Sexual Rehabilitation Interventions for Patients with Cardiovascular Disease: A Scoping Review

Abstract

Objective

This study systematically synthesizes the types, core components, and implementation characteristics of sexual rehabilitation interventions for patients with cardiovascular disease to inform the integration of sexual rehabilitation into cardiac rehabilitation and guide clinical practice.

Methods

A scoping review methodology was employed, following the framework of Arksey and O’Malley and reported according to PRISMA-ScR guidelines. PubMed, Embase, Web of Science, CINAHL, Cochrane Library, CNKI, and Wanfang Data were systematically searched from January 2000 to December 2025. Based on the Population–Concept–Context framework, inclusion and exclusion criteria were applied. Literature screening, data extraction, and evidence mapping were performed.

Results

A total of 29 studies were included: original research, systematic reviews, guidelines, scientific statements and research protocols. The included evidence primarily focused on patients with myocardial infarction or coronary heart disease and those undergoing percutaneous coronary intervention, with some studies also involving patients’ partners. Interventions were categorized into four types: (1) guidance-based interventions centered on sexual education and counseling; (2) psychological and behavioral interventions; (3) couple-based interventions; and (4) comprehensive rehabilitation integrated with cardiac rehabilitation. Most interventions were delivered by nurses or multidisciplinary teams, primarily through face-to-face interactions, with some utilizing remote methods like phone calls, video consultations, and mobile applications.

Conclusion

Current sexual rehabilitation interventions mainly focus on sexual health education and counseling, while psychological and behavioral interventions and partner-assisted interventions have also been explored, with favorable outcomes reported in some studies. However, sexual rehabilitation remains fragmented and lacks integration into cardiac rehabilitation systems. Future research should promote standardization, explore integrated models, and leverage digital health technologies for individualized care.

Background

Cardiovascular diseases (CVD) remains a major global public health challenge and a leading cause of premature mortality and disability worldwide.¹ Advances in medical care have improved the prognosis of patients with cardiovascular disease, resulting in a growing number of people living with the condition.² Accordingly, long-term disease management has gradually shifted from focusing exclusively on the survival rates of patients with cardiovascular disease to improving their quality of life.^3,4 Cardiac rehabilitation (CR) is a comprehensive secondary prevention strategy that has demonstrated significant effectiveness in reducing mortality and rehospitalization rates, improving patients’ physical function and mental health, and enhancing their quality of life.⁵ CR emphasizes a comprehensive approach, primarily focusing on exercise rehabilitation, risk factor control, medication adherence, nutritional management, psychological support and therapeutic patient education.⁶

Despite this comprehensive approach, sexual health remains an overlooked component of CR. Sexual health is defined by the World Health Organization as a state of physical, emotional, mental, and social well-being in relation to sexuality, and is an important component of overall health and well-being.⁷ For patients with cardiovascular disease, sexual activity is not only related to maintaining intimate relationships, but also closely linked to physical recovery, emotional stability, social roles, and individual self-identity. Studies show that many patients face problems such as decreased frequency of sexual activity, reduced libido, sexual dysfunction, and fear of sexual activity after a cardiac event.^8–11 These problems are usually influenced by multiple factors, including impaired cardiac function, adverse drug reactions, psychological distress, fear that sexual activity may trigger a cardiac event, and limited communication with one’s partner. Without effective intervention, sexual health problems can further exacerbate patients’ anxiety and depression, leading to strained intimate relationships and significantly reducing their quality of life.

Although sexual health issues are common among patients with cardiovascular disease, communication about sexuality varies across cultural and healthcare contexts. In some settings, healthcare professionals may hesitate to discuss sexual health because of limited training or concerns about causing discomfort, while patients and their partners may avoid raising such concerns because of embarrassment, cultural or religious norms, or the belief that these topics are inappropriate in clinical encounters.^12,13 This mutual avoidance has gradually led to a situation where patients “do not ask” and healthcare professionals “do not tell,” making sexual rehabilitation a crucial yet long-neglected part of cardiac rehabilitation.

In this review, sexual rehabilitation for patients with cardiovascular disease is defined as a recovery-oriented process comprising one or more sexual health interventions, Generally speaking, it refers to a process through which a series of interventions help patients and their partners safely resume sexual activity, manage changes in sexual function, and adapt to sexual life after the onset of the disease.¹⁴ This typically includes safety assessments of sexual activity and sexual education, sexual counseling to address fear and irrational beliefs, psychological interventions to alleviate anxiety and depression, behavioral guidance to restore intimacy, communication strategies for partners, and pharmacological treatments for sexual dysfunction.^15–17 Therefore, sexual health interventions refers to specific intervention measures, while sexual rehabilitation is the overall process of promoting the recovery and adaptation of patients within cardiovascular care. Several guidelines and consensus documents have recommended incorporating sexual counseling and sexual education into cardiac rehabilitation programs.^18,19 In this context, scholars both domestically and internationally have conducted research on sexual rehabilitation interventions for patients with cardiovascular disease. These studies primarily focus on sexual education for patients and their partners, improving sexual health issues through comprehensive approaches such as lifestyle changes (eg, diet and exercise), and pharmacological treatments for common sexual dysfunctions, such as erectile dysfunction.^20,21 Additionally, with the rapid development of digital health technologies, remote interventions such as telephone follow-up, online video courses, and mobile applications have gradually been incorporated into sexual health promotion practices,²² providing new avenues for improving the accessibility of sexual rehabilitation services.

Although existing research focuses on sexual rehabilitation for patients with cardiovascular disease, the available research evidence remains fragmented overall. Different studies vary considerably in terms of intervention types, core components, implementation methods, contextual settings, and outcome measures. Park et al¹⁵ conducted a systematic review and meta-analysis to evaluate the effects of sexual rehabilitation on sexual dysfunction in patients with cardiovascular disease. Boothby et al²³ examined the effects of participation in cardiac rehabilitation on sexual activity outcomes. Gupta et al²⁴ and Gbiri et al²⁵ focused on the influence of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction and the application of physiotherapy in the management of male sexual dysfunction, respectively. Previous studies have mostly focused on evaluating the effectiveness of a single intervention method, and there are few systematic reviews that comprehensively examine multiple intervention approaches from the perspective of sexual rehabilitation. In addition, the available empirical evidence is unevenly distributed across cardiovascular conditions, with most studies focusing on myocardial infarction, coronary artery disease, and patients undergoing PCI or CABG. Heart failure and other cardiovascular conditions are less frequently represented, and many studies predominantly involve male patients or focus on erectile dysfunction. Therefore, this study adopted the scoping review methodology to systematically search for and synthesize domestic and international research evidence on sexual rehabilitation interventions for patients with cardiovascular disease. Its purpose was to systematically identify and summarize intervention types, delivery methods, target populations, and gaps in the existing evidence. Specifically, this review addressed the following questions: (1) What are the methods and core components of sexual rehabilitation interventions? (2) In what settings are sexual rehabilitation interventions typically implemented, and what specific approaches are used? (3) Who are the participants involved in the sexual rehabilitation intervention process?

Methods

Study Design

This study followed the scoping review methodology framework proposed by Arksey and O’Malley,²⁶ which includes: (1) defining the research question; (2) systematically searching for relevant literature; (3) selecting studies; (4) extracting and organizing data; and (5) summarizing and reporting the results. At the same time, this study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines for standardized reporting, ensuring the transparency and reproducibility of the research process.

Inclusion and Exclusion Criteria

Inclusion Criteria

The inclusion criteria for this study were developed based on the PCC (Population–Concept–Context) framework.²⁷

• (1)Population: (a) Patients with cardiovascular diseases, including but not limited to coronary heart disease, myocardial infarction, heart failure, angina pectoris, valvular heart disease, and arrhythmias, as well as patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG); (b) Patients aged ≥18 years.
• (2)Concept: (a) Involves sexual rehabilitation or sexual health-related interventions, ie, any intervention aimed at improving patients’ sexual function, quality of sexual life, sexual satisfaction, sexual cognition, or adaptation to sexual life; (b) Intervention methods include, but are not limited to: sexual education, sexual counseling, psychological intervention, behavioral guidance, partner intervention, lifestyle intervention, integrated interventions combined with cardiac rehabilitation, pharmacological or medical interventions for sexual dysfunction, and digital health interventions based on telephone, internet, or mobile applications; (c) The study must report on at least one intervention measure and describe the specific content or implementation method of that intervention.
• (3)Context: (a) The intervention is implemented in medical or nursing-related settings, including hospital wards, outpatient clinics, cardiac rehabilitation centers, community healthcare facilities, or at home; (b) No restrictions on country or region.
• (4)Study types include randomized controlled trials, quasi-experimental studies, observational studies, qualitative studies, mixed-methods studies, systematic reviews, meta-analyses, and research protocols.
• (5)Published literature in both Chinese and English.

Exclusion Criteria

• (1)Conference abstracts, literature reviews, commentary articles, and case reports;
• (2)Literature for which the full text is unavailable;
• (3)Studies that have been published repeatedly.

Search Strategy

This study employed a systematic literature search strategy to comprehensively identify research evidence related to sexual rehabilitation interventions for patients with cardiovascular disease. The system searched English databases such as PubMed, Embase, Web of Science, CINAHL, and Cochrane, as well as Chinese databases such as CNKI and Wanfang Database. The search period was from January 2000 to December 2025. In addition, a backward search was conducted on the reference lists of the included literature to supplement the database search and identify relevant studies that might have been missed. The search strategy employed a combination of keywords and free-text terms, and followed an iterative development principle. The search terms revolved around keywords such as “cardiovascular disease,” “sexual health/sexual rehabilitation/sexual life/sexual activity/sexual behavior,” and “intervention/rehabilitation.” Search terms within the same conceptual domain were connected with “OR,” while those from different conceptual domains were connected with “AND.” Different databases adjust the search query according to their respective retrieval rules. The search strategy was developed and implemented under the guidance of an information specialist. The detailed search strategy is provided in Table S1.

Literature Screening

All records retrieved from the searches were imported into a reference management software for duplicate removal. A total of three reviewers were involved in the study selection process. After removing duplicates, two researchers independently screened the titles and abstracts of the literature based on pre-established inclusion and exclusion criteria to exclude articles that were clearly irrelevant to the research topic. All literature that could not be definitively determined to meet the inclusion criteria during the initial screening phase were retained for the full text screening phase. Subsequently, the two researchers conducted a full text review and further screening of the literature that passed the initial screening to ultimately determine which articles would be included in this study. During the screening process, if two researchers disagree on the inclusion criteria, they will discuss the matter to reach a consensus, if they still cannot reach an agreement, a third researcher will participate in the discussion and make the final decision.

Data Extraction and Integration

Two researchers from the research team designed a data extraction form to systematically organize the basic characteristics and information related to sexual rehabilitation interventions included in the study. The extracted content mainly includes the author and publication year, characteristics of the study participants, type of research design, and basic descriptive information about the sexual rehabilitation intervention.

This study employed thematic analysis to organize the extracted information and incorporated it into a pre-established classification framework through evidence mapping. During the evidence-mapping process, different types of evidence were summarized descriptively and were not combined for analysis or used to compare intervention effects. Based on their research objectives and their initial understanding of the characteristics of sexual rehabilitation interventions for cardiovascular disease patients, derived from existing literature, the two researchers constructed a classification framework for analyzing and integrating the results. This analytical framework categorizes the included studies based on the following four aspects: (1) type of intervention (eg, health education, counseling support, psychological intervention, or comprehensive intervention); (2) implementation setting (eg, inpatient, outpatient follow-up, home-based, or remote implementation); (3) intervention providers (eg, nurses, physicians, psychologists, or multidisciplinary teams); and (4) characteristics of the target population (eg, type of disease and whether partners were included). If disagreements arose during the analysis process, they were resolved through discussion, and when necessary, a third researcher was consulted to achieve consensus.

Results

This study retrieved a total of 12,782 relevant articles. After 260 duplicate records were removed, the remaining 12,522 records underwent title and abstract screening. Of these, 12,439 were excluded because they were unrelated to the review topic or did not meet the inclusion criteria. Subsequently, two reviewers independently assessed the full texts of the remaining 83 articles. Among them, 56 were excluded because they did not meet the eligibility criteria regarding the study population, research topic, or publication type, leaving 27 studies eligible for inclusion. In addition, a manual search of the reference lists of the included articles identified two additional studies. Ultimately, a total of 29 studies were included in this scoping review (Figure 1).

Figure 1.

Flow chart of literature screening based on PRISMA-ScR.

Characteristics of the Included Studies

Among the 29 included publications, 19 were original studies, including 14 randomized controlled trials. The remaining publications comprised four systematic reviews or meta-analyses, four guidelines, consensus documents, or scientific statements, one research protocol, and one clinical practice paper. The included evidence mainly focused on men and patients with coronary artery disease. 13 studies specifically targeted male patients or male sexual dysfunction, while only 2 studies explicitly involved female patients. There were only 2 studies related to heart failure. 10 studies included partner-collaborative interventions, 14 used face to face delivery, and 9 used remote delivery. Detailed characteristics are presented in Tables 1–3.

Table 1.

Basic Characteristics of the Included Studies

No	Title	Author	Year	Study Design	Participants
1	Sexual activity in patients with cardiovascular disease28	Michael J Blaha et al	2026	Clinical practice guideline	Patients with cardiovascular disease
2	Effect of Aerobic Exercise on Erectile Dysfunction in Young and Middle-aged Patients with Coronary Heart Disease29	Zeng Hui-qin et al	2018	Randomized controlled trial	Young and middle-aged patients with coronary heart disease
3	A Home-Based Walking Program Enhances Erectile Function in Men Post-Myocardial Infarction30	Begot I et al	2015	Randomized controlled trial	Patients with acute myocardial infarction
4	A Randomized Trial of the Effect of Peer Education on the Sexual Quality of Life in Patients with Myocardial Infarction31	Abbasi A et al	2020	Randomized controlled trial	Partners of patients with myocardial infarction
5	A Social-Cognitive Sexual Counseling Intervention Post-MI—Development and Pilot Testing32	Steinke EE et al	2012	Pilot study	Patients with myocardial infarction
6	A Videotape Intervention for Sexual Counseling after Myocardial Infarction33	Steinke EE et al	2002	Quasi-experimental study	Patients with myocardial infarction
7	Effect of Cardiac Rehabilitation on Sexual Satisfaction Among Patients After Coronary Artery Bypass Graft Surgery34	Rakhshan M et al	2019	Randomized controlled trial	Patients after coronary artery bypass grafting
8	Effect of Sexual Rehabilitation Program on Anxiety, Stress, Depression and Sexual Function among Men with Coronary Artery Disease17	Tirgari B et al	2019	Randomized controlled trial	Men with coronary artery disease
9	Effectiveness of Online Versus Telephone Counseling of Rational-Emotional-Behavioral Therapy on Sexual Function of Women Undergoing Cardiac Rehabilitation: A Randomized Clinical Trial22	Farajkhoda T et al	2022	Randomized controlled trial	Women with cardiovascular disease
10	Effectiveness of Physiotherapy Interventions in the Management of Male Sexual Dysfunction: A Systematic Review25	Caleb Ademola et al	2023	Systematic review	Men with sexual dysfunction
11	Effects of Sexual Rehabilitation on Sexual Dysfunction in Patients with Cardiovascular Disease: A Systematic Review and Meta-Analysis15	Park Jae Joon et al	2023	Systematic review and meta-analysis	Patients with cardiovascular disease
12	Effects of short-term moderate exercise training on sexual function in male patients with chronic stable heart failure35	Romualdo Belardinelli et al	2005	Randomized controlled trial	Men with chronic heart failure
13	Investigating the Impact of Couple Counseling Based on the CHARMS Model on Sexual Quality of Life and Marital Satisfaction of Wives of Men Suffering from Myocardial Infarction: A Randomized Clinical Trial Study36	Delniya Ghafuri et al	2025	Randomized controlled trial	Men with myocardial infarction and their spouses
14	Princeton IV consensus guidelines: PDE5 inhibitors and cardiac health37	Kloner Robert A et al	2024	Consensus document	Men with erectile dysfunction
15	Sexual Activity and Cardiovascular Disease38	Levine G et al	2012	Scientific statement	Patients with cardiovascular disease
16	Sexual Counseling for Individuals With Cardiovascular Disease and Their Partners39	Steinke EE et al	2013	Consensus document	Patients with cardiovascular disease
17	Sexual counselling for patients with cardiovascular disease: protocol for a pilot study of the CHARMS sexual counselling intervention40	Murphy PJ et al	2016	Study protocol	Patients with cardiovascular disease
18	Sexual rehabilitation for cardiac patients with erectile dysfunction: a randomised clinical trial41	Pernille Palm et al	2018	Randomized controlled trial	Patients with ischaemic heart disease and/or implantable cardioverter defibrillator
19	Sildenafil Improves Quality of Life in Men with Heart Failure and Erectile Dysfunction42	Freitas D et al	2006	Prospective study	Men with heart failure and erectile dysfunction
20	The CHARMS pilot study: a multi-method assessment of the feasibility of a sexual counselling implementation intervention in cardiac rehabilitation in Ireland43	Patrick J. Murphy et al	2018	Pilot study	Patients with cardiovascular disease
21	The Effect of Sex Counseling in the Sexual Activity of Acute Myocardial Infarction Patients After Primary Percutaneous Coronary Intervention21	Xu Feng et al	2015	Randomized controlled trial	Patients with acute myocardial infarction
22	The Effect of Cardiac Rehabilitation Attendance on Sexual Activity Outcomes in Cardiovascular Disease Patients: A Systematic Review23	Boothby CA et al	2018	Systematic review	Patients with cardiovascular disease
23	The Effect of Lifestyle Modification and Cardiovascular Risk Factor Reduction on Erectile Dysfunction24	Bhanu P. Gupta et al	2011	Systematic review and meta-analysis	Men with erectile dysfunction
24	The Effect of Modified Cardiac Rehabilitation on Erectile Dysfunction and Coping with Stress in Men Undergoing Coronary Artery Bypass Graft (CABG): A Clinical Trial44	Kaikhosro Doulatyari et al	2019	Randomized controlled trial	Men undergoing coronary artery bypass grafting
25	The effect of sexual counseling on depression, anxiety, stress, sexual knowledge and sexual quality of life in men who have undergone invasive coronary interventions: An RCT45	Sadatinejad SM et al	2021	Randomized controlled trial	Men after invasive coronary interventions
26	The Impact of a Neuromuscular Rehabilitation Programme on the Quality of Life of Patients with Acute Coronary Syndrome and Its Relationship with Sexual Dysfunction: A Randomised Controlled Trial46	Noemí Valtueña-Gimeno et al	2024	Randomized controlled trial	Patients with acute coronary syndrome
27	The Impact of Sexual Therapy on Patients After Cardiac Events Participating in a Cardiac Rehabilitation Program47	Klein R et al	2007	Randomized controlled trial	Men after myocardial infarction or coronary artery bypass grafting
28	Treatment of Erectile Dysfunction in Patients with Cardiovascular Disease48	Graham Jackson et al	2004	Clinical practice	Patients with cardiovascular disease
29	Effectiveness of a Videotape for Sexual Counseling after Myocardial Infarction49	Steinke E. E. et al	2004	Quasi-experimental study	Patients with myocardial infarction

Table 2.

Mapping of Sexual Rehabilitation Interventions

No	Author / Year	Sexual Education	Sexual Counseling	Psycho Behavioral	Couple-Based	Exercise	Cardiac Rehabilitation	Lifestyle/Risk Management	Medical Treatment	Physio Therapy
1	Michael J Blaha et al/202628	√	√						√
2	Zeng Hui-qin et al/201829		√			√
3	Begot I, et al/201530					√
4	Abbasi A et al/202031				√
5	Steinke EE et al/201232		√	√
6	Steinke EE et al/200233	√			√
7	Rakhshan M et al/201934	√				√
8	Tirgari B et al/201917	√
9	Farajkhoda T et al/202222	√		√
10	Caleb Ademola et al/202325	√		√		√				√
11	Park Jae Joon et al/202315	√		√	√	√				√
12	Romualdo Belardinelli et al/200535					√
13	Delniya Ghafuri et al/202536	√			√
14	Kloner Robert A et al /202437								√
15	Levine G et al/201238		√		√	√	√		√
16	Steinke EE et al/201339	√	√	√	√
17	Murphy PJ, et al/201640	√	√		√					√
18	Pernille Palm et al/201841	√		√		√				√
19	Freitas D et al/200642								√
20	Murphy PJ, et al/201843	√	√		√
21	Xu Feng et al/201521		√
22	Boothby CA et al/201823	√	√			√		√
23	Bhanu P. Gupta et al/201124					√		√
24	Kaikhosro Doulatyari et al/201944			√			√			√
25	Sadatinejad SM et al/202145		√
26	Noemí Valtueña-Gimeno et al/202446					√
27	Klein R et al/200747		√	√	√		√
28	Graham Jackson et al/200448								√
29	Steinke, E. E. et al/200449	√			√

Notes: “√” indicates that the corresponding intervention component was included in the study.

Table 3.

Implementation Characteristics of Sexual Rehabilitation Interventions

No	Author/Year	Implementation Setting	Delivery Method	Intervention Medium	Participants	Intervention Providers
1	Michael J Blaha et al/202628	Hospital	Face to face	/	Patients with cardiovascular disease	Physician
2	Zeng Hui-qin et al/201829	Hospital	Face to face	/	Young and middle-aged patients with coronary heart disease	Physician
3	Begot I, et al/201530	At home	Telephone	Telephone counseling	Patients with myocardial infarctions	/
4	Abbasi A et al/202031	Hospital	Face to face	/	Partners of patients with myocardial infarction	Nurse
5	Steinke EE et al/201232	At home	Telephone	Video, Written materials, Telephone counseling	Patients with acute myocardial infarction	Nurse
6	Steinke EE et al/200233	At home	Video	Video	Patients with acute myocardial infarction	Nurse
7	Rakhshan M et al/201934	Hospital	Face to face	/	Patients after coronary artery bypass grafting	/
8	Tirgari B et al/201917	HospitalAt home	Face to face andTelephone	Video, Pamphlet, Telephone follow-up	Men with coronary artery disease	Nurse
9	Farajkhoda T et al/202222	At home	On line and telephone	App, Telephone counseling	Women with cardiovascular disease	/
10	Caleb Ademola et al/202325	/	/	/	Men with sexual dysfunction	Physiotherapis
11	Park Jae Joon et al/202315	/	/	/	Patients with cardiovascular disease	Nurse
12	Romualdo Belardinelli et al/200535	Hospital	Face to face	/	Men with chronic heart failure	/
13	Delniya Ghafuri et al/202536	At home	Telephone	Telephone follow-up, Pamphlet	Men with myocardial infarction and their spouses	Researchers and nurses
14	Kloner Robert A et al /202437	/	/	/	Men with erectile dysfunction	/
15	Levine G et al/201238	/	/	/	Patients with cardiovascular disease	/
16	Steinke EE et al/201339	/	/	Lecture, Brochure, Video, Seminar discussions	Patients with cardiovascular disease	Healthcare professionals
17	Murphy PJ, et al/201640	Cardiac rehabilitation centre	Face to face	Booklet	Patients with cardiovascular disease	Cardiac rehabilitation staff
18	Pernille Palm et al/201841	Hospital	Face to face	Booklet	Patients with ischaemic heart disease and/or implantable cardioverter defibrillator	Physician and nurses
19	Freitas D et al/200642	Hospital	/	/	Men with heart failure and erectile dysfunction	/
20	Murphy PJ, et al/201843	Cardiac rehabilitation centre	Face to face	Booklet	Patients with cardiovascular disease	Cardiac rehabilitation staff
21	Xu Feng et al/201521	At home	Telephone	Written materials, Telephone counseling	Patients with acute myocardial infarction	Cardiac rehabilitation staff
22	Boothby CA et al/201823	Outpatient	Face to face	/	Patients with cardiovascular disease	/
23	Bhanu P. Gupta et al/201124	/	/	/	Men with erectile dysfunction	/
24	Kaikhosro Doulatyari et al/201944	Cardiac rehabilitation centre	Face to face	/	Men undergoing coronary artery bypass grafting	Cardiac rehabilitation staff
25	Sadatinejad SM et al/202145	Before discharge and at home	Face to face andTelephone	Telephone follow-up, Brochure, Video	Men after invasive coronary interventions	/
26	Noemí Valtueña-Gimeno et al/202446	Hospital	Face to face	/	Patients with acute coronary syndrome	Physiotherapis
27	Klein R et al/200747	Hospital	Face to face	/	Men after myocardial infarction or coronary artery bypass grafting	Clinical social worker and Physician
28	Graham Jackson et al/200448	/	/	/	Patients with cardiovascular disease	/
29	Steinke, E. E. et al/200449	At home	Patients viewed the material independently	Video	Patients with myocardial infarction	Nurse

Note: “/” indicates not reported.

Publication year and Characteristics of Participants

Most of the studies included were conducted within the last 10 years, totaling 19 articles. The participants mainly included patients with cardiovascular diseases, including myocardial infarction, coronary heart disease, and those undergoing PCI and related treatments. Most studies primarily focused on male patients, while a small number of studies also included partners as part of the study population.

Study Design

The included studies were mainly randomized controlled trials (RCTs), clinical practice guidelines, systematic reviews, and pilot studies, and also included some observational and quasi-experimental studies. Specifically, RCT studies are primarily used to evaluate the effects of specific interventions on patients’ sexual function, quality of sexual life, sexual satisfaction, and related outcome measures. Pilot studies tended to focus more on the feasibility, acceptability, and preliminary outcomes of intervention programs, thereby providing a basis for subsequent large-scale studies. Clinical practice guidelines systematically summarize the principles and methods for the safe resumption of sexual activity and the provision of sexual counseling for cardiovascular disease patients from an evidence-based medicine perspective (Tables 1 and S2).

Type of Intervention

Based on a mapping analysis, the types of sexual rehabilitation interventions included in this study are categorized as follows: (1) Guidance-based interventions centered on sexual health education and sexual counseling; (2) Psychobehavioral intervention focused on psychological support and behavioral modification; (3) Couple-based collaborative intervention involving both the patient and their partner; (4) Comprehensive rehabilitation intervention integrated with cardiac rehabilitation. Mapping analysis identified four broad intervention types, as detailed in Table 2 and Table 3.

Guidance-Based Interventions Centered on Sexual Education and Sexual Counseling

In the literature included in this study, sexual education and sexual counseling were the main intervention methods.^{15,21,28,31,34,36,39,45} In terms of intervention content, sexual education mainly includes knowledge related to safe sexual practices, the appropriate timing for resuming sexual activity, the impact of sexual activity on health, environmental considerations during sexual activity, choices of sexual positions, foreplay, physiological responses, and warning signs related to sexual health. In addition, health education content also includes the effects of cardiovascular medications on sexual life.^28,31

Sexual counseling mainly focused on addressing anxiety related to sexual activity, fear, and uncertainty experienced by patients during the process of resuming sexual activity after disease treatment.³¹ Through counseling support, patients were helped to develop an accurate understanding of sexual activity and related risks after illness, alleviate psychological burden, and enhance confidence. During the counseling process, patients’ concerns regarding sexual activity were addressed, thereby changing their unreasonable perceptions and facilitating the early resumption of sexual activity.⁴⁵

Psychobehavioral Intervention Focused on Psychological Support and Behavioral Modification

The approach primarily focuses on psychological support and behavioral adjustment, addressing the psychological reactions and behavioral changes that patients experience during sexual activity during the disease recovery period, and helping them cope with the psychological stress and anxiety caused by changes in their sexual life due to the illness.^{15,22,32,33,36,38,47} The intervention focuses on addressing patients’ anxiety, fear, and tension, as well as negative cognitions, and uses psychoeducation and counseling to help patients develop a correct understanding of the risks and safety of sexual activity.²² Some studies adopted cognitive behavioral therapy,³² providing staged guidance to patients centered on key components such as cognitive restructuring, emotion regulation, and behavioral modification. In terms of behavioral intervention, a gradual behavioral guidance strategy is typically combined to support patients in progressively resuming activities within safe limits. In these studies, techniques such as relaxation training, guided imagery, and sensory focus were employed to help patients reduce psychological stress during sexual activity, enhance sexual physiological arousal, and thereby improve their subjective sexual experience.³³ Some studies incorporate relationship and communication adjustments as important components of psychological and behavioral interventions. By guiding patients and their partners to understand each other’s needs and concerns, these interventions promote supportive interactions and emotional connection, thereby improving cooperation during the recovery process of sexual activity.³⁶

Couple-Based Collaborative Intervention Involving Both the Patient and Their Partner

The included studies shows that some studies treated patients and their partners as joint intervention targets and developed collaborative intervention models with active partner involvement.^31,36,40,43 Resuming sexual activity is a process that patients and their partners must face and adjust to together.⁴⁰ Therefore, incorporating the partner as a target of intervention in the sexual rehabilitation process, the collaborative intervention mainly includes providing sexual health related information and communication support, guiding patients and their partners to communicate about their sexual needs, concerns, and expectations, and jointly adjusting their sexual lifestyle based on mutual understanding.⁴³ By helping both partners recognize the normality of changes in sexual activity following illness and encouraging joint participation in sexual counseling, such interventions can reduce anxiety, avoidance, or feelings of insecurity, promote emotional connection, and enhance couples’ confidence and capacity to cope with sexual issues.³⁶

Comprehensive Rehabilitation Intervention Integrated with Cardiac Rehabilitation

In the included studies, some integrated sexual-related interventions into cardiac rehabilitation, thereby forming a comprehensive rehabilitation model centered on cardiac rehabilitation and encompassing multiple intervention components. These components typically included exercise training, lifestyle modification, risk factor management, and the use of cardiovascular medications.^{24,30,34,44,47} Overall, these rehabilitation measures aim to improve patients’ cardiopulmonary function and overall physical capacity, thereby contributing to improvements in sexual function. Based on this, some studies have incorporated sexual education or counseling content into cardiac rehabilitation programs, focusing on aspects such as the safety of sexual activity, the appropriate timing for resuming sexual activity, and risk identification.³⁹ Building upon a focus on overall function, some studies incorporated psychological support or behavioral adjustments into cardiac rehabilitation,^15,31 and encouraged partner involvement in the rehabilitation process,^36,43 to promote joint coping and adaptation to illness-related changes in sexual life.

Intervention Settings and Delivery Methods

Implementation Settings

In terms of implementation settings, the sexual rehabilitation interventions included in the study were primarily conducted during hospitalization and at home. Some studies integrated the interventions into routine health education or discharge instructions during hospitalization. Once the patient’s condition stabilized, healthcare professionals provided information and counseling support related to sexual health to the patient and their partner.¹⁷ Some studies have extended sexual intervention to the post-discharge follow-up phase, providing continuous attention and support to patients regarding problems they encounter during the recovery of their sexual life through regular follow-up or staged interventions.^21,36

Delivery Methods

In terms of delivery methods, sexual rehabilitation interventions are primarily conducted face to face, usually by medical staff or research team members in wards, outpatient clinics, or rehabilitation centers.^17,23,43,44 Meanwhile, some studies have adopted non face to face intervention methods, such as telephone follow-ups, written materials, or video resources, to improve the adherence and continuity of the intervention.³³ In some studies, patients and their partners were encouraged to participate together, with sexual health support delivered through interventions targeting both members of the couple.³¹

Intervention Mediums

In terms of intervention mediums, the intervention methods used in the studies showed considerable diversity. Besides traditional oral instruction and distribution of printed materials, some studies used videos or recordings as the main medium for sexual health education and counseling, creating video materials that patients could watch repeatedly after discharge.^33,49 Other studies have implemented interventions combining telephone calls, mobile apps, or remote follow-up, reflecting a trend towards extending sexual rehabilitation interventions to remote and home based settings.²²

Intervention Providers

From the perspective of intervention providers, the sexual rehabilitation interventions included in this study were primarily led and implemented by healthcare professionals, including nurses, physicians, and members of multidisciplinary teams (therapists, researchers).^25,29,32,40 In most studies, interventions were delivered directly by healthcare professionals during hospitalization, discharge education, or follow-up, reflecting a predominantly professionally led model of sexual rehabilitation in clinical practice.^15,36

Participants

In terms of participants, some studies targeted patients as the direct recipients of interventions,^22,29,35,37 while others included both partners in the intervention,^17,33,34 particularly in studies involving communication about sexual life, adjustment of intimate relationships, and psychological and cognitive interventions.

Overall, sexual rehabilitation interventions demonstrated considerable diversity in implementation settings, delivery methods, intervention media, providers, and target populations. Sexual rehabilitation can be integrated into routine health education or discharge instructions during hospitalization, or extended to the follow-up phase after discharge to ensure continuity of intervention. In terms of implementation, the intervention primarily involves face to face interactions led by healthcare professionals, combined with non face to face methods such as telephone calls, written materials, and video resources, to enhance the continuity and accessibility of the intervention. In terms of intervention media, in addition to traditional oral explanations and the distribution of paper materials, the use of video, remote follow-up, and mobile applications is gradually increasing. Overall, interventions are primarily implemented by professional healthcare providers or multidisciplinary teams, mainly targeting patients. Some studies include partners in the intervention process, which is particularly common in interventions involving communication about sexual life and psychological adjustment.

Discussion

Marginalization of Sexual Rehabilitation in Cardiovascular Disease Management

Although sexual health is considered an important component of quality of life,⁵⁰ This review found that sexual rehabilitation remains a marginal area in cardiovascular care and rehabilitation, and its implementation primarily takes the form of supplementary education or sexual counseling, rather than being integrated into routine cardiac rehabilitation programs. The marginalization of sexual rehabilitation is not only influenced by practical issues such as time and resources in clinical practice, but also closely related to how patients perceive sexuality and their bodies within specific cultural contexts.^51,52

In China, Confucianism, Taoism, and Buddhism collectively influence patients’ perceptions of sex and the body.⁵³ However, the influence of culture on sexual rehabilitation is not unique to China. Across countries and regions, sociocultural norms and religious beliefs may shape how patients, their partners, and healthcare professionals perceive sexual health, their willingness to discuss sexual concerns, and their acceptance of sexual rehabilitation interventions.^54,55 In addition, healthcare system factors, including the availability of trained professionals, the integration of sexual counseling into cardiac rehabilitation, consultation time, privacy provisions, and referral pathways, may influence the implementation of sexual rehabilitation.⁵⁶ The education and healthcare systems might also be one of the potential sources contributing to the heterogeneity in the inclusion of the studies, thereby limiting the applicability of the research results in different cultural backgrounds and healthcare systems. Given the limited reporting of contextual information in existing studies and the lack of direct cross-cultural comparisons, future multinational and cross-cultural studies are needed to compare sexual rehabilitation practices and intervention outcomes across countries and healthcare systems.

Structural Fragmentation Between Sexual Rehabilitation and Cardiac Rehabilitation

Although some studies included in this research integrated sex-related interventions into cardiac rehabilitation, overall, the number of such studies remains limited, and sexual rehabilitation is often implemented in a fragmented manner, without being systematically integrated with other rehabilitation components in cardiac rehabilitation programs.

Currently, cardiac rehabilitation primarily focuses on exercise training, risk factor control, and medication management,⁵⁷ while sexual health issues lack clear intervention points and well defined implementation standards. This often leaves sexual rehabilitation at the level of merely “whether it is mentioned,” making it difficult to integrate it effectively with cardiac rehabilitation. The result not only weakens the continuity of sexual rehabilitation interventions but also, to some extent, deviates from the holistic rehabilitation concept advocated by cardiac rehabilitation,⁵⁷ leading to a situation where, while patients’ physical function gradually improves, the recovery of their sexual life lacks synchronous and systematic support. Relevant guidelines indicate that healthcare professionals should proactively discuss sexual activity, sexual concerns, and sexual function issues with cardiovascular disease patients, and tailor the discussion content and intervention focus based on the patient’s individual needs, type of cardiovascular disease, symptoms, and risk level.^38,58 However, this recommendation has not yet been implemented in clinical and rehabilitation practice, and sexual health content has not been integrated into routine cardiac rehabilitation assessment and intervention processes. The difficulty in effectively integrating sexual rehabilitation into cardiac rehabilitation programs is not simply due to insufficient intervention content. In the studies included in this review, sexual rehabilitation interventions showed substantial variation in content composition, implementation frequency, and delivery methods, and a clear and consistent standardized implementation process has not yet been established.^40,44 The lack of standardized intervention procedures has led to uncertainty regarding how and in what ways sexual rehabilitation should be implemented in practice. The implementation of sexual rehabilitation relies on the experience of healthcare professionals and has not yet formed a stable, reproducible practice model, further exacerbating its marginalization within the cardiac rehabilitation pathway. Therefore, it is necessary to consider sexual rehabilitation as a natural extension of cardiac rehabilitation, explore standardized procedures and content for sexual rehabilitation, and integrate it into the cardiac rehabilitation assessment and intervention process. This integration, along with exercise training, risk factor control, and long-term management, will create a synergistic approach to better meet the actual needs of patients during their comprehensive rehabilitation.

The included evidence was unevenly distributed across cardiovascular conditions and by sex. Although some studies involved patients with heart failure and other cardiovascular conditions,^35,42,46 the primary evidence was concentrated on patients with myocardial infarction or coronary artery disease and those undergoing PCI or CABG.^{17,21,30,34,44} This concentration may limit the applicability of the findings to other cardiovascular disease populations. A similar imbalance was observed in sex representation. Most of the studies focused on male patients or erectile dysfunction,^{24,25,35,37,42} while only a few explored sexual rehabilitation for women with cardiovascular diseases.²² This imbalance may limit the applicability of the findings to women. Future studies should include a broader range of cardiovascular conditions, ensure greater representation of women, and examine differences in sexual health concerns and rehabilitation needs across disease and sex groups to inform more targeted interventions.

Digital and Intelligent Sexual Rehabilitation Interventions Show Emerging Potential

The included studies show that some research has introduced intelligent methods such as video, telephone follow-up, online consultations, or mobile applications into the field of sexual rehabilitation intervention, extending sexual rehabilitation from the hospital to the home. However, overall, existing digital interventions still primarily remain at the level of information dissemination and consultation support, and have not yet formed a systematic intervention model based on dynamic monitoring, continuous evaluation, timely feedback, and individualized decision-making.

Sexual health issues are highly contextual and private. Research shows that healthcare professionals are often hesitant to discuss sexual topics in face-to-face consultations, and some patients may avoid proactively expressing their sexual concerns due to embarrassment, which to some extent limits the progress of sexual rehabilitation.^59,60 In this context, future research could explore the development of specialized intelligent agents or conversational systems tailored to sexual rehabilitation for patients with cardiovascular disease. Through human–computer interaction, such systems can enable patients to express sexual concerns in a safer and more anonymous environment while reducing the discomfort that healthcare professionals may experience when discussing sexual health, thereby reducing communication barriers and improving access to information.

The included studies indicate that some sexual rehabilitation interventions extend from hospitalization into the post-discharge period, with ongoing support delivered through regular follow-up or staged interventions.^36,40,41,45 However, most interventions use predetermined content and fixed delivery methods, and few incorporate continuous assessment or dynamic adjustment in response to changes in patients’ conditions and needs across different stages of rehabilitation. In recent years, wearable devices have been applied in the field of cardiac rehabilitation. Their main functions include continuously monitoring patients’ vital signs and physical activity, and transmitting relevant data to medical institutions via applications to support healthcare professionals in conducting remote monitoring and follow-up management.⁶¹ Future research could explore the application of wearable technologies in sexual rehabilitation, the integration and analysis of physiological indicators, activity tolerance levels, and patient-reported symptoms obtained from wearable devices will provide healthcare professionals with more objective and continuous reference data during sexual rehabilitation follow-up,⁶² this will offer supportive assistance in risk stratification and determining the appropriate timing for resuming sexual activity during sexual rehabilitation. Based on continuous monitoring using wearable devices, this approach helps reduce patients’ uncertainty about cardiovascular events related to sexual activity, and to some extent reduces fear or avoidance behaviors resulting from insufficient risk awareness. Furthermore, given the sensitive and private nature of sexual health information, future digital interventions should also focus on informed consent, data security, privacy protection, and equitable access.

Limitations

This study also has several limitations. First, no bias risk assessment was performed on the studies included in the research, making it impossible to quantitatively compare the effects of the interventions. Second, the studies included in the analysis showed considerable heterogeneity in terms of study designs, intervention types and outcome measures, which limits direct comparisons between the results of different studies. In addition, the concentration of evidence on male patients with coronary artery disease-related conditions may limit the applicability of the findings to women, older adults, patients with other cardiovascular conditions, and more diverse populations. Finally, most studies originate from Western cultural backgrounds. Differences in cultural norms, religious beliefs, and healthcare systems may have influenced attitudes toward sexual health, patient-healthcare professional communication, and the implementation of sexual rehabilitation, thereby contributing to heterogeneity across studies and limiting the applicability of the findings in other contexts.

Conclusion

This scoping review mapped research on sexual rehabilitation interventions for cardiovascular disease patients. It found that existing interventions primarily focus on sexual education and sexual counseling, while psychological and behavioral interventions and partner-assisted interventions have also been explored, with favorable outcomes reported in some studies. Overall, existing interventions remain fragmented, with limited integration into routine cardiac rehabilitation. These findings highlight the need to incorporate routine assessment of sexual health needs into cardiac rehabilitation and to establish standardized pathways for referral, counseling, and follow-up. However, the available evidence is derived predominantly from studies of male patients with coronary artery disease, which may limit the generalizability of the findings to women and patients with other cardiovascular conditions. Future research should include more diverse cardiovascular populations and evaluate culturally appropriate, sustainable, and individualized sexual rehabilitation strategies.

Funding Statement

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Data Sharing Statement

All data supporting the findings of this scoping review were derived from the published sources cited in the manuscript and are presented in the article and supplementary materials. No confidential patient-level data were collected.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.