Sexual Health in Heart Failure: How Age, Sex, and Dyspnea Interact to Shape Intimacy and Unmet Clinical Needs
Thibaud Damy, Benoit Lequeux, Barnabas Gellen, Emmanuelle Berthelot, Brigitte Letombe, Elodie Huet, Charles Taieb, Clemence Gout, Loriane Saliegé, François Roubille, Guillaume Baudry, Marc VillacequeAbstract
Aims
Sexual health is a cornerstone of well-being among the least explored aspects of heart failure (HF) care. Guidelines offer minimal, male-focused recommendations, leaving female sexual health underaddressed. The ROMANT'IC study investigated how HF affects intimacy and sexuality across sex, age and symptom burden.
Methods and results
ROMANT'IC was a national descriptive questionnaire study including1,398 patients with HF (921 men, 477 women; age 18–93 years). Overall, 655 (46.9%) provided detailed responses:491 (53.3%) men, 164 (34.4%) women indicating a reluctance to disclose information on sexuality (p<0.001). 57.8% men, and 53.7% women reported no sexual activity in the previous three months. Sexual inactivity varied significantly across age groups (χ2=17.02, p=0.001): 52.9% at 18–40 years, 50.0% at 41–55 years, 48.3% at 56–65 years, and 65.5% at ≥66 years and increased markedly with dyspnea severity: 47.8% at Grade 1, 50.3% at Grade 2, and 79.0% at Grades 3–4 (χ2=40.96, p<0.001). Men reported erectile dysfunction (49.0%) and treatment side effects (39.5%); women reported loss of desire (65.4%), reduced sense of seductiveness (61.5%), and depression (42.3%). Severe dyspnea independently predicted sexual inactivity (OR=3.88 [2.26–6.64], p<0.001), whereas sex and age were not significant after adjustment. Overall, 72–80% had never discussed sexuality with their cardiologist, regardless of dyspnea severity or age.
Conclusion
HF profoundly alters sexuality. Dyspnea severity is the dominant independent driver of sexual inactivity and represents a potentially modifiable therapeutic target. These findings call for systematic, gender- and age-sensitive, dyspnea-graded sexual counselling in routine HF care.