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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

Medical Myths Medical Myths

Can Sex Be a Health Hazard?

October 10, 2013

By Robert H. Shmerling M.D.

Beth Israel Deaconess Medical Center

Surely, you've heard the warning: Sex can be hazardous to your health. Maybe you first heard this from your parents, during sex education classes at school or from your friends. More recently, you may have heard this caution from television commercials: "Make sure you are healthy enough to have sex before taking this drug."

Can you suffer serious harm from sexual activity? Is it really a health threat? The notion that sex can seriously affect your health is not a myth.

Whether wishful thinking, blissful ignorance or the delusion of immortality, many people — especially young people — don't believe what they have heard about the potential health risks of sexual activity. What's more, many people who engage in potentially risky sexual activities remain healthy. Maybe it's due to luck or an overestimation of the risks. Either way, staying healthy despite risky sexual behavior may reinforce the belief that health risks are a just a myth.

Few people think of sex as a major health risk other than those with AIDS or other sexually transmitted diseases. Some would add unplanned pregnancy and the emotional side effects of having sex before being psychologically ready to the list. While most people who have sex survive it, there are important health issues you need to know about.

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Sexually Transmitted Diseases

While STDs may cause annoying symptoms such as burning with urination or a discharge (from the penis or cervix), some STDs can be fatal. The best known is AIDS. While it's true that drug therapy has transformed the outlook for people infected with HIV, the virus that causes AIDS, premature death due to complications of the disease is still a real problem. And, of course, not everyone has access to the medications, which are expensive and largely unavailable in many places.

Untreated, many STDs can cause serious illnesses:

  • Hepatitis B and C — These viruses can cause long-term liver damage, ultimately causing cirrhosis and liver failure; they also increase the risk of liver cancer.
  • Gonorrhea — Most cases are limited to the genital tract, causing a discharge and local irritation, but there is a more serious, widespread form called disseminated gonococcal infection, or DGI that causes rash, fever and arthritis. In addition, women with gonorrhea are at risk for pelvic inflammatory disease (PID), a serious infection of the internal genital organs that can lead to pain, widespread infection, infertility and even death.
  • Chlamydia — Complications from chlamydia can cause PID (as above).
  • Syphilis — Syphilis can progress to a chronic ("tertiary") form; over years it can damage internal organs, including the spinal cord and brain, ultimately causing death.
  • Human papilloma virus (HPV) — Although it causes genital warts and is rarely dangerous on its own, infection with HPV can lead to cervical cancer, which can be fatal if not detected and treated.
  • Genital herpes — Mothers can transmit this infection to a newborn, causing serious illness and organ damage; there is no cure for herpes and while it rarely causes a serious illness itself, this viral infection can make it easier for HIV to be passed between sexual partners.

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Sexual activity can lead to pregnancy, which carries a small, but real, risk of serious illness. For example, sometimes the pregnancy develops in the fallopian tubes (the passageway through which the egg travels from the ovary to the uterus), a condition called "ectopic pregnancy" or "tubal pregnancy." If untreated, it can be dangerous. Another pregnancy-associated condition, called eclampsia, is marked by dangerously high blood pressure, seizures, and, in some cases, coma and death.

Fortunately, the risk of serious illness related to pregnancy is low in the United States and most other developed countries, but it remains remarkably high in many parts of the world and among women with medical problems that can be worsened by pregnancy. For example, a woman with poorly controlled lupus can become quite ill during pregnancy.

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Heart Disease

Many people, especially those with known heart disease, worry that the physical demands of sexual activity could cause a heart attack. The good news is that the risk appears to be quite low:

  • The estimated risk of heart attack in a 50 year old man without major risk factors for heart disease (such as smoking) was about 2 in a million per hour of sexual activity according to one study.
  • In another study, men with a history of angina (a type of chest pain that may be a warning sign of a heart attack) had nearly the same risk of heart attack during sexual activity as those without past angina; even men with a previous heart attack had only a slightly higher risk than men who hadn't had a heart attack.
  • A 2011 review of 14 prior studies concluded that while exercise (including sex) could triple the risk of heart attack in the hours after exertion, this heightened risk could be reduced by getting in shape. That is, most of the increased risk associated with sex was noted in people who were sedentary. And even with the tripled risk, the actual risk associated with sexual activity was still quite low (increasing from about 1 in a million to 3 in a million in this recent review).

With appropriate testing and proper treatment, the vast majority of people with heart disease can be sexually active with a very low risk of problems. A standard stress test is a good way to determine whether a person with possible heart disease can tolerate the physical demands of sexual intercourse. As a general rule, people who can briskly climb a couple of flights of stairs without symptoms such as chest pain are able to tolerate sex as well.

It's also true, however, that medications approved in recent years for erectile dysfunction (ED) — sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) — allow and, perhaps, encourage men who have risk factors for heart disease to have sex. Men with blood flow problems that contribute to ED are often the same men who are most likely to have cardiovascular problems, such as heart disease. As a result, there has been considerable concern that use of these ED drugs might lead to heart attacks during sex, especially among men who already have heart disease and are taking medications to treat it. These medications may interact with those taken for ED. That's one reason why these drugs include warnings such as, "Be sure you are healthy enough to have sex," and "Avoid use with nitrates."

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What You Can Do

It's important to put some perspective on those serious health problems that could follow sexual activity.

Even though most people suffer no illness as a result of having sex, it's a good idea to recognize that sexual activity can cause major problems. Beyond abstinence, you can take some simple precautions such as the following to avoid the rare, but serious, risks that may accompany sex:

  • Always use a condom to help reduce the risk of getting an STD.
  • See your doctor and get screened for STDs, including HIV; suggest that a potential sexual partner also get tested.
  • Limit your number of sexual partners to reduce your chances of getting an STD.
  • Consider getting the HPV vaccine, which was recently approved for girls and women between the ages of 9 and 26. (It prevents infection with certain strains of HPV that can cause cervical cancer.)
  • Avoid alcohol or other drugs that can impair your judgment; risky behavior becomes much more likely when using drugs.
  • Talk to your doctors about any health concerns you have, such as heart disease or medications you take that might make sex risky.
  • Use an effective form of birth control to prevent unplanned pregnancy.
  • Exercise regularly.

Sex can certainly be risky, but you can take measures to minimize the dangers. There are plenty of reasons to think twice before having sex — the psychological and emotional effects, pregnancy and sexually transmitted disease — but serious illness can usually be avoided.

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Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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