Case Presentation: We present the case of a 34-year-old female with PMHx of chronic hypoxemic respiratory failure secondary to LCH with cor pulmonale that had questions about sexual intercourse. She reported that she and her partner were planning to have sexual intercourse, and she wanted a medical opinion about the health risks because of probable changes in her oxygen requirements, breathing, and heart rate. A comprehensive sexual history was performed. It was explained that intercourse may worsen hypoxia, increase cardiovascular demand, increase weakness, and increase fatigue. Education was provided to the patient, which included counseling her to monitor her respiratory effort, oxygen saturation, and heart rate before, during, and after intercourse. Our patient was strongly advised to take proactive steps to prevent pregnancy and contraceptive counseling was offered. Our patient was also offered counseling to address any challenges which may arise from this complex issue.
Discussion: Patients with chronic illnesses oftentimes remain sexually active; however, clinicians rarely proactively and comfortably introduce this subject during patient encounters. Sexual histories are very important to assess the risk of an adverse health event. Inquiries should be sensitive, direct, and approached in a comfortable manner. The physiologic demands of intercourse may worsen hypoxia, increase cardiovascular demand, increase weakness, and increase fatigue. Unfortunately, there is no clear guidance for providers to stratify risk or counsel patients with chronic hypoxic respiratory failure. Self-monitoring of pulse oximetry, heart rate, respiratory rate, and respiratory effort can be encouraged as there will be increased physiological demand. Sexual activity pre-orgasm averages 2-3 METs and sexual activity during orgasm averages 3-4 METs. For management, supplemental oxygen may be increased during intercourse, pre-intimacy bronchodilators can be considered if comorbid COPD is present, counseling services can be offered to address potential psychosocial challenges that may arise, and pulmonary rehabilitation can be performed for further training, education, and support. Discussing contraceptive options is also important for these patients.
Conclusions: Sexual activity may place chronically hypoxic patients at increased risk for adverse events because of the increased physiologic demands. Providers must proactively and comfortably perform sexual histories in these patients to best stratify risk and manage these patients. Self-monitoring can be performed during intercourse, and an interprofessional team approach is ideal for managing these patients.