Moyamoya disease and Sex Although the title may capture the interest of many audiences, this is a serious and touchy problem for patients with moyamoya and their partners. The topics, which are important to women with moyamoya, such as marriage, pregnancy, and delivery, have already discussed in this web site. Data from the medical literature on such topics are provided in detail. However, the information on sex has not been discussed so far. This is not because such issue does not exist, but patients with moyamoya hesitate to talk such topics to the doctors, even to their partners. Therefore, the patient alone or with his/her partner is warring about their sex without consultation to the doctor. Is sex safe for patients with moyamoya? Can they enjoy it? Should they restrict it for fear of possible ischemic or hemorrhagic events? How can they cope with it? It is well known that children with moyamoya may develop ischemic symptoms when they play on the flute or blow the hot- noodle. This is because hyperventilation causes decrease of the carbon dioxide concentration of the blood, which further causes constriction of the cerebral arteries, resulting in brain ischemia. This phenomenon may occur during coitus. Especially, the patients with frequent ischemic episodes are at risk. It is a fact that many women with moyamoya have their babies without problem. I believe that many of them were pregnant when their moyamoya symptoms were stable without ischemic events. In another word, they enjoyed sex when their moyamoya was not so symptomatic. Also, if the women with moyamoya have frequent ischemic attacks, it is less likely that they may have baby for fear of cerebral infarction during pregnancy or postpartum period. Sex is not risky when patients are free of ischemic attacks. Thus, no restriction to the sexual behavior is needed. On the other hand, patients with frequent ischemic episodes are at risk for brain ischemia. If patients have not undergone the bypass surgery and have frequent ischemic attacks, it is a good chance to consider bypass surgery. After the surgery, they may enjoy sex without any fear of ischemic attacks. Anxiety or fear of brain ischemia during coitus is difficult to be understood by the healthy partners, but the partners should understand this. The healthy partners have to understand not only moyamoya disease, but sex-related potential risks, to which the patients with moyamoya are always worrying about.�@ The ideas on sex may be different in each individual or between men and women. We cannot say, "Do not make love when you are anxious enough." The partners may consider this issue with their loved ones on this occasion. 2005.5.21