The condition might be somewhat facetiously charted as “RSI – Repetitive Sex Injury”; however, writing seriously in the journal Medical Hypotheses, researcher John Zenian, says: "Sexual intercourse can explain the increase in the overall incidence of carpal tunnel syndrome seen in recent years, since it is the most widely practiced activity that uses both hands at the same time" [Zenian 2010]. Carpal tunnel syndrome (CTS) is a prevalent form of repetitive strain injury in the United States, affecting anywhere from 1 of 20 persons in the general population to half of all persons in select high-risk groups [data here]. Sexual activity is generally not considered in the workup for a differential diagnosis of CTS; nor as a major contributor to “overuse injury” or cumulative trauma disorder.
Zenian proposes that carpal tunnel syndrome (CTS) can develop during sexual intercourse in the missionary position when the hands of the top person are repeatedly extended while under pressure from the weight of the upper body. Of the well-known risk factors associated with non-occupational carpal tunnel syndrome, age, marital status, and use of hormonal agents may also relate to the frequency of sexual intercourse. Along with those factors, obesity, macromastia (excessive breast size), and large chest circumference incur increased pressure on the wrists due to a heavier upper body. According to Zenian, the bilaterality of CTS in afflicted persons can be explained by the fact that both hands are needed to support the upper body during sexual intercourse. The overall decrease in the frequency of sexual intercourse and a declining incidence of CTS between the 6th and 7th decades of life suggests a possible cause and effect relationship between sexual intercourse and CTS, he notes. However, the popularity of erectile dysfunction medications (eg, sildenafil, tadalafil, others) appears to be eliminating age differences in recent years.
If sexual activity seems a plausible explanation for chronic wrist pain in patients young or old, short of abstinence, what can be recommended?
- Patients can be instructed to limber up their wrists before sex by doing some gentle exercises.
- They should try different positions that are less straining on the wrists.
- Avoid prolonged sexual activity in the same positions, especially those that put pressure on wrists.
- Fitness outside the bedroom counts, too, including exercise and weight control.