Death by Sex: How Lovemaking May Prove Fatal

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.

That pretty much sums up the conventional wisdom on death by sex. 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.

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) including 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.

Death by sex 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, similar to Rockefeller’s, occurred during lovemaking due to heart attack, stroke, ruptured aneurysm, or sudden cardiac death, which is similar to heart attack but involves the 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 such as 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 and 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 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. You may have heard of two people believed to have died during AEA—actor David Carradine, star of the 1970s television series Kung Fu, and Australian rock star Michael Hutchence, of the band INXS.

• Mixing erection and nitrate drugs. Beyond the German study, there’s another possible cause of death during sex—the simultaneous use of erection drugs and nitrate medications, particularly nitroglycerin for angina, and the party drug amyl nitrate (“poppers”). The combination may 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. These days few men die this way, but some still do.

To Avoid Death by Sex:

• Maintain healthy weight. Death by sex is strongly associated with obesity. Rockefeller was overweight.
• Stay physically fit. It helps control weight.
• Limit alcohol and other drugs.
• Beware of 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 play that way. If you’re interested in AEA, have at least one sober designated rescuer nearby at all times.
• Never use Viagra or other erection medications if you take nitrate medication.