Sex rarely causes death, but four erotic activities may prove lethal
In 1979 at age 71, former New York Governor Nelson Rockefeller, Vice President under Gerald Ford, had a heart attack in the arms of a woman who was not his wife. His 26-year-old lover, his secretary Megan Marshack, faced what the tabloids called a “mistress’ dilemma.” Should she slip away, allowing him to die and be discovered later with his reputation intact? Or call 911 hoping to save him—and by doing so, reveal his infidelity? Marshack dialed 911, but Rockefeller died, prompting New York Magazine to quip: “Rocky thought he was coming, actually he was going.”
That pretty much sums up the conventional wisdom on sex that proves fatal. Older men get it on with younger women, and the combination of the men’s bad hearts, their sexual exertion, and the stress of extra-marital sex causes heart attacks. But a recent analysis shows that sex-triggered heart attacks account for less than one-third of deaths while twisting the sheets.
The Study
German researchers reviewed 16,437 autopsies over a 25-year period (1993-2017), and found that 74—about one-half of 1 percent (0.005), 43 men, and 31 women—had died while in the throes. Given the overwhelming similarities of sexual practices in Europe and the U.S., there’s every reason to believe this study’s findings also apply to Americans who die during sex.
Lethal sexual activities fell into four groups:
- Sexual assault. This category was the most likely to prove fatal. It accounted for 29 deaths (39 percent of total sex-related fatalities)—13 men, 16 women. No one in this group died from engaging in sex, per se, but rather from injuries sustained during the assaults, usually blunt force trauma or massive blood loss from knife wounds during vicious rapes.
- Consensual lovemaking. This category included 23 of the 74 deaths (31 percent)—nine men and 14 women. These deaths were similar to Rockefeller’s, sudden deaths during lovemaking from heart attack, stroke, ruptured aneurysm, or sudden cardiac death, which is similar to heart attack but involves failure of the heart’s neuro-electrical system that controls its beating. Contrary to the stereotype that sex-related deaths kill men cheating on their wives, in this analysis, consensual sex was more likely to kill WOMEN. And in this group, sex alone rarely caused the deaths. Most involved a combination of sex and severe intoxication—high blood levels of drugs, usually alcohol, with victims disproportionately likely to have underlying medical conditions: diabetes, obesity, high blood pressure, and/or heart disease.
- Auto-erotic asphyxiation (AEA, “breath play”). This category accounted for 22 deaths (30 percent)—one woman, 21 men. AEA involves intentionally reducing blood flow to the brain during masturbation, which some believe enhances the intensity of solo orgasms. Unfortunately, reducing the brain’s blood supply involves self-strangulation, usually with rope, scarves, neckties, or covering the face with plastic bags. It’s an outgrowth of the childhood game of holding your breath until you come close to passing out as a way to feel high. Those involved in AEA have no intention of dying. They’re not committing suicide. They simply want to enhance their orgasms. They typically devise self-rescue plans to stop the action if they feel like they might pass out. But sometimes, self-rescues fail, often because of intoxication. Typically, first responders find bodies hanging with ropes around their necks, genitals exposed, and porn nearby. Several famous people are believed to have died during AEA, among them, actor David Carradine, star of the 1970s television series Kung Fu, and Australian rock star Michael Hutchense, lead singer of the band INXS.
- Mixing erection and nitrate drugs. Beyond the German study, there’s another possible cause of death during sex—using erection drugs and nitrate medications, particularly nitroglycerin for treatment of angina, and the party drugs amyl nitrite or nitrate (“poppers”). The combination can cause a rapid, potentially fatal drop in blood pressure. When this came to light shortly after the 1998 approval of Viagra, the FDA ordered doctors to stop prescribing Viagra to anyone taking nitrate medications. Few men die this way these days, but some still do.
To avoid sex-related death:
- Maintain healthy weight. Death during lovemaking is strongly associated with sedentary lifestyle and its frequent manifestation, obesity. (Rockefeller was overweight.)
- Stay physically fit. It helps control weight.
- Limit alcohol and other drugs before sex.
- Limit sexual stressors, for example, infidelity and encounters with sex workers.
- Refrain from solo AEA/breath play. Physicians who specialize in emergency medicine say there is no reliably safe way for single individuals to engage in AEA/breath play. If you’re interested in AEA, have at least one uninvolved person nearby at all times as your designated rescuer.
- Never use Viagra or other erection medications if you take any nitrate medication.