Physicians have known for a long time that, for most men, sex is safe and even life-prolonging. Yet evidence is growing that, at least for adulterers, the picture is different. In a review of the literature on infidelity published online in April in the Journal of Sexual Medicine, researchers presented intriguing evidence that extramarital sex can kill.
To be sure, death by copulation is rare. But the data suggest that when it happens, it usually happens to adulterers, and the cause is typically cardiovascular. In 1963 a Japanese pathologist reported that of 34 men who had died during intercourse, nearly 80 percent had died during extramarital sex, most of cardiac causes. In 2006 South Korean pathologists documented 14 cases of sudden coital death and found that only one had involved a man who had been having intercourse with a woman known to be his wife; all the other men had died of cardiovascular causes. In 2006 researchers at Goethe University Frankfurt in Germany published an analysis of sex-related autopsy reports for 68 men. Ten had died with a mistress and 39 with a prostitute.
Why do unfaithful men, especially, die doing what they love to do? “Extramarital sex may have its own hazards,” says Alessandra Fisher, the study's lead author and an expert on sexual disorders at the University of Florence. “The lover might be much younger. Sex might be particularly athletic or follow excessive drinking or eating”.
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Guilt may also play a role. The University of Florence team's 2011 statistical analysis of health outcomes for almost 1,700 male patients showed that those involved in stable extramarital relationships had about twice the cardiovascular disease as other patients in the study, particularly if the man reported that his wife was still sexually interested in him. “Deceiving a sexually available and involved mate could lead to a deeper sense of guilt,” the researchers wrote. That type of psychological distress has been shown to up cardiovascular risk.