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Patients with heart failure (HF) face significant challenges in maintaining quality of life (QOL), particularly for sexual intimacy. Although recommended for all cardiac patients, it has been suggested that few HF patients receive sexual counseling. This study explored sexual counseling needs, sexual concerns, and sexual activity using a descriptive survey with HF patients (n = 45), recruited from a HF clinic or cardiology office. Most (77%) had not discussed sexual concerns with a health care professional (HCP). Sexual concerns that were rated as occurring 'occasionally/frequently' included partner overprotectiveness (63%), partner fear of sex (36%), lack of sexual interest (42%), erectile problems (74%), orgasmic difficulties (51%). Frequency of sexual intercourse before HF to present was striking, with 53% reporting no sexual activity in the last 2 months compared with 11% before diagnosis of HF. HCPs must provide sexual counseling to HF patients and partners to enhance QOL and to assist in any adaptations to sexual activity.