Which of the following is NOT a common cause of spontaneous esophageal perforation?

Spontaneous esophageal perforation is a serious medical condition that can arise from different causes, with certain activities recognized as more likely triggers. Among the options listed, sexual activity is generally not considered a common cause of spontaneous esophageal perforation.

Heavy lifting, coughing, and childbirth can all lead to increased intra-abdominal pressure or trauma that may precipitate perforation of the esophagus. Heavy lifting, in particular, can cause strain, while severe coughing can lead to violent contractions that might result in a rupture. Childbirth, especially if complicated or resulting in significant straining, has also been reported as a potential risk for this condition.

In contrast, the link between sexual activity and esophageal perforation is much less established in medical literature. While it is theoretically possible that certain vigorous activities during sexual intercourse could lead to such an outcome, it is not recognized as a significant or common cause compared to the other options listed. Thus, it is accurately identified as the option that does not align with typical causes of spontaneous esophageal perforation.