If you're living with heart failure, you know that physical activity may leave you feeling fatigued or short of breath. If exercise makes you feel winded, you might wonder — is it safe to have sex?

Sex is typically a moderate form of exercise — it generally falls into the same activity level as climbing two or three flights of stairs. So it's not uncommon for those with heart failure to worry that having sex might further harm the heart, especially after surgery or a procedure. Also, heart failure medications may reduce the sex drive or cause unpleasant sexual side effects. More than half of people with heart failure say they are having a lot less sex or none at all due to their heart health. A little more than 3 in 10 report problems with sexual performance.

Remaining sexually active is important for maintaining a healthy quality of life and staying connected to your partner. How do you do that with heart failure? Follow your cardiac rehabilitation plan. Cardiac rehab is a supervised program including counseling, education and physical activity. It helps you improve your heart health and build endurance after a heart event. The American Heart Association says cardiac rehab and exercise can lower the risk of sex-related complications in those with heart failure.

The American Heart Association also says that sex rarely causes heart attacks, but it's a good idea to skip sex until your doctor says your heart condition is stable. For example, you're considered to have a high risk of complications during sexual activity if you have New York Heart Association Class IV heart failure or if you had heart surgery within the last one to two weeks.

While sexual intercourse may not be safe for your class and type of heart failure, kissing and touching are still OK. It's important to take all your medications as directed, and don't skip meds for fear of sexual side effects. Also, don't try over-the-counter herbs or supplements to boost your sex drive.

If you have any sexual difficulties, don't be shy about talking to your doctor. The American Heart Association and the European Society of Cardiology recommend that everyone with the disease be screened for sexual problems and offered counseling as part of their rehabilitation. Sexual counseling with your partner can help answer questions, build intimacy and provide useful tips on how to safely resume sex.