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In addition, routine hospital activity data and relevant clinical and pathological reports were abstracted from hospital notes for all men suspected of suffering a stroke.

General practitioner records were inspected for events that had not led to hospital admission.

Conclusions: The differential relation between frequency of sexual intercourse, stroke and coronary heart disease suggests that confounding is an unlikely explanation for the observed association with fatal coronary heart disease events.

Middle aged men should be heartened to know that frequent sexual intercourse is not likely to result in a substantial increase in risk of strokes, and that some protection from fatal coronary events may be an added bonus.

Frequency of sexual intercourse was not associated with all first ischaemic stroke events: age adjusted odds ratios (95% CI) for intermediate and low frequency of sexual intercourse of 0.61 (0.32 to 1.16) and 0.71 (0.34 to 1.49) respectively compared with the reference category of high frequency.

The high levels of recent and past media interest in reported relations between sexual intercourse and cardiovascular disease do not reflect a merely prurient interest (see for example, Daily Express and Associated Press stories.) Rather, given the very meagre scientific literature available, media stories provide almost the only source of information to support or refute lay epidemiology.As strokes occur quite commonly at night and in the early morning, coincidence with sexual activity may result in survivors and their partners assuming a causal association.None of the conventional risk factors vary between patients suffering stroke at night or in the morning compared with other times.Main outcome measures: Ischaemic stroke and coronary heart disease, all first events and fatal events.Results: Of the 914 men studied, 197 (21.5%) reported sexual intercourse less often than once a month, 231 (25.3%) reported sexual intercourse twice or more a week, and the remaining 486 (53.2%) men fell into the intermediate category.

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