Regular sexual activity is comparable to moderate exercise and may be safe for patients with cardiovascular disease (CVD). According to the recommendations of the Princeton III Conference (P3), people with a low risk of adverse cardiac events can undertake sexual activity safely, while other patients must first stabilise their cardiovascular status. Exercise testing is recommended to assess the safety of sexual activity in people with questionable or uncertain cardiac risk (P3). Patients after successful and uncomplicated treatment of myocardial infarction (MI) can return to sexual activity after 3 weeks if the stress test is negative. The 4th Princeton Conference (P4) recommends the use of the 2019 regimen developed by the American College of Cardiology (ACC) and American Heart Association (AHA) to assess the risk of atherosclerotic cardiovascular disease (ASCVD) in men with ED (ACC/AHA ASCVD 2019). Sexual health education plays an important role in the successful return to safe sexual activity, which should include post-MI patients and their relatives. The responsibility for counselling lies with cardiologists, general practitioner (GP) and nursing staff. Sexual rehabilitation should be an integral part of cardiac rehabilitation, and lifestyle modification and optimal treatment of underlying medical conditions are key to maintaining psychophysical well-being and a successful sex life.