Sexual dysfunction after a myocardial infarction is a common problem said to occur in 50% to 75% of all patients. Sexual dysfunction often antedates the myocardial event. The advice given by current textbooks is too often based on anecdotal reports that lack scientific accuracy. Studies of the cardiovascular response during sexual intercourse are few, but those that exist consistently show that there are wide individual variations in heart rate, blood pressure, and oxygen consumption. Recent reports have also identified potentially dangerous arrhythmias during intercourse. Patients who reach 5 to 6 metabolic equivalents (METS) on stress-testing without ischemia or arrhythmias can in all likelihood resume their normal sexual activities without any risk. All other cases have to be considered individually according to the current physiologic knowledge.