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Direct Arterial Pressure, Heart Rate and Electrocardiogram During Human Coitus

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Direct Arterial Pressure, Heart Rate and Electrocardiogram During Human Coitus DIRECT ARTERIAL PRESSURE, HEART RATE AND ELECTROCARDIOGRAM DURING HUMAN COITUS W. A. LITTLER, A. J. HONOUR and P. SLEIGHT Cardiac Department and Department of the Regius Professor of Medicine, Radcliffe Infirmary, Oxford 0X2 6HE {Received 27th September 1973) Summary. Direct arterial blood pressure, heart rate and electrocardio- grams were recorded continuously over a 24-hr period in seventy-two human subjects. Seven normotensive subjects (six males and one female) had coitus at home during the period of study. The duration of inter- course ranged from 8 to 20 min and orgasm was achieved by all six males but not by the female. Significant changes in arterial systolic and diastolic pressure and heart rate were noted. Compared with values at the onset of coitus, systolic pressure rose by 20 to 107% ( + 25 to 120 mmHg), diastolic pressure by 31 to 60% ( + to 48) and heart rate increased from 25 to 120% ( +20 to 87 beats/min). Changes in arterial pressure closely followed changes in heart rate throughout the activity. Peak arterial pressure and heart rate occurred at the time of orgasm; after which, arterial pressure and, to a lesser extent, heart rate quickly fell to below the precoital level within 20 to 120 sec. INTRODUCTION Sexual intercourse is a private and spontaneous activity, which is inappropriate for study under laboratory conditions. Masters & Johnson (1966) made an exhaustive study of the anatomy and physiology of the human sexual response, using adult men and women who were willing to serve as subjects in the laboratory. In reporting their findings, they described marked increases in heart rate and arterial blood pressure during sexual intercourse. Unfortunately, they failed to state the number of observations or the method used to determine the blood pressure. In this communication, we will describe circulatory changes which were recorded continuously throughout sexual intercourse. SUBJECTS AND METHODS Direct arterial blood pressure, heart rate and the electrocardiogram (ECG) have previously been recorded continuously over a 24-hr period in seventy-two human subjects (Littler, Honour, Sleight & Stott, 1972, 1973; Littler, Honour & Sleight, 1973). Seven of these subjects who were normotensive (six males and one female— Table 1), and who had sexual intercourse in their home environment during 321 Downloaded from Bioscientifica.com at 10/08/2021 06:16:38AM via free access 322 W. A. Littler et al. Table 1. Sex, age, occupation and clinical details of the seven subjects Subject Sex Age Occupation Partner Resting Chest Electro¬ (years) blood pressure X-ray cardiogram M 31 Doctor Wife 110/60 M 32 Lorry driver Wife 130/70 Normal Normal M 20 Student Girl friend 138/82 Normal M 22 Car worker Wife 130/90 Normal Normal M 35 Doctor Wife 136/84 Normal M 26 Builder Wife 125/80 Normal Normal F 31 School teacher Husband 130/85 Normal the 24-hr period of the study, form the basis of this report. All subjects gave fully informed consent to the study. The methods used have been previously described (Littler et al., 1972). Subject 1 was studied with an earlier type of direct arterial pressure recorder using an otherwise similar technique except that the ECG and heart rate were not recorded. The arterial pressure data were included in another publication (Bevan, Honour & Stott, 1969). Briefly, a Teflon catheter (length, 10 cm; i.d. 0-9 mm) was inserted into the left brachial artery using the Seldinger technique. The catheter was connected to a trans¬ ducer and perfusion pump by a 1-m length of Teflon tubing (i.d. 0-35 mm), and was perfused with normal saline at about 1 -5 ml/hr. The recording system was a miniature (four-channel analogue) tape recorder using standard compact cassettes. The transducer, perfusion pump, and tape recorder were carried in a padded harness at heart level; the reference point for pressure was therefore constant irrespective of the position of the arm. The frequency response of the whole system was flat to 10 Hz. The zero baseline varied less than 2 mmHg over the 24-hr period. The ECG system consisted of bipolar electrodes placed over the V5R-V5L positions. Leads were held in place by electrode discs and secured by surgical tape to minimize movement artifact. The tape cassettes were replayed on a separate playback deck at twenty-five times the recording speed. The output from this playback deck was fed into a u.v. recorder so that com¬ pressed or expanded records, for beat-to-beat analysis, might be obtained. The subjects were all studied over a 24-hr period from 09.00 to 09.00 hours. During this time, they attended the laboratory only once for 15 min after a 12-hr period in order to apply a calibration to the tape and to service the per¬ fusion chamber. When analysing our results, the arterial systolic and diastolic pressures and the heart rate were averaged over ten consecutive beats at 1-min intervals throughout the sexual activity. The records were scrutinized for changes in cardiac rhythm and ST segment shift using previously described criteria (Littler et al., 1972). RESULTS All six males achieved orgasm but the female did hot. Table 2 shows the absolute figures for arterial blood pressure and heart rate at 1-min intervals throughout intercourse and these are summarized in Table 3 and in Text-fig. 1. Text-figure 2 Downloaded from Bioscientifica.com at 10/08/2021 06:16:38AM via free access Circulatory changes during human coitus 323 «3 CO CO 00 co CO o CO CO O CO CO OCOCOCOCOCOOOOCOCOCMCO—iCNCS — COCNCMCO «*& -^—< —- > —. —< ~ ~- —< ~ ~ ~- co *lO-+-*-*-+COCOir>COt£>000 t-.<0IC<DlOM»C0C000C0OOO mneofflcooioooois-oo OUI- *8l r~r^r^r-^r^r^co — > > co oo — —· — r~ to OÎDCNThCOT^CÛCOCSOCM cococococococococnocn *8i 1 )000)OìOìiJ)C CNO^COCNOCOCrjiO -, - - -( - CM CO oooioooo-H^eo COCOCTiCOCOCOCO—i^J> 3ä3 COOlLOLOiniOCOOlCOCM s."fe Downloaded from Bioscientifica.com at 10/08/2021 06:16:38AM via free access 324 W. A. Littler et al. Table 3. A summary of the significant changes in the circulation of seven human subjects during sexual intercourse Duration of Time for BP to Subject intercourse Orgasm Change in Change in Change in fall below precoital (min) systolic BP diastolic BP heart rate value (sec) + 59 32 25 + 107 60 120 34 12 + 80 48 81 20 10 + 20 31 25 30 20 + 53 39 52 120 20 + 33 42 76 24 16 0 23 44 46 20 The pressure and rate changes are the maximum levels achieved. BP = arterial blood pressure. shows the typical evolution of these changes in arterial pressure and heart rate. Text-figure 3 shows that there was a linear relationship between the maximum percentage increase in mean arterial pressure during coitus and the maximum percentage increase in heart rate, as compared with levels before coitus. Analysis of the data provided by one subject showed that the arterial pressure began to fall immediately after ejaculation (Text-figs 4 and 5). In the female 150 200 100 180 50 160 140 | 120 100 80 60 - 40 9 20 - I Start Peak Finish Text-fig. 1. The arterial blood pressure (·-·) and heart rate (·) levels of seven human subjects during sexual intercourse; the peak levels in the males were achieved at orgasm. There is no heart rate record for Subject 1. Downloaded from Bioscientifica.com at 10/08/2021 06:16:38AM via free access Circulatory changes during human coitus 325 Text-fig. 2. A tracing from Subject 2 showing the behaviour of arterial pressure during intercourse. 80 60 40 - Ç 20 2 40 60 80 100 120 % Increase in heart rate Text-fig. 3. The relationship between the maximum °/0 increase in mean arterial pressure and maximum % increase in heart rate during sexual intercourse in six subjects. Downloaded from Bioscientifica.com at 10/08/2021 06:16:38AM via free access 326 W. A. Littler et al. Text-fig. 4. The behaviour of arterial pressure in Subject 5 who managed to indicate ejaculation and withdrawal. Note that the arterial pressure fell rapidly after orgasm. subject, a small rise and fall in arterial pressure was recorded during the period of sexual activity (Text-fig. 6). In all male subjects during sexual activity, there were marked swings in arterial blood pressure and our records illustrate baroreceptor activity during this time (Text-fig. 7). Before orgasm, the pressure and heart rate seemed to be little influenced by these reflexes and increased part passu. Text-fig. 5. A beat-to-beat analysis of the data shown in Text-fig. 4, emphasizing the fall of arterial pressure following ejaculation. Downloaded from Bioscientifica.com at 10/08/2021 06:16:38AM via free access Circulatory changes during human coitus 327 3 O be 3 O 3 co ß ? •S S "3 c 3·- X S s 3 - c .Su ci •3 « 13'C .5 "3 s O CS -a 5 fe S o < c Downloaded from Bioscientifica.com at 10/08/2021 06:16:38AM via free access 328 W. A. Littler et al. Text-fig. 7. A portion of record from Subject 2 obtained during intercourse to demon¬ strate (a) reflex bradycardia with rising arterial pressure (baroreceptor activity), (b) the loss of baroreceptor activity immediately before orgasm. No arrhythmias or ST segment changes were noted in any of the seven subjects during intercourse. DISCUSSION The recording methods used allowed the subjects great personal freedom. Since sexual intercourse took place in the home environment, most of the criti¬ cisms inherent in laboratory observations are not applicable. All seven subjects developed a substantial increase in heart rate and arterial pressure during sexual intercourse compared with the levels immediately beforehand.
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