Auto-erotic Asphyxia

Introduction

Autoerotic fatalities occur as a result of dangerous self-stimulatory sexual practices. Death has been reported to accompany the use of electric current [1-3], power hydraulics [4], automobiles [5], vacuum cleaners [6], and asphyxiation for sexual stimulation [7-16]. Autoerotic asphyxiation typically involves the production of cerebral hypoxia in an effort to enhance sexual arousal. The methods utilized for the induction of hypoxia include: neck constriction [7]; plastic bags and women’s clothing wrapped about the head and face [8,9]; inhalation of anesthetics, propellants and propane [10-12]; chest compression [13]; total body constriction by wrapping one in a series of rugs and blankets [14]; submersion in water [15]; and abdominal ligature [16].

Reports of autoerotic fatalities began to appear in the medical literature around 1856, when they were thought to be suicides [17]. However, they had been well described in classical literature for many years [18,19]. The Marquis de Sade described in great detail the act of sexual asphyxiation in the book "Justine" [20].

Historically, erection, and occasionally ejaculation, have been observed in exicutional hangings and English brothels reportedly experimented with the act of hanging as a cure for impotence in the 1600’s [19,21]. In the late 1700’s a Czechoslovakian musician by the name of Kotzwarra often requested prostitutes to hang him, sometimes for up to five minutes. Eventually this lead to his death and thus the coining the future term "Kotzwarriaism" as a reference for sexual asphyxia [19,21].

The practice of sexual asphyxia has also been observed in various cultures throughout the world. Inuit children have been known to play a sexual game where they strangle each other [21]; it is also said to be a frequent sexual practice among Asians to grasp the partner’s throat in a strangling manner [22]. The practice has also been described in the Yaghans of South America [23], the Celts [20], and the Shoshone-Bannock Indians [18].

The exact number of individuals practicing autoerotic asphyxiation in the general population is unknown, since the majority of case reports are the result of fatal incidents. Estimates of the number of deaths per year range from 250-1,000 in the United States [24,25].

Investigation of the scene of an autoerotic death is a challenging process. Originally thought to be suicides in the older medical literature, the deaths are now classified as accidents, as it was never the intention of the victim to die and death usually results from the failure of the escape mechanism.

Hazelwood [25] has described 12 distinguishing characteristics of the scene of an autoerotic death, which may aid in differentiating between accidents, suicides, and sexual homicides. They include: a secluded location such as a basement, closet, or wooded area; the body is typically suspended upright, partially supported by the ground; the device inducing hypoxia is most commonly a ligature about the neck; there is evidence of a self-rescue mechanism, such as a knife to cut the rope or a slip-knot; evidence of bondage, where ropes, chains, belts or other devices are wrapped around the body and genitalia; there is evidence of masochistic practice, such as clothespins on the nipples; there is often transvestism, typically with the victim only partially clothed in female garments; protective padding is located between the ligature and the skin to prevent rope burns; sexual paraphernalia including dildos, vibrators and various fetish items such as rubber, leather and female clothing are discovered in proximity to the body; prop items such as mirrors and cameras for self-observation are commonly found; evidence of masturbatory activity such as exposed genitals or the possible presence of semen; and there is often evidence of previous and repeated activity.

Furthermore, Resnick [19] described the participants to have the following characteristics: they were almost exclusively of the male gender; control of neck constriction was voluntary; partial or complete nudity was observed; there was no apparent wish to die, reflected by the absence of a suicide note; the act was performed alone; and the presence of pornographic literature was common.

Hazelwood [25] also noted in his study of 132 autoerotic fatalities that the mean age was 26 years, with 71% being under the age of 30. Blanchard [26] published a report of 117 autoerotic asphyxial deaths in which he found that the majority of deaths occurred in white males with an age range of 10 to 56 years with approximately 33% being adolescents. Interestingly, Blanchard also reported that the degree and complexity of the bondage increased with age, and he felt these individuals intensified their masturbatory rituals over time. It should be noted that although the majority of fatalities occur in males, a small number of cases have been reported in females [15,22,27-32].

It is the variations in these typical scene characteristics that make the investigation of an asphyxial autoerotic fatality challenging. It is paramount in the interpretation of the scene, and the variance of these distinct characteristics, to rule out the possibility of suicide or sexual homicide. We report here a complex case with multiple fetishes and extreme progression of both bondage and transvestism activity.