If you have heart disease, it’s normal to be worried about having sex. You may be concerned about the state of your cardiovascular system and how much exertion your heart can handle. But getting back to your normal daily activities and the things that make you happy is key to maintaining your quality of life.

Michael Blaha, M.D., M.P.H, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, explains how to know if sex is safe when you have heart disease.

Signs You’re Healthy Enough for Sex

The primary fear regarding intimacy for most people with heart disease is being scared that having sex will cause a heart attack. While sexual activity does increase your heart rate, it’s not something that most people with stable heart disease should worry about, says Blaha. In general, if you’re able to climb stairs or jog or walk a mile without difficulty, it’s safe for you to have sex.

“The possibility of having a heart attack during sexual activity is exceedingly low and shouldn’t scare you away,” says Blaha. “As long as you’re not experiencing any symptoms, it’s not worrisome.”

You should abstain from any heavy physical exertion, including sex, until you see a doctor if you have heart disease symptoms such as:

• Chest pain
• Shortness of breath
• Irregular heartbeat
• Nausea or indigestion

“Is there a chance of having a heart attack during sex? Yes. Your risk is slightly elevated whenever you’re physically active, whether it’s sexual activity or going for a run or any other type of aerobic exercise, compared to when you’re resting. But for people with a stable heart, the long-term benefits of regular physical activity — including sex — far outweigh the risks,” says Blaha.

Heart-Healthy Benefits of Sex

Instead of causing harm, sex may benefit your heart health. Studies suggest that men who have sex at least twice a week and women who report having satisfying sex lives are less likely to have a heart attack.

The protective benefits may be many: Sex is a form of exercise and helps strengthen your heart, lower your blood pressure, reduce stress and improve sleep. In addition, intimacy in a relationship can increase bonding. Strong social connections, says Blaha, can lower feelings of loneliness, depression and anxiety, which have been linked to higher heart disease risk.

“As long as your doctor has given you the go-ahead and you aren’t experiencing any symptoms, it’s OK to return to your normal activities,” says Blaha.