If you're living with heart failure, you know that physical activity can leave you tired or short of breath. If exercise makes you feel winded, is it safe to have sex?

Sex most often is a moderate form of exercise. The activity level is like climbing one or two flights of stairs. So it's common for those with heart failure to worry that having sex might cause more harm to the heart. This is especially true after surgery or a procedure.

Also, heart failure medicines may lower the sex drive or cause sexual side effects that aren't pleasant. More than half of people with heart failure say they have less sex or none, due to their heart health. About 3 in 10 report problems with having sex.

Staying sexually active helps you have a healthy quality of life. And it helps you stay close to your partner. How do you do that with heart failure? Follow your cardiac rehabilitation plan.

Cardiac rehab is a program that includes counseling, education and physical activity. It helps improve heart health and build strength after a heart event. The American Heart Association says cardiac rehab and exercise can lower the risk of sex-related problems in those with heart failure.

The American Heart Association also says that sex rarely causes heart attacks. Still, it's good to wait to have sex until your healthcare professional says your heart condition is stable.

For instance, your risk of complications during sex may be high if you have New York Heart Association Class III or IV heart failure, meaning you have heart failure symptoms with mild activity. Your risk also may be higher if you had heart surgery within the last 1 to 2 weeks.

While sexual intercourse may not be safe for your class and type of heart failure, kissing and touching are still OK. Be sure to take all your medicines as directed. Don't skip meds for fear of sexual side effects. Don't take herbs or supplements to boost your sex drive.

If you have any sexual troubles, talk with your healthcare professional. The American Heart Association and the European Society of Cardiology suggest that everyone with heart disease be screened for sexual problems and offered counseling as part of their rehabilitation. Sexual counseling with your partner can help answer questions, build closeness and give useful tips on how to have sex again safely.