Aortic Dissections Type A during Sexual Intercourse in Male Patients: Accident or Systematic Coincidence? Examination of 365 Patients with Acute Aortic Dissection within 20 Years

Abstract

Objectives Physical exercise accompanied by arterial hypertension is known to trigger acute aortic dissections. As a booster effect, mental stress leads to aggravation of hypertensive crisis. The aim of the study was to evaluate whether stress factors during sexual intercourse play any role as a catalyst in patients with acute type A aortic dissections. Concerning this subject, only two case reports have been published.

Methods A total of 365 patients with acute type A aortic dissections, operated between January 1993 and July 2014, were analyzed retrospectively. The main focus was to identify the provoking situation before onset of symptoms. A total of 247 patients were males and mean age was 60.2 years (range, 17.0–91.9 years). Of the total cohort, 86 patients (24%) were younger than 50 years (68 males) and 184 patients (50%) were younger than 60 years (149 males).

Results The explicit trigger could not be determined in 24% of the patients. In majority of the patients, onset of symptoms occurred during physical exercises, such as sports or lifting of heavy weights (68%), without a significant difference between males and females. In only 8% of the patients, symptoms occurred at rest. In 0.9%, Marfan syndrome was evident. Eleven of 68 males < 50 years (16%) and 17 of 149 males < 60 years (11%) but none among females (p = 0.03) experienced sudden onset of symptoms during sexual intercourse.

Conclusion Combined physical and emotional stress during sexual intercourse seems to present a meaningful promoter effect for acute aortic dissections, especially in younger males, but not in females. Despite self-evidence of this phenomenon, frequency of this sensitive issue appears to be surprisingly high.

Keywords

aortic dissections - sexual intercourse - gender aspects

• References

• 1 Schifferdecker B, Pacifico L, Ramsaran EK, Folland ED, Spodick DH, Weiner BH. Spontaneous coronary artery dissection associated with sexual intercourse. Am J Cardiol 2004; 93 (10) 1323-1324
• 2 Pierli C, Casini S, del Sordo M, Fineschi M, Bravi A, Leosco D. Post coital coronary artery dissection. Eur Heart J 1995; 16 (12) 2004-2005
• 3 Salhab KF, Said SM, Sundt III TM. Aortic dissection and recurrence both precipitated by sexual activity. J Card Surg 2012; 27 (3) 374-375
• 4 Morris-Stiff G, Coxon M, Ball E, Lewis MH. Post coital aortic dissection: a case report. J Med Case Reports 2008; 16 (2) 6
• 5 Hsu KC, Tsai SH, Kao HW, Chu SJ, Hsu CW. Acute aortic dissection presenting with acute lower-back pain following sexual intercourse. J Intern Med Taiwan 2008; 19 (19) 418-421
• 6 Shepherd JT. Circulatory response to exercise in health. Circulation 1987; 76 (6 Pt 2): VI3-VI10
• 7 Spittell PC, Spittell Jr JA, Joyce JW , et al. Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990). Mayo Clin Proc 1993; 68 (7) 642-651
• 8 Niederhoffer N, Kieffer P, Desplanches D, Lartaud-Idjouadiene I, Sornay M-H, Atkinson J. Physical exercise, aortic blood pressure, and aortic wall elasticity and composition in rats. Hypertension 2000; 35 (4) 919-924
• 9 Khanafer KM, Bull JL, Upchurch Jr GR, Berguer R. Turbulence significantly increases pressure and fluid shear stress in an aortic aneurysm model under resting and exercise flow conditions. Ann Vasc Surg 2007; 21 (1) 67-74
• 10 Vaccarino V, Parsons L, Every NR, Barron HV, Krumholz HM. Sex-based differences in early mortality after myocardial infarction. National Registry of Myocardial Infarction 2 Participants. N Engl J Med 1999; 341 (4) 217-225
• 11 Airaksinen KE, Ikäheimo MJ, Linnaluoto M, Tahvanainen KU, Huikuri HV. Gender difference in autonomic and hemodynamic reactions to abrupt coronary occlusion. J Am Coll Cardiol 1998; 31 (2) 301-306
• 12 Nienaber CA, Fattori R, Mehta RH , et al; International Registry of Acute Aortic Dissection. Gender-related differences in acute aortic dissection. Circulation 2004; 109 (24) 3014-3021
• 13 Grubb KJ, Kron IL. Sex and gender in thoracic aortic aneurysms and dissection. Semin Thorac Cardiovasc Surg 2011; 23 (2) 124-125
• 14 Su YJ, Liu CH, Yeh YH. Gender-Differences in aortic dissection. Journal of Acute Disease 2014; 3 (1) 10-13
• 15 Kojima S, Sumiyoshi M, Nakata Y, Daida H. Triggers and circadian distribution of the onset of acute aortic dissection. Circ J 2002; 66 (3) 232-235
• 16 Lovas JG, Silver MD. Coincident rupture of berry aneurysm and aortic dissection during sexual intercourse. Arch Pathol Lab Med 1984; 108 (4) 271-272
• 17 Chang GY, Ahn PC. Postcoital vertebral artery dissection. Am Fam Physician 1996; 54 (7) 2195-2196
• 18 Paz O. Sexualalchemie und erotische Courtoisie. Essays 1. Suhrkamp 1979; 91-105
• 19 Beller CJ, Maurer T, Labrosse MR, Mesana T, Karck M, Veinot JP. Gender-specific differences in aortic sinus curvature during aging: an anatomical and computational study. Cardiovasc Pathol 2009; 18 (3) 148-155
• 20 Kelly BA, Bond BC, Poston L. Aortic adaptation to pregnancy: elevated expression of matrix metalloproteinases-2 and -3 in rat gestation. Mol Hum Reprod 2004; 10 (5) 331-337
• 21 Hagan PG, Nienaber CA, Isselbacher EM , et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000; 283 (7) 897-903
• 22 Erbel R, Alfonso F, Boileau C , et al; Task Force on Aortic Dissection, European Society of Cardiology. Diagnosis and management of aortic dissection. Eur Heart J 2001; 22 (18) 1642-1681
• 23 Milewicz DM. Stopping a killer: improving the diagnosis, treatment, and prevention of acute ascending aortic dissections. Circulation 2011; 124 (18) 1902-1904