Objective: This study explores sexual concerns and educational needs of individuals and their partners after implantable cardioverter defibrillator (ICD) insertion.
Design: A multi-method component design, specifically a complementarity design, is used in this study. According to Polit and Hungler (1999), the features of a complementarity design include a dominant research method for which the results are further clarified by results from another research method. These results from the first phase of study include a quantitative descriptive method to determine issues and concerns, educational needs, and demographic information from persons with ICD's and their partners. A second phase of study will include face-to-face interviews.
Population, Setting, and Sample: The population includes all persons with an ICD and their partners identified, from a member list from two support groups (N=391). After excluding undeliverable questionnaires and deceased support group members (N=24), the accessible population was 367 individuals. The final sample included 81 individuals with an ICD, a 22% return rate, and 47 partners. The setting was the participants home and data collection occurred from October to December 2001.
Outcomes: The concepts of sexual integrity (McFarlane & Rubenfeld ,1983) and health promotion were used to frame the study. Major outcomes of the study were to identify psychosocial concerns about resuming sex after ICD insertion and educational needs of both individuals and partners. In studies of recovery from ICD, some patients noted total abstinence or reduced sexual activity after the ICD. Some described anxiety and fear in resuming sexual activity, including fear of ICD firing with sex and cardiac arrest. Return to usual activities, including sexual activity, can be an important measure of recovery. The literature however, reveals few specific reasons for concerns about resuming sex. Concerns might include worry about bumping the ICD, triggering the device, and fear of touching others when the device fires. Spouses describe fear and anxiety about cardiac arrest and ICD firing, often resulting in overprotectiveness of the spouse for their partner. The relationship of these concerns to resuming sex is largely unknown. Specific guidelines for resuming sexual activity after ICD are generally unavailable.
Methods: A descriptive approach using an anonymous questionnaire was chosen for this study to obtain a diverse sample and representative views of the population under study. Questionnaires were reviewed for content validity and reading level was established between the 7th and 8th grade level. Each questionnaire includes demographic information, patient education received (if any), incidence of sexual problems or concerns, frequency of the ICD firing during sex, and other issues and concerns. A cover letter and postage paid envelope accompanied the mailed questionnaire; a separate cover letter was included for patients and partners. A reminder postcard was sent to all potential subjects two weeks after the original mailing.
Findings: Most individuals with an ICD (60%) did not receive information on resuming sex after ICD implantation. Likewise, most partners (62%) were not included in any education on resuming sex. Information received by patients on resuming usual activities and sexual activity included: when to resume sex (31%), potential for ICD shock with sex (19%), what to do if shock occurs with sex (26%), avoiding bumping the ICD (10%), rate of triggering of the device (16%), safe levels of activity (30%), discussion of fears and concerns (20%), effects of medications on sex (10%), and reporting symptoms (28%). If received, information was provided verbally (33%, N=27) and in written materials (20%). Although some with an ICD and their partners believed they had sufficient information, others wanted more information on resuming activities, what to expect, and handling ICD shocks. Lack of interest in sex (occasionally or frequently) after the ICD was reported by patients (29%) and partners (39%). Those with an ICD reported overprotectiveness by the partner (56%), similar to partners report (59%). Fear of ICD firing with sex was noted by both patients (29%) and partners (30%). A fear of cardiac arrest if the ICD did not fire was also a concern (patients 25%; partners 32%). Many male ICD patients reported erectile difficulties after the ICD placement (48%). Additional concerns were expressed in written comments.
Conclusions: Information on resuming sex for those with an ICD has largely not been addressed by health care providers. Partner concerns have also been neglected. Although some individuals and their partners had no concerns about resuming sexual activity, some reported significant difficulties.
Implications: Further research is needed to clarify reasons for concerns expressed by patients and partners. The development of formal teaching plans to address resumption of sexual activity is warranted.
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