Sexuality, Body Image and Relationship Satisfaction in Women with Heart Failure - Narrative Review

Abstract

Heart failure (HF) is a chronic condition with a steadily increasing prevalence that significantly reduces patients’ quality of life, with women experiencing a greater psychosocial burden and poorer quality-of-life indicators than men. One of the insufficiently recognised areas of functioning in this population includes sexuality, body image perception, and partner relationships, despite the fact that these are integral components of health and overall well-being. The aim of this review was to present the current state of knowledge regarding sexual functioning, body image, and satisfaction with partner relationship in women with heart failure, as well as to identify significant research gaps and clinical implications. Sexual dysfunctions are highly prevalent among women with HF and involve reduced sexual desire, difficulties with arousal, lubrication, and orgasm, as well as pain during sexual activity. The key aspects limiting sexual activity include fatigue, dyspnoea, fear of disease exacerbation or death during intercourse, adverse effects of pharmacotherapy, and a negative body image, which may be amplified by somatic symptoms, menopause, and the presence of implantable cardiac devices. The topic of partner relationships and intimacy remains poorly explored. However, available data indicate changes in relationship roles and the importance of adaptive strategies to maintain intimacy. A significant issue is the lack of systematic sexual counselling in cardiovascular care. Sexuality and partner relationships in women with heart failure require greater clinical attention and an interdisciplinary approach that addresses both the somatic and psychosocial aspects of the disease. Sexual dysfunction is highly prevalent in women with heart failure, affecting desire, arousal, lubrication, orgasm, and satisfaction. Fear of cardiac events during intercourse and absent medical counselling are primary barriers to sexual activity in women with heart failure. Disease symptoms, pharmacotherapy side effects, and negative body image significantly impair sexual well-being. Heart failure may shift partner relationships toward caregiving dynamics, reducing intimacy and relational satisfaction. Sexual health assessment should be integrated into routine cardiovascular care for women with heart failure.