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. 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:
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. 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:
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." 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:
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. 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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