Sexual health in patients with an implantable cardioverter-defibrillator: A narrative review

Sexual health is a vital but often overlooked aspect of quality of life in patients living with an implantable cardioverter-defibrillator (ICD). Although the absolute risk of malignant ventricular arrhythmias during sexual activity is low, fear of shocks, anxiety, and partner concerns frequently lead to avoidance of intimacy and psychological distress. Both men and women experience sexual dysfunction after ICD implantation, driven by a complex interplay of physiological, psychological, and relational factors, with women remaining underrepresented in research. Pharmacologic effects, altered body image, and insufficient counseling further contribute to diminished sexual satisfaction. Evidence supports a multimodal approach encompassing individualized counseling, integration of sexual health into cardiac rehabilitation, partner involvement, management of medication side effects, and interventions aimed at restoring perceived control and self-efficacy. Cognitive behavioral therapy and structured exercise programs are particularly effective in reducing fear and improving adjustment. However, high-quality, gender-inclusive trials are scarce, and standardized outcome measures are lacking. Normalizing sexual-health discussions within ICD follow-up is essential to bridge the gap between evidence and practice, ensuring holistic care that not only prolongs life but also enhances its quality.