Autoerotic deaths: report of two unusual cases.

Autoerotic death is a rare but recurring phenomenon in forensic medicine. This article presents two cases of unusual autoerotic death with signs of autoerotic asphyxia. Although the first case appeared to be asphyxia, the autopsy confirmed natural cause of death during solitary sexual activity of 69-year-old man found with exposed and bandaged genitals. The other case was asphyxiation utilizing a plastic bag and multiple panties wrapped around the head of 18-year-old man disguised in women´s dress.

Current reports on autoerotic deaths--five persistent myths.

Autoerotic deaths are defined as accidental deaths that occur during individual, solitary sexual activity in which some type of apparatus that was used to enhance the sexual stimulation of the deceased caused unintentional death. In the Western countries, the incidence of these deaths is of approximately 0.5 deaths per million inhabitants per year. In this paper, five myths about autoerotic death are explored. Myth #1: the manner of death in autoerotic death is usually accidental but could also be suicidal or natural (reality: by definition, all autoerotic deaths are accidental). Myth #2: autoerotic death can happen with a sexual partner (reality: by definition, autoerotic deaths are solitary activities). Myth #3: an escape mechanism must be found at the scene (reality: there is no escape mechanism to be observed at the scene in the majority of autoerotic deaths). Myth #4: all autoerotic deaths are related to asphyxia (reality: not all autoerotic deaths are related to asphyxia). Myth #5: masturbation is an important component of all autoerotic activities and therefore all autoerotic deaths (reality: evidence of masturbation at the scene is a rare finding).

Autoerotic deaths: a 25-year retrospective epidemiological study.

It is written in almost all articles on autoerotic deaths that these fatalities account for about 500 to 1000 deaths per year in the United States and Canada. However, contrary to the general belief, this incidence rate was not obtained through a study, but it is an estimation based on 30-year unpublished data from Canada and England. In the present retrospective study from 1985 to 2009, 38 cases of autoerotic deaths were identified in the province of Alberta (Canada). This number corresponds to an incidence of 0.56 autoerotic deaths per million inhabitants per year. The vast majority of these deaths are related to typical, predominantly asphyxial methods, such as hanging. The bodies were most commonly found in basements, bedrooms, and bathrooms. There is no clear evidence of a preferential time of day for these deaths, but there appear to be slightly more autoerotic deaths during summer. The incidence of autoerotic deaths is higher in big cities compared with rural areas. The previously published estimate of 500 to 1000 'autoerotic deaths per year should not be used for Canada. An incidence of 0.2 to 0.5 cases per million inhabitants per year is a better estimate of the incidence of autoerotic deaths. The incidence in United States should be reassessed using epidemiological studies.

Autoerotic death: incidence and age of victims--a population-based study.

Review of the Australian National Coronial Information System and the Swedish National Forensic Database was undertaken over a 7-year period from 2001 to 2007 for all cases where death had been attributed to autoerotic death or sexual asphyxia. In Australia, there were 44 cases (M:F = 42:2) with the majority of victims aged >30 years (77%)-a yearly national rate of approximately 0.3/million. In Sweden, there were nine cases (M:F = 9:0) with the majority of cases aged <30 years (55%)-a yearly national rate of approximately 0.14/million. The usual male predominance was present in both populations, although the Australian victims were older than is usually reported. Lethal sexual asphyxia is uncommon in both the Australian and Swedish populations, with a lower rate than has been cited for North America. Whether this is because of different kinds of paraphilic activities in different populations or of differences in methods of central data collection is uncertain.

[Lethal sex].

Asphyxiophilic sex is a form of autoerotic activity, in which the user creates mechanical means (such as hanging or bondage) in order to achieve cerebral hypoxia, which, in turn, enhances sexual, as well as orgasmic, stimulus. Failure of safety mechanisms, created by the user, may lead to instant death as a result of asphyxiation or strangulation. This kind of sexual practice is more prevalent among men than in women. In cases of death, it is difficult to relate it to the sexual practice itself. Suicide and homicide are the main differential diagnoses. Closely related derivatives of asphyxiophilic sex are anesthesiophilia (inhalation of variable volatile substances) and electrophilia (use of electric current during sexual activity)--both also intended to enhance the sexual stimulation. These forms of sexual practice are less prevalent than asphyxiophilia.

Autoerotic deaths in the literature from 1954 to 2004: a review.

Autoerotic death by hanging or ligature is a method of autoeroticism well known by forensic pathologists. In order to analyze autoerotic deaths of nonclassic hanging or ligature type, this paper reviews all published cases of autoerotic deaths from 1954 to 2004, with the exclusion of homicide cases or cases in which the autoerotic activity was not solitary. These articles were obtained through a systematic Medline database search. A total of 408 cases of such deaths has been reported in 57 articles. For each case, the following characteristics are presented here: sex, age, race, method of autoerotic activity, cause of death, and location where the body was found. Autoerotic death practioners were predominantly Caucasian males. Victims were aged from 9 to 77 years and were mainly found in various indoor locations. Most cases were asphyxia by hanging, ligature, plastic bags, chemical substances, or a mixture of these. Still, atypical methods of autoerotic activity leading to death accounted for about 10.3% of cases in the literature and are classified here into five broad categories: electrocution (3.7%), overdressing/body wrapping (1.5%), foreign body insertion (1.2%), atypical asphyxia method (2.9%), and miscellaneous (1.0%). All these atypical methods are further discussed individually.

Forensic aspects of 40 accidental autoerotic deaths in Northern Germany.

Between 1983 and 2003, 40 accidental autoerotic fatalities have been investigated. in the Institute of Legal Medicine in Hamburg. Only 50% (n=20) were autopsied (13 legal autopsies, 6 for scientific purposes and 1 for an insurance company). All the victims were males, aged between 13 and 79 years (among them five children and adolescents, the deceased mainly between 20 and 40 years). The paraphiliacs utilized a great range of devices and props as fetishism, sexual aids or pain-stimulating agents, like intimate feminine garments, ropes, chains, bondages, locks, pornographic magazines, condoms, rubber items, and chemical anaesthetics. The cause of death was strangulation in 20 cases (17 x hanging, 3 x ligature strangulation), 11 x suffocation (8 x under plastic bags, 3 x with face-masks, 2 x thoracic compression, 1 x positional asphyxia, and 1 x cocaine intoxication). Five cases without autopsy remained unclear because of missing morphological and toxicological findings; it could not be differentiated between asphyxiation/intoxication/natural disease, although the scene characteristics seemed to be typical for autoerotic deaths. It is emphasized that the findings at the scene, the morphological and toxicological examination of the dead body (full autopsy as prerequisite) by experienced investigators and the personal history of the deceased have to be evaluated very carefully and intensely to reconstruct the accidental fatal autoerotic course accurately and undoubtedly (to exclude the possibility of sexual homicide, neglected killing, or suicide).

Accidental autoerotic deaths between 1978 and 1997. Institute of Legal Medicine, Medical School Hannover.

Between 1978 and 1997 the Institute of Legal Medicine of the Hannover Medical School examined 17 fatal autoerotic deaths. The incidence for the Hannover region was 0.49 cases per million inhabitants per year. The victims included 17 men with an average age of 36.8 years; a peak in the age distribution was seen between 20 and 29 years. Twelve of the men were found by friends or family in a domestic environment, while other situations in which the victims were found included the victim's own car, a hotel room, a canal embankment, a public parking lot as well as the holding cell of the youth detention center. The men were of varying socioeconomic status and held a number of different types of jobs or still attended school. Five of the men were found completely nude, while five were only undressed below the waist. Four men wore women's clothes and two were fully clothed with exposed genitals. Besides women's clothes, other objects found at the scene included various types of sexual aids, including ropes, chains, metal bars, locks, sex magazines, condoms, plastic bags, rubber items, etc. In four cases blood alcohol levels between 0.1 and 2.5 per thousand (urine alcohol levels between 0.2 and 2.5 per thousand ) were found. Toxicologic examination revealed chloroform, ketamine, a propane-butane gas mixture in one case each, and in two cases cocaine and morphine. Causes of death included central paralysis after strangulation (seven cases), asphyxiation (4), subarachnoid hemorrhage (2), intoxication (1), hypothermia (1), left heart failure (1), and drowning (1). The history, findings at scene, and autopsy findings and, in individual cases, other investigations are of utmost importance to accurately reconstruct a fatal autoerotic accident.

The lethal paraphiliac syndrome: accidental autoerotic deaths in four women and a review of the literature.

Four previously unpublished cases of female asphyxiophilia are presented. All women were found immobilised by obviously self-tied ropes, string or handcuffs. The women, who were alone at the time of death, died of a lethal paraphilia. The autopsies revealed asphyxiation as the cause of death, caused in two cases by suffocation as a result of hanging and strangulation and in the other two cases by plastic bags placed over the individuals head. In one case there was additional evidence at the scene that the deceased had inhaled ether. In none of the four cases was there any indication that the asphyxiation was due to homicide or suicide. Thus they can be described as accidental autoerotic deaths (AAD). The four cases closely mirror findings from scenes of male AADs, although autoerotic practices are generally believed to be rarer among females than in males.

The lethal paraphiliac syndrome. Accidental autoerotic deaths in Denmark 1933-1990.

A new definition of accidental autoerotic death (AAD) is proposed. A death is an AAD if it is solitary, accidental, and caused by a lethal paraphilia. On the basis of a series of 46 AADs, all occurring among men in the period 1933-1990 in Denmark, the definition cannot be rejected. A paraphilia is regarded as lethal if it is inherently life-threatening. The results of this study have been related to previous reports of similar autoerotic deaths in the literature. It is suggested that the present distinction between asphyxial AAD as typical and nonasphyxial ADD as atypical be replaced with lethal paraphilia with accompanying nonlethal paraphilia or props as typical AAD and lethal paraphilia with no accompanying nonlethal paraphilia or props as atypical AAD.

Age, transvestism, bondage, and concurrent paraphilic activities in 117 fatal cases of autoerotic asphyxia.

Autoerotic asphyxia is the practice of self-inducing cerebral anoxia, usually by hanging, strangulation, or suffocation, during masturbation. This study investigated the relationships between: asphyxiators' ages; two paraphilias commonly accompanying autoerotic asphyxia, bondage and transvestism; and various other types of simultaneous sexual behaviour. Subjects were two concurrent series totalling 117 males aged 10-56 who died accidentally during autoerotic asphyxial activities. Data concerning sexual paraphernalia at the scene of death or among the deceased's effects were extracted from coronors' files using standardised protocols. Anal self-stimulation with dildos, etc., and self-observation with mirrors or cameras were correlated with transvestism. Older asphyxiators were more likely to have been simultaneously engaged in bondage or transvestism, suggesting elaboration of the masturbatory ritual over time. The greatest degree of transvestism was associated with intermediate rather than high levels of bondage, suggesting that response competition from bondage may limit asphyxiators' involvement in a third paraphilia like transvestism.

Asphyxiophilia and autoerotic death.

Eight cases of autoerotic asphyxia deaths on Oahu are reviewed. Distinguishing features typically separate these deaths from intentional suicides or homicides. The sexual nature of these incidents is a salient feature of the death. The etiology of the practice is unknown but worth investigation.

Asphyxiophilia in Scandinavia.

Asphyxiophilia, the desire for a state of oxygen deficiency in order to enhance sexual excitement and orgasm, is a very precarious form of sexual gratification. Asphyxiophilia has been difficult to document since it is mostly practiced in secrecy and solitude and is usually not discovered until the practitioner has been found dead. Most of the information about asphyxiophilia is found in police reports and medicolegal investigations by doctors of forensic medicine. Our study is based on information from 18 doctors of forensic medicine in Denmark, Norway, and Sweden. Six sources indicate similar frequencies (0.5-1 cases per million inhabitants per year) of observed deaths in Scandinavia. Although the frequency of observed deaths is different from the true mortality rate, this study gives a good illustration of the estimated prevalence. This accuracy is enhanced by the length of the observation periods (10-40 years).

Autoerotic asphyxial deaths and social network response.

A study of 132 autoerotic asphyxial deaths revealed that family members and friends, in addition to experiencing shock over the sudden aspect of the death, frequently were the ones to discover the decedent's body and were confused by the sexual nature of the death. Clinicians are urged to be alert for signs of such potentially lethal sexual activity among the young people they see, and to be prepared to assist bereaved family members.

Diagnosis and chronic mental illness.

This paper describes the occurrence of chronicity in varying psychiatric illnesses. There is not an unequivocal definition of chronicity, but with the exception of the illnesses that will be described below and that lead directly or indirectly to death from CNS complications of the illness, chronicity will require a duration of a minimum of five years without a significant remission. Chronicity is further differentiated into four different kinds of chronicity: chronic--death, chronic--self-limited, chronic--remission, and chronic--recurrent. The illnesses that may be considered as possibly fulfilling the criteria for chronic will be noted and a method for deciding whether an illness qualifies will be outlined.