title: 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: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Klinikum Augsburg, Augsburg, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Gansera
authors.affiliation: Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Bavaria, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Deutsch
authors.affiliation: Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Bavaria, Germany.
authors.forename: Larissa
authors.initials: L
authors.lastname: Szameitat
authors.affiliation: Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Bavaria, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Eichinger
authors.affiliation: Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Bavaria, Germany.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Gansera
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D003075:Coitus; D004644:Emotions; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology