Hemoptysis During Orgasm

To the Editor.— Regarding the discusion in QUESTIONS AND ANSWERS (239:351, 1978) concerning a patient with hemoptysis during orgasm, we would like to share the following case. Report of a Case.— A 34-year-old woman was referred for evaluation of hemoptysis occurring only when she achieved orgasm during her menstrual period. Physical examination, chest x-ray film, coagulation values, and cardiac echo were normal. Bronchoscopy during her menses was entirely normal below the cords, but upper airway examination showed a greatly engorged nasal mucosa that bled easily when touched. This engorgement was not present between menses. Comment.— Since this phenomenon occurred only while supine, our supposition is that this patient aspirated blood from the erectile tissue along the inferior turbinates, tissue known to become engorged during menstruation and orgasm. A second cause of hemoptysis during menses considered in this patient was extrapelvic endometriosis. An area of ectopic endometrium would be vascular and