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Comprehensive autopsies showed that sex rarely triggered sudden cardiac death (SCD), though more women than expected were affected.

Mortalities occurred during or within 1 hour after sexual intercourse in just 0.2% of 6,847 SCD cases reviewed in England, and rates of post-sex death remained low across cases of SCD by cause of death:

• Sudden arrhythmic death syndrome: 0.2%
• Aortic dissection: 2%
• Arrhythmogenic cardiomyopathy: 0.7%
• Hypertrophic cardiomyopathy: 0.3%
• Ischemic heart disease: 0.1%
• Idiopathic fibrosis: 0.6%
• Idiopathic left ventricular hypertrophy: 0.3%
• Mitral valve prolapse: 1%

Notably, the 17 people who died from SCD after sex averaged just age 38, and two-thirds were men, reported Mary Sheppard, MD, of St. George's University of London, and colleagues in .

"Younger individuals (aged <50 years) with cardiac conditions, such as cardiomyopathies and channelopathies, may be concerned about their risk for sudden death during sexual intercourse because of the catecholaminergic surge that accompanies this activity," they wrote.

"We believe these findings provide some reassurance that engaging in sexual activity is relatively safe in patients with a cardiac condition, especially in younger (aged <50 years) individuals."

The investigators cited a that associated sex with 0.2% of natural deaths that underwent autopsy, a cohort of predominantly middle-aged men (average age 59.1, 92.6% men).

"In the present cohort, we found that the proportion of female decedents was substantially higher than in previous studies. This difference was likely associated with the difference in age bracket given that we included individuals with a mean age at death of 38 years and the other reports included older male individuals among whom a higher prevalence of coronary artery disease was expected," Sheppard's group noted.

The study relied on one cardiac pathology unit's database of SCD cases referred from 1994 to 2020.

SCD was defined as death occurring within 12 hours of apparent well-being. All cases underwent macroscopic and histological evaluation of the heart by cardiac pathologists.

Sheppard and colleagues cautioned that they did not include survivors of sudden cardiac arrests in their report, nor did they examine deaths after sex not attributed to SCD.

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