medications and life circumstances. And, as emerging research shows, it may also be connected to cardiovascular health. 

What does sexual health have to do with the heart? 

The connection between erectile dysfunction (ED) and cardiovascular disease (CVD) in men is well established. Erectile dysfunction can sometimes be an early sign of cardiovascular problems, and clinical guidelines recommend assessing cardiovascular risk when someone presents with ED. 

But what about women? 

Female sexual dysfunction (FSD) — which can include changes in sexual desire, arousal, lubrication, orgasm, satisfaction or pain — is a common, but often under-recognized and under-treated condition that can have a substantial impact on quality of life. Estimates suggest that approximately 50% of women experience symptoms of sexual dysfunction, but many do not seek treatment. Further, many cardiac and stroke events can occur during the menopausal transition, a time when changes in sexual function are also common so many women attribute these changes to menopause

Concurrently, CVD is a major health concern for women worldwide and is the leading cause of premature death in women. Yet women have historically been underrepresented in cardiovascular research. 

So, an important question is emerging: if we recognize the connection between cardiovascular and sexual health in men, should we be paying more attention to this relationship in women? 

What does the research tell us? 

A 2024 systematic review and meta-analysis examined the relationship between cardiovascular disease and female sexual dysfunction. The researchers brought together 56 studies involving nearly 149,000 people. 

Overall, women with CVD had about 1.5 times the risk of experiencing FSD compared with women without CVD. The association was particularly strong among women who had experienced a heart attack or stroke, or who had hypertension. 

Sexual arousal and genital responses depend partly on healthy blood flow. Conditions that affect the cardiovascular system can also affect blood vessels and circulation, potentially making it more difficult to experience arousal, lubrication or orgasm. 

Cardiovascular conditions can also affect sexual health in less direct ways. Fatigue, shortness of breath, reduced physical capacity or concerns about physical activity can make sexual activity more difficult or less appealing. 

After a stroke or other cardiovascular event, people may also experience changes in body image, confidence, mood or relationships. Anxiety or depression, which are common after a cardiac event or a stroke, can further affect sexual desire, arousal and satisfaction. 

Medications may play a role 

Some medications used to manage cardiovascular conditions have been associated with changes in sexual function or sexual activity. However, we still need more research to understand which medications may have an effect, how large that effect may be, and how these effects vary between individuals. The authors of the 2024 systematic review specifically identified the effects of cardiovascular medications on women’s sexual function as an important area for future research. 

Why does this matter? 

For a long time, health care has been organized into silos. Providers often work in specific areas of care such as heart health, sexual health, reproductive health, or mental health. But we’re increasingly understanding that our bodies do not work in silos. 

A person experiencing sexual difficulties after a cardiovascular diagnosis may not think of bringing up their sexual health with their cardiologist. A health care provider may focus on managing blood pressure or cholesterol without asking how a patient’s health is affecting their sexual well-being.  

Breaking down these silos and integrating a more holistic version of care can support increased health and well-being through a person-centred approach.  

For women and people seeking care 

If you are experiencing changes in sexual desire, arousal, lubrication, orgasm, satisfaction or pain — particularly if those changes are affecting your quality of life — you can bring them up with a health care provider. 

You do not need to wait until a problem becomes severe, and you do not need to assume that sexual difficulties are simply something you have to live with. Your sexual health is part of your overall health. 

For health care providers 

Ask about patients’ sexual health and well-being. 

Patients may not bring up sexual health concerns themselves, particularly when they are already managing a new diagnosis or focusing on more immediate health concerns. Sexual health continues to be stigmatized, and many people do not feel comfortable sharing their concerns unprompted.  

Creating an environment where sexual health is a normal part of the conversation can make it easier for patients to raise concerns and may support more holistic, person-centred care.