Well, Mind Hacks points us to a case report of a woman who died while having an extramarital affair with her lover:
The presented case is unique in that the deceased was a femaleA review of the literature in the discussion section of the article sheds more light on the subject:
affected by chronic hypertensive cardiovascular disease, engaged in a long standing extramarital romantic relationship.
A 46-year old woman, married and mother of two, has been meeting with her 52-years old married lover twice a month for several years. These sexual encounters were conducted in the male partner’s class B car, typically lasting less than an hour. The last tryst took place on a hot summer afternoon, in a car exposed to direct sunlight. Reportedly, the male companion urged her to rush their activities as he was supposed to pick up his wife later on. During foreplay, the woman became dyspneic, and was unable to drink the water offered by her companion. He rushed her to a nearby medical center and immediately drove off. She was pronounced dead on arrival. Rectal temperature was not measured. The lover was later apprehended by local police and released after questioning.
Autopsy revealed an obese female (BMI = 32), with enlarged heart of 560 g, with thickening of the anterior left ventricular wall and interventricular septum, atherosclerotic narrowing of three major coronary vessels of up to 60–70% of the lumen, and severe pulmonary edema and congestion. Microscopic examination of the heart did not disclose acute myocardial infarction, but rather myocardial hypertrophy along with interstitial fibrosis. Severe fatty change of the liver and hepatomegaly (2360 g) were noted. Other organs, along with her brain, showed acute congestion. Toxicological screening revealed no alcohol, drugs or any other chemical substance in her body.
In a study conducted in Korea on causes of sudden death related to sexual activity, out of the 14 reported fatalities, only five women were described, aged 43–50 years, three of which died from subarachnoid hemorrhage (SAH), while two suffered from complications of CAD, which falls within the gender differences in cause of death in the general population (CAD in men vs. SAH in women). Sudden death following sexual activity is mainly caused by re-infarction or acute myocardial infarction (AMI) in males, while in females most commonly by intracranial hemorrhage or cardiovascular disease.But the authors of the current case report wonder if the size of the car might have contributed to this outcome of this case:
These findings are supported by Parzeller et al., who report that the main cause of death following sexual activity in Germany was re-infarction or AMI (55%), followed by coronary artery disease (29%) or, less commonly, left ventricular hypertrophy (9%). Two instances of intracerebral hemorrhage and one myocarditis were listed in this study, all three of which in women between the ages of 43 and 49 years.
Although it was impossible to obtain sufficient information as to the deceased position in the car during their foreplay, the authors estimate that the relatively small size of the car required some physical effort for achieving any desirable position to reach sexual gratification.So ladies, although it happens rarely, consider yourself warned.
Oh, and if you think you still might be tempted to proceed despite these facts and are in the market for a new car, consider buying big for your own safety.
 Lee S, Chae J, Cho Y. Causes of sudden death related to sexual activity: results of a medicolegal postmortem study from 2001 to 2005. J Korean Med Sci 2006;21:995–9.
 Parzeller M, Raschka C, Bratzke C. Sudden cardiovascular death in correlation with sexual activity — results of a medicolegal postmortem study from 1972–1998. Eur Heart J 2001;22:610–1.
 Gips H, Zaitsev K, Hiss J. "Sudden cardiac death of a woman during extramarital sex: A case report and review of the literature." Journal of Forensic and Legal Medicine 2010; 17: 186–187.