Death during consensual sex
Death can occur during consensual sex for a number of reasons, generally because of the physical strain of the activity, or because of unusual extenuating circumstances. There are various euphemisms for death during sex, including "dying in the saddle", "death by snu snu" or the French "la mort d'amour". Sex is associated with a variety of benefits and also risks. Deaths during consensual sex account for approximately 0.6% of all sudden deaths. Numerous notable cases of individuals dying during or from sex have been recorded and reported, including a president, a prime minister and a pope.
Health and physiology
Sexual intimacy, as well as orgasms, increases levels of the hormone oxytocin, also known as "the love hormone", which helps people bond and build trust. Sexual activity is also known as one of many mood repair strategies, which means it can be used to help dissipate feelings of sadness or depression.
A 2011 meta-analysis in the Journal of the American Medical Association found that each additional hour of sexual activity per week resulted in an increased risk of 2-3 myocardial infarctions and one sudden cardiac death per 10,000 person-years. Sexual intercourse can also trigger a subarachnoid hemorrhage via the Valsalva maneuver. A 2011 meta-analysis published in Journal of Sexual Medicine found that men who were unfaithful were significantly more likely than those who were faithful to experience severe or fatal cardiac events during sex. Basilar artery dissection has also been reported in connection with sexual activity, though most coital cephalalgia is benign in nature.
Deaths during consensual sex only account for approximately 0.6% of all sudden deaths. Viagra, although generally considered to be a safe drug, has been linked to sudden cardiovascular death during sexual activity among elderly or otherwise infirm men. The majority of deaths due to cardiovascular causes during sex do occur in males. A number of deaths during consensual sex have been linked to the use of other prescription or recreational drugs, such as cocaine.
The heart condition endothelial dysfunction is a contributing cause to both atherosclerosis and erectile dysfunction. Because of the link between these conditions, rates of coronary heart disease are higher among patients with erectile dysfunction. One treatment for erectile dysfunction is cGMP-specific phosphodiesterase type 5 inhibitors, which enable patients to resume having sex despite having a cardiac condition, by lowering blood pressure. These drugs, including sildenafil, inhibit the action of the phosphodiesterase, allowing for a higher concentration of cyclic GMP in the penis when it is physically stimulated. Cyclic GMP is a second messenger in the nitric oxide pathway, responsible for erections via the vasodilating function of nitric oxide. Sudden cardiac death can be caused by myocardial ischemia, and the physical activity of sexual intercourse in patients with coronary artery disease can result in myocardial ischemia. The phosphodiesterase can act as a potentiator for other drugs which lower blood pressure and which could be used to treat heart conditions, and so may be contraindicated to prevent negative health consequences.
Notable or unusual deaths reportedly from consensual sex
- Pope John XII died on 14 May 964; one story relates that he died of a paralytic stroke suffered while having sex with a woman named Stefanetta. He may have died instead when the woman's husband defenestrated John or beat him to death with a hammer during the act.
- Lord Palmerston, Prime Minister of the United Kingdom, died in 1865 following a brief illness; sources disagree about the immediate circumstances of his death. It is rumored that sex on a billiard table with a maid precipitated his demise, but this account is disputed, with other sources stating that he died of pneumonia.
- Félix Faure, president of France from 1895 to 1899, died while receiving fellatio from his mistress, Marguerite Steinheil. The cause of death was listed as a cerebral hemorrhage. Eyewitnesses stated he was in a state of partial undress. This version is disputed by some historians.
- Cardinal Jean Daniélou, who wrote extensively on sexual ethics, died in 1974 inside a Paris brothel at seventy years of age. Although official accounts have him delivering charity to a prostitute, this account was not believed by the public.
- Nelson Rockefeller, former Vice President of the United States and heir to the Rockefeller family fortune, died in 1979 of a heart attack at age 70, rumored to be caused by an orgasm during intercourse with his secretary, Megan Marshack. The unusual circumstances surrounding his death caused New York Magazine to quip, "Nelson thought he was coming, but he was going". Contemporaneous accounts of his death differed greatly and his hasty cremation left the exact cause of death uncertain.
- Japanese writer Isamu Togawa suffered heart failure in 1983 due to his chronic arrhythmia; according to Taro Maki, Togawa died during sexual intercourse at his hotel room. Togawa's younger brother Itaru Kikumura also acknowledged that Togawa died during sex, though this theory was denied by Tsuneo Watanabe.
- Jack McConaughey, father of actor Matthew McConaughey, died of a heart attack in 1992 while having intercourse with his wife, Kim.
- A woman from Houston died in 1997 after she fell from a balcony in Los Angeles during sex with her boss. It was ruled a homicide by the Los Angeles County coroner's office after they investigated and concluded that he likely pushed her over the balcony railing during their encounter.
- An Atlanta police officer died in 2009 from atheroschlerotic coronary artery disease while engaged in a threesome. His widow sued his doctor and was awarded a $3 million settlement, with the jury finding that the doctor did not properly diagnose and treat the police officer's pre-existing health issues.
- A York County, Pennsylvania, woman died in 2008 when she was electrocuted by homemade nipple clamps, an example of an erotic electrostimulation practice. Her death was ruled a homicide.
- In 1999, Mario Bugeanu, a Romanian soccer player, and Mirela Iancu both died of carbon monoxide poisoning while having sex in a car which they had parked in Bugeanu's garage with the engine still running.
- In 2013, a woman named Sharai Mawera was mauled and killed by a lion in Zimbabwe during intercourse.
- Australian politician Sir Billy Snedden "expired 'at the peak of physical congress' (as a policeman memorably told Truth)" in 1987. Nineteen years later, his son (and lover of the same woman with whom Snedden was having sex at the time of his death) was quoted as saying "I'm sure the old man went out happy - anyone would be proud to die on the job." 
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