Fear of Sexual Intercourse in Patients with Coronary Artery Disease: A Pilot Study of Associated Morbidity Davoud Kazemi-Saleh, MD,* Bahram Pishgou, MD,* Shervin Assari, MD, † and Seyed Abbass Tavallaii, MD* *Behavioral Sciences Research Center, Baqiyatallah Medical Sciences University, Tehran, Iran; † Clinical Research Unit, Baqiyatallah Medical Sciences University, Tehran, Iran DOI: 10.1111/j.1743-6109.2007.00619.x ABSTRACT Introduction. Sexual fear is a known cause for avoidance of intercourse, especially in patients with chronic conditions. Aim. Given the significant impact of fear of intercourse on the quality of life, we herein report our pilot results regarding the differences in the demographic, clinical, marital, and psychological characteristics of coronary artery disease (CAD) patients with and without sexual fear. Methods. In this cross-sectional study conducted in Baqyiatallah Hospital, Tehran, Iran, in 2006, 87 married CAD patients were assessed for the presence of sexual fear. Subjects with and without sexual fear were compared for demographic and clinical data as well as for Hospital Anxiety and Depression Scale (HADS) and Revised-Dyadic Adjustment Scale (R-DAS) scores. Main Outcome Measure. Demographic and clinical data, sexual fear (Relationship and Sexuality Scale), symptoms of anxiety and depression (HADS), and marital relation quality (R-DAS). Results. Twenty-nine subjects were reported to have some degrees of fear of sexual intercourse and a lower frequency of sexual intercourse. Age, socioeconomic status, education level, tobacco smoking, and history of myocardial infarction were significantly different between those with and the ones without sexual fear. Body mass index, extent of coronary involvement, chronic obstructive pulmonary disease, hypertension, stroke, hyperlipidemia, history of diabetes, and the use of beta-blockers were not statistically different in the two groups. The subjects with sexual fear reported higher HADS depressive and R-DAS scores but not higher HADS anxiety scores. Conclusion. Among different nonmodifiable and modifiable correlates of fear of sexual intercourse in CAD patients, marital relationship and depressive symptoms should be highlighted in future interventional studies with the aim of allaying such fears. Kazemi-Saleh D, Pishgou B, Assari S, and Tavallaii SA. Fear of sexual intercourse in patients with coronary artery disease: A pilot study of associated morbidity. J Sex Med 2007;4:1619–1625. Key Words. Sexual Fear; Coronary Artery Disease; Marital Adjustment; Psychological Morbidity Introduction A lthough sexual fear is known to beget the avoidance of intercourse [1] and has been reported in Crohn’s disease [2], stroke [3], chronic obstructive pulmonary disease (COPD) [4], and surgical procedures [5], as well as in post- heart transplantation patients [1], pregnant women [6], and those afflicted with urinary incontinence [7] and anatomical genital disorders and gynecologic malignancies [8,9], it still re- mains the least explored sexual problem in the sexual medicine [5]. There may be a host of reasons for sexual fear, but first and foremost, it is the patient’s concern about the possible negative impact of intercourse on his or her health status that is the main culprit [10]. Such feelings of unease tend to stem from fearing the exacerbation of hypertension (HTN) in HTN patients [11]; fearing relapse, anguish, lack of excitation, and impotence in stroke victims [3,12,13]; fearing dyspnea and reduced exercise tolerance in COPD sufferers [4]; fearing death in heart transplantation patients [1]; and fearing failure, infarction, or even sudden death in CAD and myocardial infarction (MI) patients [10,14]. 1619 © 2007 International Society for Sexual Medicine J Sex Med 2007;4:1619–1625