The time after you have had a heart attack is a frightening one. You are afraid that every little exertion may trigger another episode. Will your life ever be “back to normal?”

And how do you handle sex?

First off, you look at the numbers. Despite nearly every man citing that he prefers to die while having sex, fewer than one percent ever do. Sex is just a physical activity like any other physical activity, and if your cardiologist clears you for physical activity after your heart attack, you are cleared for sex as well.

But don't just look for code words, have a frank talk with your doctor about sex after your episode. Many patients – and just as many doctors! – are embarrassed to talk about sex. This is a problem on multiple levels, as impaired sexual function is common after heart attacks. It occurs at the same rate as a loss of general physical function and at a higher rate than the incidence of depression after heart attack. Rarely do health care providers address these issues. But the data show that if a physician talks to the patient about sexual health and function after a heart attack, the patient is more likely to resume sex.

It may not even be a physical issue. A lot changes after a heart attack – it is most men's first real brush with issues regarding their own mortality – and it is not unusual for a man to lose interest in sex. It may be that the surgical scar makes him feel less attractive, or a side effect of the drugs he has been prescribed diminishes his desire.

Oftentimes a man's fear of post-heart attack sex can be put to rest in cardiac rehab programs. The structure and supervision of these exercise sessions can restore his confidence, and provide him with a measure of knowledge regarding exactly how much physical exertion is safe. (It's usually way more than he thought.)

There are, however, times when too much sex will really be too much. The telltale signs are chest pain, abnormal shortness of breath, dizziness, palpitations or fatigue. Take your nitroglycerin if you feel angina – the pain or pressure in your chest caused by your heart not getting enough oxygen – coming on. Forty-six percent of men report sexual function problems in the year after a heart attack.