Unsolved allegation of sexual intercourse and Viagra for possible causes of sudden unexpected death at the forensic autopsy

There is a controversy on the causal relationship of sexual intercourse as a cause of sudden death. Since sildenafil (Viagra™) has been introduced in 1998, there are more concerns on the safety issue of sildenafil and sexual activity as a forensic determination of the cause of death in those cases. We have collected 68 cases of sudden death occurred within 24 hours after sexual intercourse among 13,824 cases for five years from 2001 at the head office of the National Institute of Scientific Investigation in Seoul, Korea. There were 59 men and 9 women (M:F = 6.6:1). The most common cause of death was ischemic heart disease (20 in 68, 29.4%) in both men and women. Sildenafil (Viagra™) was detected in blood in 8 men and only in gastric content in 2 men (10/59, 17.0%). The level in the 8 men was in range of 0.04 to 0.48 with average 0.15 μg/ml. We could not conclude at this study on whether sexual activities and/or sildenafil are considered to have significant contribution to their death, but we would like to warn patients with cardiovascular diseases for the possible risk for sudden unexpected death particularly when their environments are in an unusual situation.