It's a common movie scene: An older man has sex with a beautiful woman when suddenly -- wham! -- he has a heart attack. So should real men be concerned?
A little yes and a little no, finds a new review in the Harvard Men's Health Watch. Fewer than one in 100 heart attacks -- and just one in 200 fatal arrhythmias -- are linked to sexual activity.
"For a healthy 50-year-old man, the risk of having a heart attack in any given hour is one in a million," writes Dr. Harvey B. Simon, founding editor of the newsletter and an associate professor of medicine at Harvard Medical School. "Sex doubles the risk, but it's still just two in a million." (For men with heart disease, the risk is 20 in 1 million.)
In fact, the review highlights research that suggests sex is actually good for men's hearts.
A Massachusetts study found that men who had sex less than once a month were 45 percent more likely to develop cardiovascular disease than counterparts who had sex twice a week or more. And a study out of the UK found that men who had three or more orgasms per week had a 50 percent lower death rate.
But Simon cautions that is not because sex is strenuous exercise, as is often touted. At about five calories burned per minute, he likened it to raking the leaves or playing ping pong.
According to Dr. Debby Herbenick, a sexual health educator at the Kinsey Institute and author of "Because It Feels Good: A Woman's Guide to Sexual Pleasure and Satisfaction," that is not necessarily a bad thing.
"It's good that sex isn't terribly strenuous for most people most of the time," she said. "If it were, more people with heart conditions might be afraid of it!"
Herbenick explained that many men and their partners are concerned about sex and heart health, a sentiment Simon echoed, saying it was this fear that prompted him to write the review in the first place.
Still, men who have had heart attacks should consult with their medical practitioners before they engage in any sexual activities, and should not take drugs for erectile dysfunction if they are taking medications with nitrates. Couch potatoes also need to proceed to the bedroom with caution.
One useful gauge: If a man can't comfortably climb several flights of stairs, he should probably avoid knocking boots.
"In some people it is the only activity they do," said Dr. Irving M. Herling, a cardiologist with the University of Pennsylvania's School of Medicine. "They may have high blood pressure and diabetes, and the only time they -- pardon the pun -- extend themselves is during sexual intercourse, which is a physical activity. And like any physical activity, if they do it without being conditioned, it could potentially evoke a response."
Herling also added that men who cheat may be at a greater risk of having a heart attack, because the excitement level may be higher.
Ultimately, though, the experts seem to agree: With just a few caveats, sex with a familiar partner is safe -- even good -- for the heart.