Sex has many beneficial physical and psychological effects, including reducing high blood pressure, improving the immune system and helping you sleep better. The physical act of sex and orgasm release oxytocin, the so-called love hormone, which is important in building trust and the bond between people.
But there is a dark side: sometimes people die during or shortly after sex. The incidence is, fortunately, extremely low and represents 0.6% of all cases of sudden death.
There are many reasons why this happens. In most cases, death is caused by the physical exertion of sexual activity, prescription drugs (drugs to treat erectile dysfunction, for example), or illegal drugs such as cocaine - or sometimes both.
The risk of any sudden cardiac death is higher as people get older. A post-mortem study carried out in Germany, which looked at 32,000 sudden deaths over a 33-year period, found that 0.2% of cases occurred during sexual activity.
Sudden death occurred mainly in men (average age 59) and the most frequent cause was a heart attack, also known as a myocardial infarction. Studies on sudden cardiac death and sexual activity from the USA, France and South Korea show similar findings. But...
It's not just middle-aged men
Recently, researchers at St George's, University of London, discovered that this phenomenon is not limited to middle-aged men.
The study, published in JAMA Cardiology, investigated sudden cardiac death in 6,847 cases referred to the cardiac pathology center at St George's between January 1994 and August 2020.
Gherardo Finocchiaro
Of these, 17 (0.2%) occurred during or within the first hour of sexual activity. The average age of death was 38 years, and 35% of cases occurred in women, a much higher rate than in previous studies.
These deaths were not typically caused by heart attacks, as seen in older men. In more than half of the cases (53%), the heart was found to be structurally normal and a sudden cardiac arrhythmia called sudden arrhythmic death syndrome (SADS) was the cause of death.
Aortic dissection was the second leading cause (12%). It happens when the layers in the wall of the large artery that exits the heart, supplying blood to the body, tear and blood flows between the layers, causing them to swell and burst.
The remaining cases were caused by structural abnormalities such as cardiomyopathy (a disease of the heart muscle that makes it difficult for it to pump blood to the rest of the body), or a rare group of genetic conditions known as channelopathies, which happen when the ion channels that allow sodium and potassium to enter and exit the heart muscle cells don't work properly. The change in sodium and potassium in the cells can alter the electrical current through the heart muscle and change the way it beats.
An altered heart rhythm can cause a lack of oxygen (myocardial ischemia) and lead to sudden cardiac arrest in which the heart stops beating. This new study suggests that sudden cardiac death in people under 50 is mainly due to sudden arrhythmic death syndrome or cardiomyopathies.
Younger adults who have been diagnosed with these conditions should seek advice from their cardiologist about the risk associated with sexual activity. However, the low incidence of death in these studies suggests that the risk is very low - even in people with existing heart conditions.
