Sexual Intercourse Andthe Cardiovascular System

Normal sexual intercourse with orgasm is accompanied by transient but brisk physiological changes, e.g. tachycardia of up to 180 beats/min, with increases of 100 beats/min over less than one min, can occur. Systolic blood pressure may rise by 120 mmHg and diastolic by 50 mmHg. Orgasm may be accompanied by transient pressure of 230/130 mmHg even in normotensive individuals. Electrocardiographic abnormalities may occur in healthy men and women. Respiratory rate may rise to 60/min.

Such changes in the healthy may reasonably be thought to bode ill for the unhealthy (with hypertension, angina pectoris, post myocardial infarction). Sudden deaths do occur during or shortly after sexual intercourse (ventricular fibrillation or subarachnoid haemorrhage), usually in clandestine circumstances such as the bordello or the mistress's boudoir, or when the relationship is between an older man and a younger woman — although this may just reflect reporting bias in the press. In one series, 0.6% of all sudden deaths were (reportedly) attributable to sexual intercourse and in about half of these cardiac disease was present. Clearly it is undesirable that the older patient with coronary heart disease should aspire to the haemodynamic heights attainable in youth.

There are few if any records of sudden cardiovascular death amongst women under these circumstances.

If there is substantial concern about cardiovascular stress (hypertension or arrhythmia) during sexual intercourse in either sex, a dose of labetalol about 2 hours before the event may well be justified (taking account of other therapy already in use). But patients taking a (3-blocker long term for angina prophylaxis have shown reductions in peak heart rate during coitus from 122 to 82 beats/min.

Patients suffering from angina pectoris should also use glyceryl trinitrate or isosorbide dinitrate as usual for pre-exertional prophylaxis 10 min before intercourse. They should be aware of the potentially fatal interaction of sildenafil (Viagra) with nitrates (see above, p. 545).

• The treatment of both hypertension and angina requires drugs that reduce the work of the heart either directly or by lowering peripheral vascular resistance.

• fi-blockade, whicft acts mainly through reduced cardiac output.and calcium channel blockade.acting by selective arterial dilatation, may be used in either condition.

• Other vasodilators are suited preferentially to hypertension (ACE inhibitors, angiotensin AT. receptor antagonists and «.-adrenoceptor blockers) or to angina (nitrates).

• The treatment of myocardial infarction requires thrombolysis, aspirin and [i-adrenoceptor blockade acutely, with the latter two continued for at least two years as secondary prevention of a further myocardial Infarction.

• Other Important steps in secondary prevention include ACE inhibitors and statins In selected patients with cardiac failure and hypercholesterolemia, respectively.

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