Man Goes Blind After Having Powerful Orgasm

Here's an interesting news story I came across today while having my morning coffee.  According to most headlines like here, here, here and here a 29-year-old guy from Southampton lost sight on his left eye for about 24 hours after having a really strong orgasm!

Sounds a bit unbelievable but it turns out this news story isn't another case of fake news. But it is old news, as the "news" story is based on a case that was published back in...2014! But what happened exactly and how did the orgasm lead to blindness? And most importantly... Are you in danger?

So, here's the background story. The patient presented to the emergency clinic after reporting an obstruction in the central vision of his left eye, which he had noticed upon waking. Visual examination revealed a paracentral scotoma which is "an island of relative or absolute vision loss within 10° in the central vision".  In simple words, there was a big blind spot in his central vision.

Further examination revealed that this was the result of preretinal haemorrhage, meaning that a tiny hemorrhage in the eye was blocking part of his vision. The doctors informed him that the condition is not serious and typically resolves with conservative treatment.

Valsalva-induced parafoveal hemorrhage (credit)

The doctors initially thought that this hemorrhage was another case of valsalva retinopathy, which means that the patient had, for whatever reason, held his breath the day before and a blood vessel in the eye popped up due to pressure build up. However, the doctors ditched this theory since "the patient denied vomiting, coughing, sneezing or constipation"! 

As a result, more examinations followed:

Several investigations were performed, including a fasting blood sugar, clotting screen, and a fundus fluorescein angiogram (FFA). The FFA showed masking due to the haemorrhage but there was no other retinal vascular pathology. All blood tests were normal. 

With all the tests failing to find the real culprit behind the blindness the differential diagnoses included:

 Macular haemorrhage includes diabetic retinopathy, retinal vein occlusion, choroidal neovascularisation, retinal artery macroaneurysm, valsalva retinopathy and Terson's syndrome. Of these, it is typically Terson's syndrome and valsalva retinopathy that cause preretinal haemorrhage in the absence of any other vascular pathology. 

Since the condition wasn't life threatening, the doctors asked the man to return for a follow-up 3 days later. 

When he returned, the issue had resolved. Furthermore, the clinician that saw him was a bit more direct and asked the man if he had sex the day before the incident. The man "reported an episode of vigorous sexual intercourse on the evening preceding the onset of symptoms" which confirmed the initial diagnosis of valsalva retinopathy!

The paper concludes that although "obtaining a sexual history can be a source of discomfort and embarrassment to the patient as well as to the clinician" it "emphasizes the importance of considering sexual activity as a cause of stress-induced pathology."

Am I In Danger?

If you are a guy the answer might be yes. According to the paper, some men hold their breath during sex to delay or intensify ejaculation. If you are one of those guys  than you might be "at higher risk of valsalva retinopathy associated with sexual activity although to our knowledge there is no epidemiological data to confirm this."