Autoerotic Deaths

Paraphilia refers to a nonpsychotic mental disorder in which an unusual act or imagery is necessary for sexual gratification (224,225). An autoerotic fatality occurs when the act created by the deceased for the purpose of sexual gratification directly

Sexual Asphyxia
Fig. 42. Apparent sudden infant death syndrome. Jaws in rigor. Attempts to intubate led to lip lacerations (arrows).

causes death (225,226). Hazelwood et al. suggested five criteria for determining death during autoerotic practice: a physiological mechanism for obtaining or enhancing sexual arousal that is dependent on either a self-rescue mechanism or the victim's judgment to discontinue its effect; solo sexual activity; sexual fantasy aids; prior dangerous auto-erotic practice; and no apparent suicidal intent (227).

2.7.1. Autoerotic Asphyxia (Sexual Asphyxia, Hypoxyphilia, Asphyxiophilia) Autoerotic asphyxia is a paraphilia in which sexual arousal and orgasm depend on self-induced asphyxia up to, but not including, a loss of consciousness (141,228,229).

Hanging is the most common mechanism used (225,228-235). Neck compression leads to decreased cerebral blood flow. Consequently, cognitive inhibition is decreased, and the subjective sensations of lightheadedness and exhilaration associated with hypoxia and hypercapnia enhance the pleasurable effects of masturbation (229, 232-234,236-238). When the victim fails to extricate himself, then the full weight of his body tightens the ligature (234,237,239-241). As in the usual hanging, a rapid loss of consciousness leads to death (6,141,229). Vagal stimulation can also progress to sudden cardiac arrest (227,231,233,236,237).

Other means of autoerotic asphyxial deaths have been described:

• Suffocation by plastic bags/wrap/raincoat/pillow/sack (224,228-232,237,242-247).

• Head wrapped in duct tape and use of airway tube (240).

• Gag (sock) or objects (rubber balls, zucchini) in mouth (141,243,248-251).

Neck Ligature Furrow
Fig. 43. Autoerotic asphyxia. Ligature strangulation. Note padding on ankles. Pornographic literature was positioned on bathroom floor.

• Ligature strangulation (one case report describes woman's hair entangled in a slipknot, preventing release; see Fig. 43 and refs. 109, 224, 228, 230, 241, 247, 249, and 252-254).

• Ligature around thorax and abdomen (see Subheading 3.7. and refs. 229, 247, and 255).

• Wrapped in plastic (a tube may be used for breathing; see Fig. 44 and ref. 256).

• Suspension by power hydraulics (258).

• Inverted suspension (258).

• Wedged in garbage can (chest compression [228]).

• Motor vehicle (chest compression [259]).

• Partial or total submersion (229,260).

• Inhalation of aerosol propellants, chemicals, and gases for euphoric effects used in combination with either a mask, a plastic bag, an item of clothing (e.g., sock), or a soaked rag (224,229,230,234,236,238,257,261).

2.7.1.1. Epidemiology

An estimated 250 to 1000 autoerotic deaths per year occur in the United States (i.e., 1-2/106/yr; in Scandinavia, 0.5/106/yr [228,229,232,238,262]). The most common age group is 12 to 25 yr (228-230,232,233,238). Males predominate and female deaths are rare (estimated male-to-female ratio > 25 to 50:1 [227-229,231-233,235,238,239, 241,243,252,262-265]). Typically, there is a solitary victim (229,233,262). The majority are single (228-230,234,238). Most are heterosexual, and the majority are reported as well-adjusted (227-232,234,238,239,262).

2.7.1.2. Scene Findings and Circumstances Associated With Autoerotic Activity Initial investigation of an autoerotic hanging suggests suicide (224,231,232,

238,253). An apparent suicide note can be staged (253). Alternatively, the unusual

Autoeroti Bondage
Fig. 44. Autoerotic asphyxia. Wrapped in garbage bags. Right hand exposed (arrow).

nature of the scene may suggest a sadistic/ritualistic homicide. Suspicion of homicide also applies if the victim is female, and the scene findings are subtle (239,241,252). Further investigation of the scene, the circumstances of the death and background of the deceased, and the external examination of the victim assist in the determination that a rare type of accident has occurred (141,229,234,237,243,250,253,266). A psychological autopsy may be necessary (see Chapter 1, Heading 3. and refs. 227, 236, 253, 255, 265, and 266). Autoerotic or masochistic suicides are uncommon (225,227, 237,249,253,267). A homicide can be disguised as an autoerotic death (133,229,262). Some fantasy hangings are not done for a sexual purpose (e.g., pretending to be a cowboy [46]). Next of kin can alter the scene to remove evidence of autoerotic activity because of the stigma associated with such deaths (228,229,231,232,239,268-270). The scene can also be disrupted by resuscitation attempts.

The location is secure or secluded (e.g., locked room in home, basement or attic, workshop, workplace after hours, motor vehicle, jail cell, motel/hotel rooms, other residences, remote outdoor locations [141,224,227-229,231,232,234,238-240,243,263, 271-273]). There are no signs of a struggle or forced entry to suggest homicide. Windows may be covered (227,274).

The victim is in a position that allows self-extrication (229). Commonly, the victim's body is partly supported with the feet touching the ground. Sitting, kneeling, and lying down have been described (225-227,229,231,238,275). In a Danish study, about two-thirds of victims were incompletely suspended, 28% completely suspended, 4% inverted, and 4% had used ligature strangulation (228).

Pornographic material, which can be homosexual or sadomasochistic in nature, may be present and mirror(s) can be positioned to allow viewing of the act (141, 225,227,228,231-235,238,239,243,261,263,268,273). One report describes photographs of a woman glued to the victim's body (48). Mirrors are also used in suicide (227,236,239,263). Sexual items are less likely to be present if the victim is female (239,241,252,263). Items that assist in sexual activity can be found on, in, or near the body (273). Some are overtly sexual (e.g., condom, vibrator, fetish and bondage objects [227-232,238,241,243,263]). Others may not appear overtly sexual (e.g., wooden table leg, hairbrush, urinary catheter, vacuum cleaner [225,268,276, 277]). More elaborate arrangements have been observed when older men are involved, and the proportion exhibiting bondage, transvestism, or both increases (230,263).

Participants learn of autoerotic behavior by word of mouth, contact with individuals of similar sexual inclinations, sex manuals, medical books, pornographic literature, and detective magazines, information from the news media, movies showing hanging, consensual observation of others, and their own initiative (228,229,232,233, 235,239,254,261,266,275,278-280). Literature showing autoerotic methods or videotapes showing personal autoerotic episodes may be present (243). Siblings in the same family have been described (281).

Information about autoerotic activity can be elicited from a spouse or girlfriend, relatives, neighbors, physicians, prostitutes, and others (46,224,225,227,231,233,235, 238,241,243,253,273,276). There may be a history of other paraphilias (240). Interviews (e.g., no history of depression) and scene investigation (e.g., no suicide note) indicate that the victim did not want to die (225,226,229,233,241,262). Scene findings can support past autoerotic activities (e.g., suspension point abrasions on a joist from previous hangings; see (Fig. 45 and refs. 46, 227-229, 232-235, 239, 255, 260, 262, 266, and 274). The complexity of the methods and paraphernalia used suggest prior experience (227,229).

2.7.1.3. External Examination

Hanging is the most common method (Fig. 46). Soft material may be interposed between the ligature and skin, but protective padding is not always present (Fig. 46; refs. 141,228,229,231-233,235,238,239,241,252,258,262-264,275, and 282). A neck furrow or mark is still possible with padding (141).

Self-rescue mechanisms are used by the victim (e.g., a knife to cut a ligature [227,229,231,232,238,243,260]). Simply standing relieves neck pressure while hanging

Autoerotica Asphixiation Hanging Deaths
Fig. 45. Autoerotic asphyxia by hanging. Indentation on joist consistent with past suspension.

(Fig. 46; refs. 232 and 238). The arrangement or configuration of the bindings on the neck and other body sites allows voluntary compression (233,281). These bindings are usually loose (Fig. 46; refs. 224, 263, and 281).

Evidence of other paraphilias has been observed (229). There may be bondage, i.e., the use of physically restraining materials or devices that have sexual significance for the user (e.g., plastic, rubber, or leather attire [225,227,228,230,233-235,238,249, 253,258,267,282]). A man may be tightly wrapped in women's apparel or other items (Fig. 46; refs. 232 and 240). The extremities and genitals may be bound (Figs. 46 and

Autoerotic Hanging
Fig. 46. Autoerotic asphyxia by hanging. (A) Man dressed in women's clothing found hanging in stairwell. Note scarf interposed between ligature and neck. (B) Shoes almost touching stair. Loose binding around wrists. Ankles bound. (C) Dress folds sewn together.

47; refs. 141, 231, 232, 235, 238, and 266). Hyperthermia could occur in a tightly bound individual (283). Bondage has also been described in women (224,241,263,265). Bindings create marks on different parts of the body (Fig. 48; refs. 252 and 281).

Devices and sexual paraphernalia can be found on or in the body. This has been described in women (224). Foreign objects may be present in the rectum, vagina, or urethra. Associated trauma is possible (e.g., peritonitis, hemorrhage; see Chapter 7, Subheading 2.4. and refs. 239, 263, 265, 266, and 282-284).

Evidence of recent and healed self-inflicted injury from sexual arousal is noted in some cases. Trauma (e.g., piercings, burns) on the genitals, nipples, and other body sites have been found (225,227,228,234,238,239,253,258,263,264,282). Pubic hair may be shaved (230). Sexual masochism is rare in women (239,241).

Evidence of sexual activity may be seen. The victim's hand may be near the genital area (225,234,241,273,275). The purpose of the autoerotic act is not necessarily masturbation; i.e., the hands are not always used to stimulate the genitals (229,258). Genitalia can be exposed (141,226,227,238,239,262,271). A zipper can be open (268). The presence of semen near the penis and priapism do not necessarily indicate masturbation but may be a postmortem event (see Chapter 2, Subheading 2.1, Fig. 2; refs. 28, 78, 90, 225, and 234). The penis may be in a condom or other material (e.g., plastic bag containing tissue paper) that may contain seminal fluid (Fig. 47; refs. 227, 238, and 274). Seminal fluid may be found on clothes or on the thighs (240,243,275).

Frequently, a male dresses in women's clothing (Fig. 46; refs. 225-227,229, 231-234,239,243,258,261,274,276,285). The clothing may belong to the deceased's wife,

Forensic Medicine Anal
Fig. 47. Autoerotic asphyxia by hanging (two cases). (A) Sock wrapped around penis. (B) Condom. Ties around penis and scrotum. (Courtesy of Dr. E. Tweedie, London Health Sciences Centre, London, Ontario, Canada.)

daughter, or girlfriend (229,238). Cisvestism (i.e., obtaining sexual satisfaction from dressing in clothes typical of one's own sex, e.g., a cowboy outfit, biker's "leathers") may be practiced (227,232). Cross-dressing men are more likely to show evidence of anal self-stimulation with various devices, mirror-gazing, and self-photography (230). Women rarely wear unusual attire (239,241,263). Victims can be partly or completely naked (227,229,231,234,241,243,258,268,273,281).

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Responses

  • Katherine
    What evidence may there be when auto erotic death?
    4 years ago
  • Tiana
    Why tape tight when intubating babyfish lips?
    3 years ago
  • NILE
    What is sexual asphyxia?
    1 year ago
  • Leighton Black
    How to practice erotic asphyxiation?
    3 months ago

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