Sexual Intercourse: You, Me, and the Microbe Makes Three-Reply

In Reply.—  Like our article, the Letter submitted by de Groen and Vukov emphasizes the spectrum of complications of sexual intercourse. In considering these conditions, practitioners tend to focus preponderantly on pregnancy and sexually transmitted infectious diseases or syndromes, including syphilis and gonorrhea as well as chlamydial, herpes simplex, and, most recently, enteropathogen and human immunodeficiency virus infections. There are, however, an increasing number of other less well-recognized complications associated with coitus.Intimate physical contact can lead to the transmission of irritant compounds, including drugs, and can result in contact dermatitis or even "spousal" headache.¹ Some unfortunate individuals may suffer hypersensitivity reactions— including anaphylaxis.² The mechanical action of intercourse may produce microscopic as well as macroscopic trauma and may predispose to localized infection. In addition, "coital-like" urethral manipulation is associated with bladder contamination by urethral microflora and is postulated by some to cause "honeymoon cystitis."³ Physical displacement