Sex & Acid Reflux: GERD After Intercourse?

In 1986, Alan J.B. Kirk coined the term “reflux dyspareunia” – to describe the specific phenomenon of heartburn (i.e. acid reflux) during sex.

At the time, Kirk discovered that 77% of women (77/100) with gastroesophageal reflux – experienced heartburn during sexual intercourse vs. just 5% of women (5/100) without gastroesophageal reflux experienced heartburn during reflux.

This early research supported the idea that sexual intercourse might trigger “reflux dyspareunia” in susceptible individuals – particularly those with preexisting reflux conditions like GERD and LPR.

How sex might cause or worsen acid reflux… (Mechanisms)

There are numerous ways in which sexual activity could cause/worsen acid reflux conditions like gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD).

Most people who experience a worsening of reflux from sex can blame a combination of factors such as: positional changes & gravity; intra-abdominal pressure; intense physical movements/motions; altered GI blood flow; etc.

Most likely mechanisms

Positional changes vs. gravity: Many people change/shift positions during sex – and some of these positions may run contra to the ability of gravity to keep acid down in the stomach. For example, if you lie down or tilt your torso over your lower body – gravity may cause stomach acid to “reflux” up the esophagus.

Intra-abdominal pressure: Many people compress their abdominal region during sex such as pressing against a partner’s torso – or lying flat on one’s stomach. Others may simply bend the upper body in ways that increase intra-abdominal pressure. Exaggerated pressure fluctuations at the thorax/abdomen could challenge the GI barrier and allow reflux of gastric contents into the esophagus.

Intense physical movements: Intense physical movements during sex may put increased pressure on the stomach and chest and promote faster breathing/gasping for air (such that the lower esophageal sphincter relaxes or is forced open). Ultimately, opening of the LES from jarring movements enables stomach contents to reflux into the esophagus.

Oral sex: Performing oral sex on a partner, particularly aggressive fellatio of a male, could cause reactions like choking, gagging, or trigger the vomiting reflex – all of which could promote regurgitation and “reflux” episodes. Additionally, some claim that swallowing sexual fluids might aggravate preexisting reflux conditions such as laryngopharyngeal reflux which tends to affect the upper esophageal sphincter.

Other possible mechanisms

Altered GI blood flow: During sex (particularly if intense), blood flow could shift away from the gastrointestinal tract and towards the active muscles and lungs – as a result of sympathetic activation. Decreased blood flow to the gastrointestinal tract might increase susceptibility to reflux events in some individuals.

Shifts in hormone/peptide secretion: Various hormones and peptides as vasoactive intestinal peptide, secretin, peptide-histidine-methionine, etc. – may fluctuate during sex. Certain shifts might alter gastric acid production, gastrointestinal motility, or esophageal sphincter function – such as to trigger reflux.

Autonomic nervous system (ANS) change: During sex it is understood that significant changes occur within the autonomic nervous system – wherein there’s a coordinated response by the sympathetic and parasympathetic branches. Activities of the sympathetic nervous system have been thought to potentially reduce GI blood flow during sex – which might induce reflux.

Altered esophageal function: The act of sex, particularly if relatively intense, may decrease contraction pressures as the mid-esophagus and peristaltic motility at both the mid and distal esophagus – all of which could delay gastric emptying and promote more frequent reflux.

Least likely mechanisms

Anal sex: It has been hypothesized by non-experts that engaging in anal sex can alter gastric emptying and modify esophageal sphincter function – such as to potentially trigger reflux. Most experts do not think this is a plausible means by which sex worsens reflux.

Deep insertion (?): Various individuals on Reddit suspect that insertion of a larger penis inside a shorter-length vagina might reach beyond the cervix to areas within the lower stomach such that it alters digestion and esophageal sphincter function to induce reflux. Most experts do not think this sounds plausible.

Could sex actually decrease reflux in some cases?

Sex can induce beneficial changes in neurochemistry/brain function (e.g. endorphin release); autonomic nervous system (ANS) activation; and hormone profiles – such as to improve mood, decrease stress, and facilitate general wellbeing.

For this reason, it’s possible, that for a subset of individuals with reflux caused and/or exacerbated by psychological stress – regular sex could potentially reduce: (A) objective reflux frequency/severity and/or (B) perceived (i.e. subjective) reflux severity.

Therefore, we should not assume that sex always increases reflux – or has no effect on reflux.

In some cases, it’s possible that regular sexual activity could have a beneficial effect on reflux – particularly in individuals with reflux from functional GI disorders via a stress reduction effect.

Sex might also improve reflux by modulating concentrations of certain sex hormones. For example, sex increases estrogen levels in women – and GERD is associated with low concentrations of estrogen.

Therefore, it’s possible that in some cases, the estrogen spike from sex might attenuate reflux symptoms in women via hormonal mechanisms.

Regular sex also increases concentrations of oxytocin – and this hormone possesses anti-secretory and anti-ulcer activity – both of which could help reverse or attenuate reflux symptoms.

Why reflux may worsen during/after sex – without sex being the only cause (Reasons)

Included below are some reasons that acid reflux might worsen during/after sex – without sex being the only cause.

• Substance use: Many individuals take drugs, medications, supplements, etc. – with the intent of increasing arousal or enhancing sexual performance. Examples include: sildenafil, alcohol, nicotine, caffeine, MDMA, amphetamine, etc. Some of these substances may alter esophageal sphincter function and stomach acidity to increase susceptibility to reflux during sex.
• Specific foods/drinks: The specific foods/drinks ingested before sex may determine whether reflux occurs during sex. Certain foods/drinks increase stomach acidity and alter esophageal sphincter function – which can increase susceptibility to reflux.
• Degree of “fullness”: The degree to which one’s stomach is full of food and/or fluid prior to sex could influence susceptibility to reflux during/after sex. Those with a full stomach such as from eating a large meal and/or drinking a large beverage prior to sex may be more likely to experience reflux during/after sex. Why? Increased sphincter pressure, transient LES relaxation, increased acid production, etc.
• Anatomical/morphological abnormalities: Individuals with abnormal body shape and/or internal structures may be more susceptible to reflux during sex. For example, persons with a large hiatal hernia are probably at increased risk of reflux during/after sex than those without.
• Medical conditions: Certain medical conditions (and medications used to treat those conditions) may impact one’s physiology in ways that might increase susceptibility to acid reflux during sex.

Things like: (1) sex position(s); (2) intensity of sex; (3) amount of body shifting; and/or (4) duration of sex – coupled with the above factors (substance use, food/drink intake, fullness, body morphology, preexisting conditions) – influence odds of sex-related reflux.

In some cases, as long as certain individuals avoid: using certain substances; consuming specific foods/drinks; excessive fullness; etc. prior to sex – then reflux won’t occur.

Sexual activity & acid reflux / GERD (Research)

Included below are summaries of papers in which the effect of sexual activity on acid reflux was discussed.

Sexual activity does not predispose to reflux episodes in patients with GERD (2014) (R)

Bor et al.: “Sexual activity does NOT predispose to increased intra-esophageal acid exposure and acid reflux events.”

• Aim: Investigate the effect of sexual activity on the intra-esophageal acid exposure and acid reflux events in patients with GERD (gastroesophageal reflux disease).
• 15 patients with GERD were instructed to either: (1) have sexual intercourse (missionary position) OR (2) abstain from sex – in a random order ~2 hours after the same refluxogenic dinner/diet for 2 consecutive nights.
• Diet: Tea, egg, cheese, honey or jam, slice of bread (breakfast); fried meat, 2 medium French fries, soup, high-fat yogurt (lunch); coffee, brownie (afternoon snack); legumes, pounded wheat, cup of yogurt, cucumber and garlic, slice of white bread (dinner); 2 pieces of baklava (dessert).
• Measures: Bravo capsule (48-hour intra-esophageal pH) & diary reports (time of sexual intercourse & GERD symptoms)
• Percentage of reflux time and acid reflux events were compared in 2 ways: (A) within 30 and 60 minutes prior to and after sexual intercourse on the day of sexual intercourse and (B) in the same time frame of the day without sexual intercourse.

What were the results?

Median reflux time percentages within the period of 30 minutes pre/post-sexual intercourse were ~21.3% (pre-intercourse) and ~10% (post-intercourse) respectively.

Median reflux time percentages within the period of 60 minutes pre/post-sexual intercourse were 16% (pre-intercourse) and ~5.7% (post-intercourse)

Median reflux time and reflux events at the time of sexual intercourse and on the corresponding time without sexual intercourse were comparable.

Ranges of reflux time percentages within: (A) 30 minutes were: 0-61.7% (pre-intercourse) and 0-70.3% (post-intercourse) – (B) 60 minutes were: 0-51% (pre-intercourse) and 0-61.7% (post-intercourse) – suggests that post-intercourse was associated with a higher maximum reflux time percentage.

Nonetheless, paired analysis comparing the individual changes of the patients prior to and after sexual intercourse did not show a statistically significant difference.

There was no difference observed in the number of reflux events: (A) prior to and after sexual intercourse and (B) on the days with and without sexual intercourse.

Women tended to have a higher percentage of reflux, but a subgroup analysis based on gender and presence/absence of esophagitis did not reveal any significant difference in percentage of reflux time and number of reflux events.

Critical thinking…

This study has a host of limitations – such that it becomes very difficult to conclude with high conviction that sex has no significant effect on reflux symptoms in patients with GERD.

• Small sample: Because this study involved just 15 patients – results may have been due to random chance and thus may not accurately reflect the prevalence and severity of reflux during sex among patients with GERD. Authors acknowledged that larger studies are needed to confirm findings.
• Missionary-only: Study participants were instructed to only have sex in a standard “missionary position” (as this reduces abdominal pressure on female patients). The problem with this is that many couples have sex in a variety of positions that are not missionary. It may have been better to allow couples to have sex however they typically do (with no restriction of positions) – as this would better reflect natural behavior.
• Sex 2 hours after meals: Participants in this study were instructed to have intercourse ~2 hours after meals. This is a massive limitation in that many individuals with reflux do not consciously set a timer and wait ~2 hours after eating before having sex. Sex is often spontaneous and unplanned – such that results of this study may be irrelevant unless the sex is performed at least 2 hours post-meal. Waiting 2 hours after meals also minimizes both likelihood of reflux and severity of reflux (if it does occur).
• No LPR patients: This study involved zero patients with laryngopharyngeal reflux disease (LPRD) – which might be significantly more likely than GERD to cause reflux-related symptoms during/after sex.
• Self-reports: The exact time period and the position of sexual intercourse were self-reported. Self-reports are problematic in that participants may give socially acceptable reports rather than truthful ones (e.g. report sex to appease researchers even if no sex was had).
• Bravo pH monitoring: This was the only means by which researchers investigated acid reflux events. Researchers considered this to be a limitation.
• Reflux-conscious choices: Participants in this study may have thought about the study and realized that sex might cause reflux. For this reason, it’s possible they modified their behavior in certain ways just for the study (e.g. less intense sex, using acid-reducing medication, etc.).
• Selection bias (mild GERD) (?): Patients were excluded from this study if they had: (1) severe esophagitis; (2) Barrett’s esophagus; (3) certain chronic conditions (renal disease; coronary artery disease; cardiac rhythm abnormalities; diabetes; COPD; hypothyroidism); (4) bleeding or coagulation disorders; (5) previous abdominal surgery; (6) chronic treatment that affects sexual function or gastric motility; (7) treatment for ED; (8) gastric motility disorders.
• Diet (specific foods, meal size, food timing, total calories): The diet followed participants in this study may not accurately reflect/represent feeding behavior in a non-study setting. For example, some individuals may ingest significantly: (1) more acidic foods/drinks; (2) larger meals; (3) more calories at night; and/or (4) more total calories per day – than in this study. If this is the case, then the meals in this study may have actually helped reduce reflux (relative to a non-study setting) for participants.
• Male vs. female patients: 10 participants were male – and 5 participants were female. It’s possible that men are less likely to experience reflux during sex than women due to positioning during missionary.  Since 10/15 participants were male – and they may be at positionally lower-risk of reflux during “missionary” sex than females, this may have skewed the results of the study to suggest sex doesn’t affect reflux.
• Reflux treatments: It is unknown as to whether the 15 patients with GERD in this study were being treated for the condition. If they were being treated and the treatment significantly reduced reflux symptoms – then perhaps we shouldn’t have expected any significant difference in reflux post-sexual intercourse. If patients were using PPIs, H2 blockers, antacids, alginates, etc. – then perhaps this covered up what would’ve been a worsening of reflux post-sex.
• Zero patients with sex-related reflux (?): Considering both the small sample size and the fact that only a minority of patients with GERD may experience symptom exacerbation due to sex – it may have been smarter to study participants only with self-reported reflux symptom exacerbation during/after sex.

Prevalence of Sexual Behavior Disorders in Patients with Treated vs. Untreated GERD (2007) (R)

Iovino et al.: “Untreated GERD is associated with disorders in sexual behavior. Compared with HC, only the surgical group partially improved after treatment.”

• Aim: Evaluate sexual behavior in patients with GERD before and after: (A) medical OR (B) surgical treatment – relative to healthy controls.
• 111 patients with GERD (59 men, 52 women) participated in this study – and were compared to 32 healthy controls (16 men, 16 women).
• Measures: Questionnaires (sexual behavior, quality-of-life, GERD symptoms); Upper GI endoscopy & 24-hour ambulatory pH testing (to confirm GERD at baseline)

What were the results?

Untreated patients with GERD showed more frequent difficulty in achieving orgasm and had [more] painful sexual intercourse.

Surgery (laparoscopic fundoplication) for GERD was favorably associated with improved ability to achieve orgasm and reduced pain associated with intercourse – but was unfavorably associated with a significant decrease in sexual desire and satisfaction with sex life and higher rates of unhelpful partners – relative to baseline.

Medication (PPIs) for GERD was associated with higher difficulty in achieving orgasm, more painful intercourse, lower sex drive, and greater perception that their sex partner was unhelpful – relative to baseline.

Despite the fact that GERD surgery was associated with improved ability to orgasm and reduced pain during intercourse – the ability to orgasm was still significantly impaired relative to healthy controls.

Since medication (PPIs) for GERD caused greater sexual dysfunction in all aspects relative to baseline – it predictably maintained significantly greater sexual dysfunction relative to healthy controls.

Conclusion: GERD is the cause of significant impairment in sexual behavior. Treatment is effective when it provides good control for GERD symptoms for a long-term. Surgical treatment may be superior to standard medical treatment for improving sexual behavior and QoL in GERD.

Critical thinking…

• Medications post-surgery: 19.4% of patients who had undergone surgery were taking antireflux drugs “occasionally.” It’s possible that antireflux drugs affect ability to achieve orgasm – and thus would explain the lingering significant difference in ability to achieve orgasm between surgery recipients and healthy controls.
• Uneven comparison (?): The GERD patient group had 111 participants and the control group had just 32 participants. It’s possible that there were certain factors that were more common in the GERD group that would’ve explained significant sexual impairment relative to the healthy controls – other than the GERD itself. Average BMI was slightly higher in GERD patients (24.7) than healthy controls (23.8). Perhaps patients with GERD may have other medical conditions that predispose to greater sexual dysfunction than healthy controls.
• Questionnaire data: Using questionnaires as the sole way to gauge sexual behavior; GERD symptoms; and quality-of-life – may be suboptimal, as the responses are completely subjective and may be subject to inaccuracies/biases.
• No randomization or blinding: This study did not utilize randomization or blinding – such that outcomes may have been biased by both patients and researchers.
• Zero objective measures: Although researchers used objective measures at baseline to confirm the diagnosis of GERD (in GERD patients) – zero objective measures were utilized for the remainder of the study to assess GERD severity. It may have been useful to determine if significant objective reduction in GERD correlated with sexual behavior improvements.

Reflux dyspareunia (1986) (R)

Kirk: In a prospective study of 100 women with known gastroesophageal reflux, 77% suffered (to some extent) from symptoms as a result of sexual intercourse.

• Aim: Investigate the prevalence of “reflux dyspareunia” or heartburn during sexual intercourse.
• 100 sexually-active women attending a general surgical outpatient clinic complaining of heartburn were evaluated with contrast radiography or endoscopy participated in this study.
• 100 sexually-active women without heartburn or gastrointestinal complaints were used as the control group.
• Factors such as: smoking habit, diet, drug treatment, height, weight, etc. – were documented.
• Questions were asked: (1) During what activities and times is heartburn noted? (2) In general, are there any problems related to sexual intercourse? (3) Is heartburn experienced during sexual intercourse?
• Those with “reflux dyspareunia” were asked to rate symptoms as “mild,” “moderate,” or “severe.”
• A management plan was discussed with each patient and involved: (1) encouraging weight loss; (2) stopping smoking (especially at night); (3) avoiding refluxogenic foods; (4) avoiding heavy meals at dinner; (5) using alginates before sleep or sex; (6) raising the head of the bed; (7) bending from the knee rather than stooping from the waist; and (8) “female superior” sex position should be utilized instead of missionary.
• All 100 patients were then reviewed ~3 months later.

What were the results?

Baseline (pre-management)

77/100 women (77%) with reflux reported heartburn during intercourse – and 23/100 (23%) denied the symptom.

Of the 77 women with reflux dyspareunia: 6 cases were “severe,” 22 cases were “moderate,” and 49 cases were “mild” – all based on subjective assessment.

5/100 women (5%) in the control group (without reflux) reported heartburn during sexual intercourse.

Follow-up (~3 months later)

61/77 women (79.22%) with reflux dyspareunia were improved within 3 months – such that they either had “no symptoms” (full remission) or “mild symptoms” (significant improvement).

16/77 women (20.78%) with reflux dyspareunia were NOT improved within 3 months – such that symptoms remained the same as baseline.

It was noted that most of the 16 women who were unimproved after 3 months – had mild reflux dyspareunia with otherwise well-controlled heartburn.

(3 of the 16 were completely unresponsive to treatments and required antireflux surgery which generated good results.)

Conclusion: Reinforcing a standard plan for the management of heartburn can facilitate a substantial degree of improvement in patients with reflux – both generally and in specific relation to intercourse.

Critical thinking…

• Unknown adherence to management plan: It’s unclear as to whether all of the women in this study adhered properly to the recommended management plan. It’s also unclear as to whether women may have adhered more significantly to specific recommendations within the management plan relative to others.
• Variety of recommendations: Because a variety of recommendations were given to manage reflux – it’s impossible to parse out effects of specific recommendations. Perhaps weight loss, alginates, and not eating late at night generated most of the benefit and the other recommendations had no significant impact on reflux.
• Impact of sex-specific management variables: Kirk recommended 2 specific modifications to women with regard to sexual activity: (1) alginates before sex and (2) “female superior” position (instead of missionary).
• Subjective severity: Kirk did NOT utilize objective reflux measures throughout the study (e.g. 24-hour pH monitoring). Results are based primarily upon subjective reported improvement in reflux symptoms during sex. This is problematic in that participants may have simply told the researcher what they thought he’d want to hear or expect to hear (e.g. improvement) or may have had a slight change in perception such that objective reflux remained same but perceived severity was reduced.
• Effect of time: It’s possible that a subset of women with “heartburn” at baseline may have recovered due to the effect of time – such that heartburn resolved due to spontaneous physiological change over an extended period of time.
• Reflux disease unknown: All we know is that the women had “heartburn” at baseline. It was not reported as to whether any of these women had gastroesophageal reflux disease (GERD), laryngopharyngeal reflux disease (LPRD), etc. Simply having “heartburn” doesn’t mean as much.
• Women only: Kirk acknowledged that men also experience reflux dyspareunia. However, because this study involved only women – it remains unclear as to whether similar recommendations would improve the condition in men.
• Zero randomization/blinding: This study was not randomized or blinded – meaning it may have generated more bias from both the participants and researcher (Kirk).

What are the main takeaways from research of sexual activity & acid reflux?

There are only 2 studies that sought to determine the effect of sexual activity on acid reflux, heartburn, or GERD – and there’s 1 study that analyzed sexual function/behavior in GERD patients before and after surgery OR medication.

• Bor et al. (2014): Sexual activity does NOT increase acid reflux events.
• Iovino et al. (2007): Untreated GERD is associated with sexual dysfunction and disordered sexual behavior. Surgery for GERD is associated with improvement in sexual function/behavior in GERD patients – but medication (PPI therapy) is not.
• Kirk (1986): A significant percentage of women with gastroesophageal reflux suffer from sexual dyspareunia – or acid reflux during sex. A combination of lifestyle/diet modifications, antireflux therapies, and preparation for sex (with alginates and reflux-friendly positions) appears helpful in reducing symptoms.

Due to the lack of specific and high-quality data analyzing the effect of sexual activity on reflux frequency/severity – it’s unclear as to whether engaging in sex tends to worsen reflux.

Bor et al. conducted a relatively well-designed study with objective measures in place (pH monitoring) but it was limited by the fact that there were only 15 participants and all were instructed to follow specific schedules (e.g. meals throughout the day, sex only 2 hours after dinner, only missionary position allowed, etc.).

Iovino et al. conducted a larger study with 111 GERD patients and 32 controls – but wasn’t studying whether sexual activity exacerbated GERD symptoms. Instead, Iovino et al. evaluated the association between GERD and aspects of sexual behavior, performance, and satisfaction. This study had numerous limitations such as relying solely upon questionnaires for data collection.

Kirk was the first to formally analyze whether there’s a relationship between: (A) sexual activity and acid reflux and (B) reflux management with lifestyle/diet modifications, overall acid reflux, and reflux specifically during sex.  This study was limited in numerous ways including: zero objective reflux measurement and female-only sample.

In summary: 1 study suggests sexual activity doesn’t increase reflux; 1 study suggests that GERD is associated with disordered sexual behavior/function – and treating it with surgery helps reverse some of the sexual behavior/function disorder; and 1 study suggests sexual activity can cause reflux in women with gastroesophageal reflux.

Anecdotes of Heartburn & Acid Reflux from Sexual Activity

Included below are some anecdotes (with one question) regarding heartburn/acid reflux from sexual activity.

• Anecdote #1: My guy is pretty well endowed and we both enjoy intense deep sex. I’ve noticed that after long sessions (piv, anal, oral) – I get really bad heartburn/acid reflux. It doesn’t matter if I had eaten before. Sometimes it’s barely noticeable, other times it’s hell on Earth like last night. I suspect the whole deep penetration along with maybe the BJ choking thing has something to do with it and I intend to bring it up with my gyno next time I see him.
• Anecdote #2: Giving oral sex aggravates my reflux when he’s lying down and I’m on all fours.
• Anecdote #3: I’m 24 weeks pregnant and have been getting heartburn during sex for about 4 weeks. We do mostly missionary so that’s probably part of it.
• Anecdote #4: Another pregnant woman with severe acid reflux that’s aggravated by sex. She claims that only one sex position (left side with left leg straight between her partner’s legs) is the only position that doesn’t trigger additional reflux.
• Question: 36 y/o female here, happily married, throwaway account. I didn’t have the nerve to ask my doc and Google searches aren’t bringing anything up. Can oral sex aggravate GERD/LPR? Does size matter in this instance? I don’t know where to start with this, sorry for a NSFW topic but I’m out of options right now.

Question to Medical Doctor (Practo)

Patient: I have a problem where I’m experiencing acid reflux after sex accompanied by a headache. Why is this?

Dr. Sandeep Gupta (Dermatologist): “Heavy meals before any kind of physical exertion can cause acidity. It may be related to heart too (rarely).”

This doctor implied that people who experience reflux during sex  may have eaten a heavy meal in close proximity to sex – such as would trigger reflux.

Specific variables to consider (Sex & Reflux)

A number of specific variables may predict who experiences worse reflux during/after sexual activity – relative to those who experience no change in reflux.

Reflux specifics

• Specific reflux condition or location: The specific reflux condition(s) with which a person is diagnosed – or location of the reflux – may influence: (A) susceptibility to reflux during sex and/or (B) the specific symptoms of reflux from sex.
• Reflux severity: The severity of one’s reflux condition may determine whether the person experiences reflux during/after sexual activity.
• Management of reflux: Is the reflux being properly managed via diet, lifestyle, antacids, and/or acid-reducing medication (e.g. PPIs and/or H2 blockers)? Or is the reflux condition effectively untreated?

Sexual activity specifics

• Positions: Which positions are being utilized during sex by the person with reflux? Any positions that increase intra-abdominal pressure and/or work opposite gravity – could promote reflux.
• Intensity: The intensity of sex could determine how likely a person is to experience reflux during/after sex. More intense sex should theoretically be associated with worse reflux than less intense/mild sex.
• Physical movements: Both the (A) cumulative and (B) specific – physical movements/motions performed during sexual activity may influence the likelihood of reflux during sex.
• Duration: The total duration over which you have sex may influence reflux likelihood.
• Intra-abdominal pressure: The amount of intra-abdominal pressure occurring as a result of: (A) pressure from partner’s bodyweight; (B) certain body positions; (C) intense physical movements; and/or (D) specific motions – will influence odds of reflux during sex.
• Time of day: It is thought that reflux during sex is significantly more likely to occur at night relative to daytime. Why? Digestion becomes less efficient at night and many people tend to eat large dinners. Some individuals have sex shortly after dinner – and this may be reason reflux is occurring.

Food/beverage intake

• Proximity of food/drink intake to sex: The latency (time) between food/drink intake relative to sex may determine whether you’re likely to experience reflux during sex. Longer gaps between food intake and sex should yield less reflux.
• Stomach fullness (food/drink amounts): The degree to which one’s stomach is full prior to sex (from food and/or fluids) could determine likelihood of reflux during sex.
• Calories before sex: The total number of calories you’ve eaten prior to sex may also matter to some extent. Why? Because the more meals you’ve consumed, the greater the amount of digested and undigested material will be in your body. This is why having sex earlier in the day could be better with regard to reflux.

Substance use

Some individuals may take various medications, dietary supplements, and/or drugs/alcohol with the intent of enhancing aspects of sexual performance and/or arousal (e.g. sildenafil a.k.a. Viagra).

It’s possible that certain substances used to enhance aspects of sexual performance or arousal might cause and/or aggravate preexisting reflux – such that the reflux becomes noticeably pronounced before, during, or after sex.

• Alcohol
• Amphetamine
• Caffeine
• MDMA
• Nicotine
• Sildenafil

Ways in which substances (medications and/or dietary supplements) could induce reflux around the time of sex include: (1) increasing stomach acidity; (2) altering esophageal sphincter function/pressure; (3) modulating esophageal motility; and/or (4) altering rate of gastric emptying.

For example, sildenafil (Viagra) – a phosphodiesterase-5 inhibitor – significantly alters esophageal motility by: (A) modifying propagation and amplitude of esophageal contractions and (B) reducing lower esophageal sphincter (LES) pressure – all of which could cause/exacerbate reflux around the time of sex. (R)

Individual body shape & health

• Medical conditions: Individuals with certain medical conditions like gastrointestinal disorders; neurological disorders; psychiatric disorders; etc. – may be more prone to reflux during sex as a result of the conditions themselves or associated treatments.
• Body shape: The anatomical/morphological presentation of a person’s body may influence susceptibility to reflux during sex.

How to prevent or minimize acid reflux during sex… (My hypotheses)

Included below are some strategies that I think may help prevent and/or minimize acid reflux during sex – based on a combination of logic (things that usually help reflux) and research.

Keep in mind that the efficacies of these strategies will be subject to individual variation – not everyone with reflux will find them effective.

1. Treat the acid reflux properly

If acid reflux is severe, it is recommended to consult a medical doctor for proper treatment.

Various treatments for acid reflux include: proton-pump inhibitors (PPIs); H2 blockers; alginate suspension; magaldrate; antacids; and lifestyle/dietary modifications.

Proper treatment may prevent and/or reduce acid reflux episodes overall – as well as during sex.

2. Head-of-bed elevation

Individuals with reflux during sex may benefit from head-of-bed elevation (~6+ inches = what has been shown effective for nocturnal reflux in studies).

Head-of-bed elevation can be achieved via purchasing “bed risers” – or blocks that are placed under the 2 posts at the head of the bed – such that the bed appears angled or sloped.

Another way to achieve head-of-bed elevation is to purchase an adjustable bed frame and adjust until the head of the bed is elevated well above the foot of the bed.

Head-of-bed elevation ensures that one’s upper body is positioned above one’s lower body (assuming lying normally in bed) – such that gravity is harnessed to prevent or minimize backflow of stomach acid up the esophagus.

3. Evaluate sex positions

Certain body positions have significantly higher likelihood of causing acid reflux during sex – and others may be less likely to cause acid reflux during sex.

Below are sex positions that I’d hypothesize to be worst and best for reflux sufferers – based on preexisting research of sleep positions and reflux.

Worst body positions for reflux

• Lying on right side: It is well-documented that sleeping on your right side is terrible for reflux – and so is just lying down on your right side, even if it’s during sex.
• Lying on stomach: Those in a prone position during sex are at much higher risk of reflux. Why? Lying on the stomach increases intra-abdominal pressure – and this pressure can essentially force the lower esophageal sphincter open, enabling stomach contents to backflow up the esophagus.
• Bent over, hand stands, hanging upside down, etc.: Anyone bending their upper body (torso) over their lower body (waist) or doing a hand stand, hanging upside down, etc. – is at significantly higher risk of reflux during sex simply due to the effect of gravity (pulling stomach contents from the stomach through the esophagus).
• Torso-to-torso: Body-to-body pressure (particularly if abdominals are touching, pressing against each other) can increase reflux by way of intra-abdominal pressure.
• High abdominal pressure: Any position that increases pressure in the abdominal region (causing tension or flexing) is more likely to provoke reflux during sex.

Better body positions for reflux sufferers

• Lying on left side: Lying on the left side is a well-known strategy for reducing the likelihood/severity of reflux during sleep – chances are it’ll also help during sex.
• Lying on back: Lying on one’s back is a decent position for reflux sufferers in some cases – particularly if the head of the bed is elevated. A study found that 5 women in the missionary position did not experience a significant increase in GERD symptoms.
• Standing upright: This is probably the best body position for acid reflux sufferers. The more upright the body – the stronger the effect gravity will have in keeping stomach contents from oozing up the esophagus.

Males with reflux: Sex while fully or mostly upright is ideal. Lying on one’s back with head-of-bed elevation (~6 inches) with female positioned atop (e.g. cowgirl) may also be useful.

Females with reflux: Sex while positioned atop the male (e.g. cowgirl) or while lying on one’s back with head-of-bed elevation (~6 inches) in missionary position may be useful. Avoid gagging or choking during oral sex.

Both partners with reflux: Avoid positions that involve torso-to-torso compression such that midsections should not be touching. Sex while both individuals are on their left side may be an effective strategy. Fully standing sex – or sex in some sort of chair/swing may also prove useful.

4. Avoid food & beverages ~1-2 hours before sex

All food and beverages should be avoided at least 1-2 hours before sex. Why? Eating or drinking right before sex may induce excessive fullness or bloat in the stomach – and significant food will be undigested in the upper GI tract during sex.

This combination of fullness/bloat and a lot of undigested food in the upper GI tract – puts pressure on the lower esophageal sphincter, which will increase the likelihood of reflux, frequency of reflux, and/or severity of reflux episodes – during sexual activity.

For reference: It takes about 6-8 hours for food to pass through your stomach and small intestine. Food enters the large intestine for further digestion, absorption of water, and finally, elimination of undigested food. It takes ~36 hours for food to move through the entire colon.

5. Reduce intensity of sexual activity

Intense physical movements, including intense sexual intercourse, can worsen reflux – particularly if you’re the person moving most intensely.

Even if you’re a recipient of your partner’s intense physical motions – shaking/jarring of your body to a significant degree could trigger or worsen reflux.

Keeping the intensity of physical movement during sex to a minimum may help some individuals reduce the frequency of reflux events during sex.

6. Avoid unnecessary substance use

As was mentioned, common substances like alcohol, caffeine, and nicotine can cause reflux – and so can various drugs for the treatment of erectile dysfunction or enhancement of sexual performance (e.g. sildenafil).

Even various dietary supplements taken specifically to enhance arousal or sexual performance might trigger acid reflux during the act.

Unless a specific drug/substance you’re using has a proven anti-reflux effect – it probably should be avoided if the goal is to decrease odds of reflux during sex.

7. Consider acid reducers (pre-sex)

If you’re someone who consistently experiences acid reflux during sex, it might be beneficial to administer a combination of an H2 blocker (e.g. Pepcid) and/or an antacid (e.g. TUMS) prior to sex.

Obviously it’s possible that an H2 blocker might impact sexual performance and/or arousal in some cases – but this is unlikely.

Even if reflux does occur during sex – at least the acid should be reduced such that it won’t burn as significantly.

8. Consider alginates (pre-sex)

In some cases, alginates may work well as an acid reflux prophylactic during sex.

Alginates function by forming a “raft” or “barrier” between the stomach and the esophagus – such as to prevent and protect the esophagus from stomach acid backflow.

Arguably the best alginate suspension formulation is Gaviscon Advance UK Aniseed (avoid the “mint” version – as this may relax the LES and enable reflux).

Is sex actually causing or worsening your reflux? (Critical thinking)

Some people may mistakenly assume that sex is causing and/or worsening acid reflux – when it’s nothing more than a coincidence or correlation.

In other words, acid reflux might’ve occurred regardless of whether you had sex or abstained from sexual activity.

• Ingesting acidic foods/drinks and/or large amounts of foods/drinks can cause reflux.
• Taking certain medications, drugs, or supplements (e.g. alcohol, nicotine, caffeine) may cause acid reflux.
• Severe unmanaged reflux can cause reflux at unpredictable times throughout the day. (If you aren’t treating your reflux properly

In other cases, it’s likely that: (A) consuming acidic foods/drinks; (B) consuming large quantities of food/drinks; (C) ingesting certain supplements/drugs; and/or (D) having preexisting unmanaged reflux events – synergistically causes/worsens reflux with sexual activity… particularly if proximal in time to the sexual activity (e.g. less than 1 hour before).

For example: Eating a large meal, drinking alcohol, and/or taking a drug to enhance sexual performance about 30 minutes before sexual activity – may increase: (1) susceptibility to reflux; (2) severity of reflux; and/or (3) frequency of reflux – during sex.

A large meal puts pressure on the lower esophageal sphincter, alcohol causes lower esophageal sphincter relaxation, certain drugs to enhance sexual performance may alter esophageal sphincter function and/or increase stomach acidity – and when combined with certain sexual positions and physical movements, reflux may occur.

Scenarios: reflux & sex…

1. Reflux always occurs during sex: Some individuals may experience reflux during sex no matter what. This would be relatively rare though. This is relatively uncommon.
2. Reflux only occurs under certain conditions: Such as eating a large meal before sex, drinking alcohol before sex, having sex in certain positions, etc.
3. Reflux never occurs during sex: Most people do not experience any reflux whatsoever during sex.

My final thoughts on sexual activity & GERD, acid reflux…

Most people with acid reflux conditions probably won’t experience any significant change in reflux during sex – provided they’re: (A) managing the reflux properly (diet, lifestyle, medication) and (B) not engaging in ultra-intense or refluxogenic sex positions (high abdominal pressure and/or working against gravity).

That said, the effect of sexual activity on acid reflux will likely be subject to significant individual variation based on reflux severity, type, and whether the reflux condition is being properly managed/treated.

One person might experience a significant worsening of reflux during sex and another might experience zero change in reflux during sex.  Others might even report subjective improvement in the severity of reflux resulting from regular sexual activity.

Most people with sex-induced reflux (i.e. reflux dyspareunia) should, over time, be able to identify/pinpoint specific things (e.g. eating/drinking right before sex, using caffeine before sex, certain sex positions, sexual intensity, etc.) that trigger the sex-induced reflux.

Once the triggers are identified, lifestyle and/or sexual activity modifications can be made to resolve or attenuate the reflux dyspareunia.

Have you noticed a worsening of GERD or reflux from sex?

If you’ve experienced acid reflux before, during, or after sex – feel free to leave a comment about the experience.

• Have you been formally diagnosed with a reflux condition (e.g. GERD, LPR, etc.)? (If so, do you treat it properly with medication, diet, and/or lifestyle modifications?)
• Do you have any medical conditions and/or anatomical abnormalities that might increase susceptibility to reflux during sex?
• Do you consistently experience reflux after sex? (Or just every once in a while?)
• Do you use any substances (drugs, medications, supplements) before having sex that could cause or increase susceptibility to reflux (e.g. alcohol, caffeine, sildenafil)?
• Have you noticed any correlation between certain sex positions and reflux during sex? (If so, which specific positions?)
• Do you notice any correlation between ingesting specific foods/drinks (especially if acidic) and/or consuming large meals/drinks proximal to having sex – and reflux?
• Have you tried altering sex positions and/or using acid-reducing agents before sex (e.g. H2 blockers or antacids) before sex to determine whether the reflux improves?
• Have you tried using an alginate suspension prior to sex to determine whether this helps reduce sex-induced reflux?
• If any specific intervention(s) significantly reduced the severity of or completely resolved your sex-induced reflux – what were they?