Recurrent postcoital syncope due to a vagal response triggered by deep penetration: a case report.

Introduction and importance: Postcoital syncope (PCS) is a rare, transient loss of consciousness during or after sexual intercourse, often linked to an exaggerated vagal response. The condition is poorly understood, underdiagnosed, and can significantly impact patients' quality of life and intimate relationships. Differentiating PCS from other potential causes of syncope is essential for accurate diagnosis and management. Case presentation: A 34-year-old woman with no notable medical history presented with recurrent episodes of syncope during sexual intercourse, primarily triggered by deep penetration. These episodes were characterized by dizziness, bradycardia, hypotension, and brief loss of consciousness, typically resolving spontaneously. Her clinical examination and echocardiography (ECG) were normal. A tilt table test was performed, revealing a significant vagal-mediated response, supporting a diagnosis of PCS. Clinical discussion: PCS remains a challenging diagnosis due to its rarity and the difficulty in distinguishing it from other causes of syncope. It is thought to occur due to an exaggerated vagal response, triggered by deep cervical or pelvic stimulation during intercourse. Cardiovascular and neurological causes should be ruled out through comprehensive evaluation, including ECG, echocardiography, and tilt table testing. Treatment mainly focuses on lifestyle changes, such as avoiding specific sexual positions, and psychological counseling to address any anxiety or emotional distress linked to the episodes. Conclusion: PCS, though rare, is typically benign and can be managed effectively with non-pharmacological approaches. A thorough evaluation to exclude other causes, alongside patient education and psychological support, can help alleviate symptoms and improve overall quality of life.