Sexuality is an essential aspect of quality of life. Nevertheless, sexual intercourse is physically challenging and leads to distinct changes in blood pressure, heart, and respiratory rate that may lead to vital complications.

We present a case report of a 22-year-old female suffering from subarachnoid hemorrhage after sexual intercourse. The patient was immediately transported to hospital by emergency medical services and, after diagnosis, transferred to a tertiary hospital with neurosurgical expertise but died within 24 hours. After postcoital headaches, subarachnoid hemorrhage is the second most common cause of neurological complications of sexual intercourse and therefore patients admitted to an emergency department with headache after sexual intercourse should always be carefully evaluated by cerebral imaging.

Table 1

Overview on stages of the sexual cycle [3, 13].

Stage	Explanation	Body's response
1	Excitement (initial state of arousal)	Increases in muscular tone, heart rate, and blood pressure
2	Plateau (full arousal immediately preceding orgasm)	Further increases in muscular tone, heart rate, and blood pressure and increased relative vascular resistance
3	Orgasm	Associated with muscle spasms, massive elevation of heart rate, blood pressure, and respiratory rate
4	Resolution	Normalization of physical function

...Our case features sexual intercourse as a trigger of an acute intracerebral hemorrhage in a young female. Several studies have shown that sexual intercourse may provoke intracerebral hemorrhage, especially subarachnoid hemorrhage [3, 4]. It has been reported that 14.5% of all subarachnoid hemorrhages are precipitated by sexual activity [7, 8]. Our patients most likely had a preexisting vascular aneurysm as a precipitating lesion for subarachnoid bleeding, as the second computed tomography showed. It has been reported that the acute elevation in blood pressure during sexual intercourse increases the vessels' wall tension and the subsequent risk of its rupture by 15-fold [4, 9]. Nevertheless, this connection has only been seen in the few existing observational studies on this topic; further scientific evaluation of the cohesion between sexual intercourse and cerebral aneurysm rupture should be performed.

Although the published literature is sparse on the topic of sexual intercourse-related subarachnoid hemorrhage, several studies have found a male predominance [7, 9–11]. This is striking for two reasons: firstly it is known that the incidence of cerebral aneurysms is higher in females [12] and secondly as women may experience multiple and longer orgasms than men, it would be expected that wall tension in cerebral vessels would be elevated for longer than in males [9]...

Full article at: http://goo.gl/OS0KTM

By: Christian T. Braun,¹Meret E. Ricklin,¹Andreina Pauli,²Daniel Ott,²Aristomenis K. Exadaktylos,¹and Carmen A. Pfortmueller^{1 , 3 , *}

¹Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse 10, 3010 Bern, Switzerland

²University Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital Bern, Freiburgstrasse 10, 3010 Bern, Switzerland

³Department of General Anesthesiology, Intensive Care and Pain Management, Medical University of Vienna, Waehringerguertel 18-22, 1090 Vienna, Austria

*Carmen A. Pfortmueller: Email: moc.liamg@relleumtrofpc

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