Abstract
Dear Editor,
We have read the article: “Can Sex Improve Nasal Function?—An Exploration of the Link Between Sex and Nasal Function.” 1 We acknowledge the authors for recovering a topic that has sparked so much debate in the past, as well as for their recent Ig Nobel award. 2 Since the 19th century, neurological reflexes from the nose (“nasal reflex neurosis”) have been postulated as a cause of many symptoms, including genitalia, dysmenorrhea, pelvic pain, etc., and even nasal treatments seemed to improve them.3,4 The article of Bulut et al. 1 represents a paradigm shift. His main conclusion is that sexual intercourse with climax improves nasal breathing, being the first exploratory study of its kind.
Since the 19th century, there are various publications that have studied the sexual intercourse and worsening nasal symptoms 4 ; hence, these striking results are obtained. The book of Holmes et al. 5 presented a comprehensive study of nasal functions under a variety of circumstances where sexual excitement was accompanied by changes in the nasal mucosa (notably hyperemia, hypersecretion, and nasal stuffiness). Ten years later, Noah et al. 6 showed that sexual intercourse produces a rise in the topical temperature, a state of vasodilatation, and an increase in the blood supply of the nasal mucosa. Subsequently, cases in which sexual excitement caused postcoital or “honeymoon rhinitis” have been reported. 7 More recently, a randomized placebo-controlled study demonstrated a significant reduction in minimum cross-sectional area and increase of the inferior turbinates’ volume after visual sexual stimulation. 8 Therefore, Bulut et al. 1 study is not the first to subjectively and/or objectively assess the relationship between nasal symptoms and sexual arousal, although it is the first to report an improvement in symptoms.
The results obtained by Bulut et al. 1 should be taken with caution. First, the losses in data collection exceed 55%. This implies a bias when comparing the pre- and the post-sexual act. It is possible that only the patients who noticed a significant improvement or the most motivated responded. Second, there could be bias selection due to the fact that all are volunteers health-care workers, comorbidities were not registered, and participants presented a baseline moderate nasal obstruction according to the rhinomanometry and the NOSE questionnaire, which reduces the sexual function. 9 Finally, environmental and duration factors should have been taken into account to ensure study reproducibility.
The response to the differences found in the studies could be due to the physiology of the sexual arousal and the nasal signaling pathways. 3 On one hand, the sexual activity is associated with autonomic stimulation with the parasympathetic predominance during the early stages, while the sympathetic segment is more active toward the culmination in orgasm. This could explain the differences between the study of Bulut et al. 1 and that of Trimarchi et al. 8 While the former evaluated nasal function after orgasm (sympathetic preponderance), the latter performed these measurements after sexual arousal only (parasympathetic preponderance). An autonomic imbalance can decant the balance toward one of the two symptomatic aspects during sexual intercourse. On the other hand, in some patients with antecedents of respiratory or allergic pathology, an overactive cholinergic stimulation secondary to orgasm can cause a release of mast cell mediators which may be one of the mechanisms that can provoke postcoital asthma and rhinitis, being able to lead to a sexual dysfunction.7,10
In conclusion, controversy continues to exist in relation to nasal symptoms and sexual arousal. Future studies should take into account the duration of the act, its characteristics, environmental factors, the associated morbidities of the participants, as well as the achievement or not of orgasm in order to reduce possible biases.
