BACKGROUND
Acute type A aortic dissection is a life-threatening emergency. Sexual activity can produce transient hemodynamic stress, but causal attribution is difficult when vascular risk factors or substance exposures are present.
CASE REPORT
A 41-year-old man with schizoaffective disorder, bipolar type, treated with sertraline and olanzapine developed sudden tearing chest pain radiating to the abdomen and back at orgasm during masturbation. At follow-up, he reported prior hypertension identified during an earlier emergency department visit without subsequent antihypertensive therapy, and daily cannabis use with his usual amount smoked several hours before symptom onset. Toxicology was positive for cannabinoids and opiates; the source of the opiate result could not be established. His emergency department blood pressure was 195/102 mm Hg. Computed tomography angiography was interpreted as an acute Stanford type A dissection originating in the arch, involving the posterior ascending aorta, and extending to the right common iliac artery with preserved major branch-vessel perfusion. He received esmolol and nicardipine and was transferred to a tertiary cardiovascular center. Five months later, chest radiography documented a thoracic aortic endograft. Complete outside-hospital procedural records were unavailable, so the exact repair technique and postoperative course could not be confirmed.
CONCLUSIONS
Symptoms began at orgasm, supporting a temporal association but not causation. Patient-reported prior hypertension and recent cannabis exposure were possible predisposing or contributing factors. Acute aortic syndrome should be considered when abrupt severe chest or back pain occurs after sexual activity.

Keywords: Dissection, Ascending Aorta; Chest Pain; Hypertension; Tomography Scanners, X-Ray Computed; Orgasm; Sexual Behavior