If you're a client, and maybe it is like, a couple weeks before Valentine's Day, you might say, well, am I allowed to, like, return to sexy time?

And if no one has talked to you about this, this is a really important conversation.

To have sex is awesome.

It can be a part of a fulfilling life.

And sometimes post surgery, it might hurt.

Or is the heart ready for.

Right.

So those are the key things that we want to talk about in today's podcast, and I'm so excited to be able to talk about it with you.

Hey, welcome back to Open Heart Surgery with Boots.

I am your host, Boots Knightman, joined by my friend, Dr.

Kelly Sudowkis, and we are rocking Love Month, Heart Month with pelvic health and open heart surgery.

Yep.

And today, normally, I air every Tuesday, but we are bringing you a special episode today on Valentine's Day because it is time to have a conversation about sexy time after surgery.

Now, this.

I was not aware of the things I needed to think about.

No one ever talked to me about it.

And I am learning with all of you listeners.

I am still astonished.

Everything that we've already talked about with Dr.

Kelly this month has blown my mind.

And I keep telling her, just treat me like I have just walked into her office.

This is 101 pelvic health post open heart surgery, and it only continues today with a very, like, normal part of being a human being.

Absolutely, Absolutely, Boots.

And so if you're a client and maybe it is, like, a couple weeks before Valentine's Day, you might say, well, am I allowed to, like, return to sexy time?

And if no one has talked to you about this, this is a really important conversation.

To have sex is awesome.

It can be a part of a fulfilling life.

And sometimes post surgery, it might hurt.

Or is the heart ready for this?

Right, so those are the key things that we want to talk about in today's podcast, and I'm so excited to be able to talk about it with you.

Now, some of your listeners may have had the privilege of going to cardiac rehab.

Did you get any cardiac rehab boots or, like, do you have any statistics about, like, what percentage of heart surgery patients get cardiac rehab?

Yeah.

It's interesting you bring this up, because I was not referred.

I was treated almost like a celebrity in the hospital because, quote, unquote, my surgeon said they only operated on fat people.

His exact words.

Those are not my words.

I would not use that to describe people anyway.

And I remember the nursing staff coming in and being amazed at me because at the time, I was really athletic.

I mean, I still am, but just in a new way.

But my defects was so unique to them.

They had not usually operated on like skiers and so they just didn't think I needed to do cardiac rehab afterwards and that I could just go back.

I remember the exact words at my six week follow up were, go live your best life.

And that was all the parameters I was given.

Now I've joined Women Heart, which is listeners who've been listening for a while have heard me talk about this nonprofit.

It's a national nonprofit for women by women with heart disease.

And we, we do a lot of lobbying at the federal level to get women better heart health care.

What Women Heart has found is that more times than not, men are referred for cardiac rehab, but women are not.

And I have spoken to so many women who were not referred at all, like myself, and it's, and it's such a missed opportunity.

And so yet another reason for this podcast, we all, no matter what our backgrounds are, we all need to be referred to cardiac rehab.

Exactly.

And I would now also argue pelvic rehab.

Right.

But probably cardiac rehab.

Yeah, cardiac rehab, probably a little bit more of a priority.

And what it is for your listeners, if you don't know, it's just like you would go to physical therapy for knee rehab after a total knee replacement to retrain the knee to work.

Cardiac rehab is progressively and scientifically challenging your heart at different levels of exertion while a trained staff monitors your blood pressure and your heart rate.

And one of the terms they're going to use in cardiac rehab and if you start to do some research by yourself is a metabolic equivalent or a met.

And when we talk about sexy time post heart surgery, a MET is really important.

So the technical term of a metabolic equivalent, and I'm going to read it here because I don't have it memorized, and you'll see why.

One metabolic equivalent is equal to three and a half milliliters of oxygen per kilogram of body weight per minute.

What?

So it's how much oxygen your heart and your lungs are processing per minute.

And mets, it's a way of describing how hard you're working.

So like zero mets is like sitting absolutely still.

One MET might be walking around the house.

But here's the thing.

Chicken wings.

One met for someone like boots at her heart surgery is way different than a different human's.

One met a different human.

Walking across the house might be moderately to extremely stressful.

So walking across the house could be considered 5 metabolic equivalents.

All Right.

So this is like a whole nother topic to get into.

But the skinny is post heart surgery, we need to be gradually progressing your activity and assessing your response to this activity and having skilled medical providers to assess your heart rate and your blood pressure response is awesome.

And if we don't have that, you can do some judicious googling, Right?

Mets after heart surgery, scholarly mets after heart surgery, and bring it to your medical practitioners, like, I want to understand this more, and then they can guide you.

In general, mets of around one are like our lowest, easiest activities, like bed rest might even be considered a one.

Sitting up in the chair, taking a shower might be a MET of 2 to a 3.

Once we get up to 3 to 4 now, it's like leisure activities.

So for some people that might be walking, for some people that might be sitting up in a chair, once we start to get to five now.

And this is typically what's assumed to be the metabolic core equivalent of sexual activity as a met of five, a moderately vigorous activity.

Now, depending on where we are literally in the position for on top or bottom, that's gonna matter.

So if you are, you know, this is your, your first go at it and you're like, I'm a little nervous.

Maybe you should be the more like, receiving partner, the partner that's doing a little bit less.

As you work a little bit farther out in your recovery, you can be more of a active participant and move around a little bit more.

That'll be a higher metabolic equivalent.

But this is really important for you to understand where it fits into things, because it's a, it's a pretty vigorous activity.

So if you're still working on like walking on the treadmill for like 10 minutes, and that's exhausting, you're probably not quite ready to participate in vigorous, intimate activities just yet.

But it's something that you can work towards by increasing the duration of that time on the treadmill by introducing things like weight training and, you know, stair climbing and things.

And again, I'm not a cardiac rehab specialist.

I want you to get your cute butt and your cute heart into a trained cardiac rehab practitioner.

But it's progressive load on the heart just as important as progressive load on muscles after a shoulder surgery or a knee surgery.

And it's just, it's great to know.

And then beyond, like the mets, like, what's the highest it goes to?

I think it goes to like 10, actually.

As far as, like the metabolic equivalent scale, 10 is like a high intensity activity.

So we want to make sure that we're working up towards those activities when it's meaningful to you.

So that's mets for heart surgery.

The other important piece is heart surgery is stressful.

We talked about that in our last couple of segments.

Together with stress comes a passive elevation, an.

A subconscious elevation of your pelvic floor muscles.

So if you have a vagina, that could mean that it doesn't feel as good as it once did.

It might actually be painful because honestly, ladies, the door's closed.

If you have a penis, you might find that you're having trouble hoisting the main sail.

And if that's the case, those two conditions, the pain with intimacy or the inability to have that erection or that climax, that.

That can be due to these pelvic floor muscles resting too tight in general, and they're not really healthy.

So as a treat, we're going to have a pelvic floor relaxation, whole segment for you to go through.

But here, together, if we've had open heart surgery, if we're having it in the future, it's very important for you to relax your pelvic floor for overall health and wellbeing and for sexy time.

So sitting here, wherever you are, I want you to relax your tummy, close your eyes if you're not like driving or something, and if you're out for a walk or a run, pause for a moment and take a couple beautiful, nice, deep belly breaths.

Inhaling, fill up your lower belly in all directions.

Exhale.

Notice how your lower belly rebounds.

Your beautiful pelvic floor is at the bottom of this pelvis.

As you breathe in and your belly gets bigger in all directions, front to back, side to side, it should also soften and elongate in a downwards direction.

Inhale, soften in that downwards direction.

Exhale, Your belly rebounds in.

Can you keep your pelvic floor soft?

Taking a few breaths to relax and soften that pelvic floor will make all the difference in the world and your quality of life.

And then if we're looking for sexy time, it will help open the door, so to speak, or prepare those muscular tissues for having the resiliency to have that erection.

So those are just a couple of cool things to talk about.

Does.

Does that make sense?

Boots?

Yeah.

And I just totally relax like I was.

I just totally went into it just then.

That was.

That worked.

It's so helpful.

And.

And that little bit during out the day.

Yeah.

And if you.

Now that we tune into how that feels, can we keep that relaxed as we like, gently engage our core and then Go about our day.

And that will do all the difference in the world, not only for sexy time, but also for, like, pee and poop complaints in general.

So those are the biggest things if we're.

You know, if we're watching this on V day.

Hey, have.

Have fun out there, kids.

But if you are actively having some pain with intimacy, work on relaxing the pelvic floor.

And if you have questions about the intimacy, just don't be ashamed to ask.

It's a functional activity.

And if you're afraid to ask for any reason, you could then ask, well, how could I improve my athletic performance to tolerate five METs?

Yeah, that was.

I'm glad you just mentioned that, because I was gonna ask, like, for those out there.

Yeah.

Who might be wanting to be very private.

Right.

Which I respect.

Yeah.

There you go.

So how can I improve to 5 Mets?

I like to 5 Mets.

And that's.

And the cool thing about the Mets.

Yeah.

And they're.

They're a little sciency.

Right.

But they're.

There's also this cool scale called relative perceived exertion.

That.

There's a terrible version that's like one to 26, and there's a relative, like, a one to 10.

That's perfect.

And so how hard we work.

Right.

One is super easy, 10 is super hard.

Around a five or a six.

You know, that's right around this five or six met.

And it's not an exact science, but that is some way that you can kind of start to correlate.

So if you are walking around your house, and that's five or six out of 10 on your relative perceived exertion scale, you're not ready for sexy time yet.

But something that typically would be seen as the same as sexy time is like stair climbing for, like, 10 or 15 minutes.

That should be up to five or six mets by the end.

So if that's feeling medium hard to you, then you're probably ready.

Um, so.

So it's just a neat way to talk about it and something for us to all be aware of.

Yeah.

Thank you for this awareness and something that really, like, absolutely.

Is so necessary and important.

Yeah.

And if you're having, you know, further difficulties, you know, please consider working with a pelvic floor specialist or a sexual counselor, because there's a whole load of stuff that goes into this.

There's body image.

We might have scars that hold a lot of emotional weight.

The scars might be painful, and they shouldn't be painful, my friends.

So if they are, we need to be working on the scar mobility, we need to work.

If you've had a sternotomy, we need to work on that.

Costal cage mobility.

All things that basic physical therapists can help with.

But you know, the cardiac rehab are kind of the progressive cardiac exercise.

If you feel that functionally you're fine but you're still in pain or there's other stuff.

Right.

Regular pts can help with the physical pain.

Sexual counselors, pelvic pts can help with some of the other intricacies.

Always a good lube is nice as we age, but that's not going to cover all the other stuff.

And it's okay to talk about.

And if it's important to you and your partner, you both deserve to talk about it.

Right.

Cool.

Excellent.

Thank you for this.

You're so welcome.

So, yeah, I'm sure there's stuff that we forgot about, but I think this is a great start.

And I don't have any like sexatum specific courses on my website yet, but I will and we're offering all of your podcast people the coupon of OHS2025 for 25% off all of our online courses.

So keep checking back and you know, check out the blog and Suzanne and I's Instagrams for fun topics relative to 6A 10.

Yes.

And thank you so much for being here, listeners for this special episode.

And we'll be back on Tuesday where we're going to talk about who.

All the best topics.

I tell you, we are where it's at, people.

So I love you, you matter and your heart is your best friend.