J Korean Med Sci.  2006 Dec;21(6):995-999. 10.3346/jkms.2006.21.6.995.

Causes of Sudden Death Related to Sexual Activity: Results of a Medicolegal Postmortem Study from 2001 to 2005

• Lee S
• Chae J
• Cho Y

• KMID: 1713107
• DOI: http://doi.org/10.3346/jkms.2006.21.6.995

Abstract

Sexual activity (SA), combined with organic heart disease, may cause sudden death (SD). However, the causes of SD related to SA are not known well. The aim of this study was to assess the causes of SD related to SA. From August 2001 to November 2005, all autopsies (n=1,379) performed at Kyungpook National University were prospectively searched for SD cases related to SA. Fourteen cases (46+/-11 yr old, 9 males) of SD related to SA were found. All were heterosexual. The toxicologic study was negative in all. Ten cases were witnessed; during SA in 4 cases, just after SA in another 4 cases, 2 and 5 hr after in 1 each case. In 4 unwitnessed cases the victims were found dead less than 12 hr from the end of their SA. The partners were steady extramarital partners (n=8), prostitutes (n=2), marital partner (n=1) and unknown (n=3). The causes of the SD were as follows; coronary artery disease in 6, subarachnoid hemorrhage with ruptured berry aneurysm in 4, fibromuscular dysplasia of the atrioventricular nodal artery in 2, and unknown in 2. Coronary artery disease and subarachnoid hemorrhage with ruptured berry aneurysm were important as causes of SD related to SA.

Keyword

Death, Sudden; Death, Sudden, Cardiac; Subarachnoid Hemorrhage; Extramarital Relations; Coitus; Autopsy

MeSH Terms

Sexual Behavior/*statistics & numerical data
Risk Assessment/*methods
Prevalence
Middle Aged
Male
Korea/epidemiology
Humans
Heart Diseases/*mortality
Female
Death, Sudden/*epidemiology
Comorbidity
Cause of Death
Autopsy
Adult

Figure

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  Fig. 1 Sudden death due to subarachnoid hemorrhage in case No. 7. An aneurysm in the left middle cerebral artery (arrow) ruptured. Another unruptured aneurysm in the right middle cerebral artery (arrowhead) was observed.

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  Fig. 2 The left anterior descending artery (arrow) was completely occluded by a thrombus in case No. 11.

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  Fig. 3 Fibromuscular dysplasia of the atrioventricular nodal artery in case No. 4. Masson trichrome stain (×100).

Reference

1. Bohlen JG, Held JP, Sanderson MO, Patterson RP. Heart rate, rate-pressure product, and oxygen uptake during four sexual activities. Arch Intern Med. 1984. 144:1745–1748.

2. Ueno M. The so-called coition death. Nihon Hoigaku Zasshi. 1963. 17:330–340.

3. Parzeller M, Raschka C, Bratzke H. Sudden cardiovascular death during sexual intercourse - results of a legal medicine autopsy study. Z Kardiol. 1999. 88:44–48.

4. Parzeller M, Raschka C, Bratzke H. Sudden cardiovascular death in correlation with sexual activity--results of a medicolegal postmortem study from 1972--1998. Eur Heart J. 2001. 22:610–611.

5. Iwamoto H, Kiyohara Y, Fujishima M, Kato I, Nakayama K, Sueishi K, Tsuneyoshi M. Prevalence of intracranial saccular aneurysms in a Japanese community based on a consecutive autopsy series during a 30-year observation period. The Hisayama study. Stroke. 1999. 30:1390–1395.

6. Anderson C, Ni Mhurchu C, Scott D, Bennett D, Jamrozik K, Hankey G. Australasian Cooperative Research on Subarachnoid Hemorrhage Study Group. Triggers of subarachnoid hemorrhage: role of physical exertion, smoking, and alcohol in the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS). Stroke. 2003. 34:1771–1776.

7. Muller JE, Mittleman MA, Maclure M, Sherwood JB, Tofler GH. Triggering myocardial infarction by sexual activity. Low absolute risk and prevention by regular physical exertion. Determinants of Myocardial Infarction Onset Study Investigators. JAMA. 1996. 275:1405–1409.

8. Drory Y, Shapira I, Fisman EZ, Pines A. Myocardial ischemia during sexual activity in patients with coronary artery disease. Am J Cardiol. 1995. 75:835–837.

9. Drory Y, Fisman EZ, Shapira Y, Pines A. Ventricular arrhythmias during sexual activity in patients with coronary artery disease. Chest. 1996. 109:922–924.

10. Moller J, Ahlbom A, Hulting J, Diderichsen F, de Faire U, Reuterwall C, Hallqvist J. Sexual activity as a trigger of myocardial infarction. A case-crossover analysis in the Stockholm Heart Epidemiology Programme (SHEEP). Heart. 2001. 86:387–390.

11. Amital H, Glikson M, Burstein M, Afek A, Sinnreich R, Weiss Y, Israeli V. Clinical characteristics of unexpected death among young enlisted military personnel: results of a three-decade retrospective surveillance. Chest. 2004. 126:528–533.

12. Gonsoulin M, Barnard JJ, Prahlow JA. Death resulting from ruptured cerebral artery aneurysm: 219 cases. Am J Forensic Med Pathol. 2002. 23:5–14.

13. Cohle SD, Suarez-Mier MP, Aguilera B. Sudden death resulting from lesions of the cardiac conduction system. Am J Forensic Med Pathol. 2002. 23:83–89.

14. Cohle SD, Lie JT. Histopathologic spectrum of the cardiac conducting tissue in traumatic and noncardiac sudden death patients under 30 years of age: an analysis of 100 cases. Anat Pathol. 1998. 3:53–76.

15. Burke AP, Subramanian R, Smialek J, Virmani R. Nonatherosclerotic narrowing of the atrioventricular node artery and sudden death. J Am Coll Cardiol. 1993. 21:117–122.

16. Cho JG, Park HW, Rhew JY, Lee SR, Chung WK, Park OY, Kim W, Kim KH, Kang KT, Lee SH, Kim NH, Park JC, Ahn YK, Jeong MH, Park JC, Kang JC. Clinical characteristics of unexplained sudden cardiac death in Korea. Jpn Circ J. 2001. 65:18–22.

17. Cho Y, Park T, Yang DH, Park HS, Chae J, Chae SC, Jun JE, Kwak JS, Park WH. Arrhythmogenic right ventricular cardiomyopathy and sudden cardiac death in young Koreans. Circ J. 2003. 67:925–928.