Hi folks,

The following discussion is going on up on the newsgroup
soc.subculture.bondage-bdsm and I made the post below to it.  I'm
copying it here on a "just because" basis.  Feel free to forward or
repost it as seems appropriate.

Regards to all,



Subject: Re: Breathing Q

B asked...

>> A friend and I got to talking about breath control and such, and I
>> that occasionally I hold my breath when I get close to orgasm.  He
>> that some of his partners seem to hold their breath more
>> asked what that was called.  I know I've seen a name associated
with it,
>but I
>> couldn't think of it.  Any ideas on what it's called or where to
>> TIA,
>> B

And someone replied...

>IIRC it's called 'syncope' or cardiac syncope, and has to do with a
>drop in blood pressure. I'm sure that there are qualified people
here who
>know lots more about this, that's just my recollection from a Human
>Sexuality class a few years back.

And then I said...

Hi folks,

Let's see if I can untangle this a bit.

First, "syncope" (sin-coh-PEA) is the medical term for a brief loss of
consciousness.  It has literally dozens of causes and the differential
diagnosis can be both complex and challenging.  (Most of the causes
are fairly benign, but some are big scary.)  Note: syncope is often
accompanied by a brief period of what's called apnea (ap-knee-ah; not
breathing).  The person usually starts breathing again on their own
within 30 seconds to a minute with no ill effect.  (If they don't,
begin resuscitation as indicated.)

"Cardiac syncope" refers to syncope caused by some disruption in
cardiac function.  This is potentially one of the big scary causes.

Holding your breath and bearing down, whether during sex, during a
bowel movement, or whenever, is called a Valsalva maneuver.  The
resultant increase in intrathoracic pressure activates the aortic
sinus bodies (located in the arch of the aorta) which are, basically,
barometers and function much like the carotid sinus bodies in the
neck.  When they detect an increase in intrathoracic pressure they
send a message to our old friend the vagus nerve to decrease rate and
force of cardiac output.  This can occasionally cause syncope.  Thus
you hear reports of people passing out during orgasm, while
straining during a bowel movement, and so forth.

Most of the time, maximum vagal stimulation of the heart causes a one-
third decrease in cardiac output.  This can result in a decrease in
cerebral blood flow that sometimes causes light-headedness, momentary
dizziness, and even fainting.

However, occasionally a Valsalva maneuver causes cardiac arrest --
especially in older people and/or people with a history of heart
disease.  This is why you hear reports of people who had a "heart
attack" (more properly, a cardiac arrest) while sitting on the
toilet.  I've been out on such calls.  Talk about your undignified

Note: Valsalva maneuvers are also associated with causing occasional
strokes, vertebral disk ruptures, and other problems.  Again, "older,
sicker" people are generally more at risk than "younger, healthier"
people are, but no one knows what the shape of the age/risk curve
looks like.

Fainting during orgasm is not especially worrisome for young healthy
adults (young women seem to have the problem more frequently than
young men have it), however a medical evaluation to rule out some
potentially very serious causes such as the cardiac condition know as
Prolonged Q-T Syndrome might be advisable.

Note: I wrote an essay on assessment and treatment of "fainting"
during BDSM play.  I'll post it soon.

"Medical Physiology" 8th Edition, by Guyton
"Paramedic Emergency Care" 3rd Edition, by Bledsoe.

Regards to all,

Jay Wiseman

For basic BDSM info and links to much more, particularly regarding
the needs of novice submissive women, visit my "submissive women
kvetch" website at http://members.aol.com/oldrope/index.htm