An Objective Overview of Autoerotic Fatalities

There is an abundance of literature on the subject of autoerotic fatalities. Unfortunately, the largest portion of the early literature, circa. 1970, is terribly subjective and interpretive of morality (note: much of the early literature is still footnoted and built upon). However, some excellent work on the subject has been done since then. The purpose of this author's work is to give an objective overview of autoerotic fatalities with an emphasis on the myths, criteria, and issues faced by a Medical Examiner or Coroner. 

The following are the central terms defined according to Holmes[6]. It cannot be ignored that Holmes[6] demonstrates a schizophrenic attitude towards human sexuality in some of his definitions, to recall what was stated earlier about literature being interpretive of morality. For example, Autosexuality, the same thing as autoeroticism, is defined as "perversions performed on oneself, including masturbation,". It must be assumed that shared sexuality, by inference, would be defined by Holmes as perversions performed on others. Holmes, and others who engage in the autoerotic debate, often suffer from such failures to resolve conflicts between public and private views on sexuality. This tendency often brings poorly defined morality to the debate, and detracts from the purposes of the Forensic Sciences. 

Regardless, the author capitulates to these particular definitions as objective. 

Autoeroticism: Masturbation and other forms of self gratification. 

Autoerotic fatality: Any death that occurs as a result of behavior that is performed as a form of self-gratification. 

Example: "The victim, a twenty-six year old white male, died while suspended by leather wrist restraints from a hook in the ceiling. When found, he was wearing a commercially produced 'discipline Mask' and a had a bit in his mouth. A length of rope was attached to each end of the bit and ran over his shoulders, going through an eyelet at the back of a specially designed belt he was wearing. The pieces of rope ran to eyelet's on both sides of his body and were connected to wooden dowels that extended the length of his legs. The ropes were attached to two plastic water bottles, one on each ankle. The bottles were filled with water and each weighed 7 pounds. The victim's ankles had leather restraints about them. A clothespin was affixed to each of the victim's nipples. The victim's belt had a leather device that ran between his buttocks and was attached to the rear in front of his belt. This belt device included a dildo that was inserted in his anus and an aperture through which his penis protruded. His penis was encased in a piece of pantyhose and a toilet-paper cylinder. A small red ribbon was tied in a bow at the base of his penis."(Hazelwood, Burgess, & Dietz[5]). 

This case demonstrates a blatant, undeniable autoerotic fatality, that is complete with props. But not every case will look like it, or even be as overt. Each autoerotic fatality is as different or as similar in its engagement as the personality of the individual who orchestrates it. Every autoerotic death has its own personal script. That is due in part to the fact that masturbation is a deeply personal, sexual act. This is a critical notion that is often dismissed by even the most seasoned death investigators. Failure to accept this notion will assist in the pathologist's failure to recognize autoerotic fatalities when they are so confronted. Again, autoerotic behavior is a kind of masturbation, and masturbation is a personal and dynamic behavior. 

Specific circumstantial elements that can help a forensic pathologist distinguish an autoerotic fatality will be discussed later on. 

The general appeal of autoerotic behavior is fairly straightforward; sexual gratification. 

There are dangerous autoerotic behaviors that individuals find similarly appealing. Of these, perhaps the most prevalent is autoerotic asphyxia. 

An important question surrounding autoerotic asphyxia, for those who are not familiar with the term, is why. Why is engagement in autoerotic asphyxia pleasurable? Where does the pleasure come from? 

The pleasure can be generally understood as arriving from two distinct sources (distinct but not exclusive). The first source of pleasure is physical, and the second is psychological. Both are equally potent pleasure sources on their own. Put them together and the combination can easily provide the foundation for a dangerous habit. 

The physical pleasure from autoerotic asphyxia comes with the reduction of oxygen to the brain, or Hypoxia, which just means partial oxygen deprivation (DiMaio & DiMaio[3]). This is simple euphoric asphyxia. Less oxygen to the brain equals a semi-hallucinogenic, lucid state. It is pleasurable enough on its own to be engaged in without bondage or genital manipulation. It can be performed while entirely clothed. 

Dietz[2] gives us an example of a death by sexual asphyxia (classified as an autoerotic fatality), with all of the classic earmarks, yet little sexual obviousness at the scene: 

"A 42 year-old Asian man was found hanging by the neck, suspended by a rope attached to the raised shovel of a John Deere Model JD410, diesel powered, backhoe tractor...The decedent was suspended in a semi-sitting position by a cloth safety harness strap wrapped around his neck and clipped to a rope that was hooked to the raised shovel of the backhoe tractor. A towel was between the loose fitting strap and the victim's neck. A long piece of plastic pipe was connected on one end by conduit tape to the hydraulic control lever of the shovel in the operator's compartment of the tractor. A broom stick was taped to the other end of the pipe and was partially under the decedent's buttocks. The hydraulic shovel could be easily raised or lowered by slight pressure applied to the broomstick. The decedent was fully clothed, and his genitals were not exposed. No pornographic materials, women's clothing items, or mirrors were at the scene...He had no known psychiatric illness." 

Determination of autoerotic death was made from decedent history and circumstantial indicators. The victim kept a journal of love poetry dedicated to his tractor that he had named "Stone," outlining his desire for them to "soar high" together. The victim was unmarried and lived with his parents on their farm. He also had a reasonable expectation of privacy for an extended period, as he engaged in this behavior in the late evening down by the barn. Cause of death was determined to be accidental autoerotic asphyxiation with carbon monoxide intoxication as a contributor. 

The psychological source of pleasure from autoerotic asphyxia is personal, and therefore difficult to generalize. The pleasure is best understood as residing in the fantasy. It is widely accepted that the fantasy is fueled by the masochistic/ cordophilic aspect of the behavior. The sexual pleasure associated with binding oneself up in a restrictive and/or complex fashion can have a twofold effect; 1) Self-restriction, and 2) Pain/ pleasure. The psychological pleasure derived from either of those fantasy behaviors is sufficient reason for many individuals to engage in that form of sexual activity. Bondage and masochism are widely practiced without the element of Hypoxia. 

An individual involved in dangerous autoerotic behavior of any kind generally has a rich and intense fantasy life. The most accurate way to understand that form of fantasy and pleasure, on an individual basis, is to have the individual explain it to you themselves, in their own words, or to read about it in a journal of love poetry they wrote in honor of their backhoe tractor. 

What can be seen and understood of the fantasy, by the pathologist, is the object. Every fantasy requires an object to fulfill it. In the above case it was the backhoe tractor. In other cases it may be complex ligature, pornographic paraphernalia, women's undergarments, or perhaps some other masochistic element. All of these objects assist the fantasy and accelerate sexual arousal. If the pathologist or death investigator can identify the object of the decedent's fantasy, the autoerotic behavior will begin to explain itself. 

Additional explanations include masochistic sensations when approaching death and backing off at the last possible second. Prevailing over that brush with mortality is often perceived as empowering. On that note, many individuals who engage in autoerotic asphyxia may do so in concert with genital masturbation and insertion of objects into their body's orifices for further sexual stimulation, although not necessarily. 

Combining all of these elements together, it becomes clearer as to why some extreme types of autoerotic behavior (including autoerotic asphyxia), although dangerous, are a behavior of choice for certain individuals. Individuals of all ages and social strata find behaviors akin to autoerotic asphyxia pleasurable. This is not disputed. 

MYTHS

There are many common myths surrounding autoerotic fatalities. This is largely the product of social fear and social ignorance which girdles the issue. It is widely documented that parents or loved ones alter the scene of victims in such cases[5] in order to mislead investigators. They wish to avoid embarrassment. They wish to hide the truth of their loved ones demise and put it away where no one can see it. In addition, investigators and pathologists have their own problems with the issue. Some have problems because they consider the behavior perverse, others because they simply do not recognize it for what it is. 

Autoerotic asphyxia is, as discussed earlier, a form of masturbation. Masturbation is one of the few cultural taboos that older society pretends to hold on to. There is also a great deal of cultural evidence to suggest that we are still very publicly ashamed of our sexuality. It is therefore no great wonder that bad and often judgmental information can lead the way to investigating or even discussing autoerotic fatalities. 

In discussions on this topic with colleagues, the author has noted that several individuals labor under the impression that the deceased in these cases should be regarded as criminal. Holmes[6] lists Erotic Asphyxiation under the heading "Dangerous Sex Crimes", along with others including Lust Killers, Pyromaniacs, and Necromaniacs. That classification is an egregious error for too many reasons to list here. 

It is important to express that individuals who die while engaging in autoeroticism are not guilty of a crime, unless perhaps they live in Missouri or Mississippi. There is nothing criminal about exercising careless masturbation unless someone else is killed or property is damaged. In autoerotic asphyxia and other types of autoerotic fatalities, this is rarely the case. Once a death is ruled to be an autoerotic fatality, law enforcement is generally out of the picture. 

Moreover, the author perceives four principal myths surrounding autoerotic fatalities. To effectively engage in the death investigation of a possible autoerotic fatality, the pathologist or death investigator must reconcile these myths with the documented facts. They are as follows: 

MYTH # 1 - AGE

"Decedents tend to be young boys"

Adelson[1], in his book, The Pathology of Homicide, published in 1974, was a proponent of this theory. He stated, in reference to autoerotic deaths, that they were "A unique group of accidental hangings usually involving young boys ages nine and fourteen or fifteen." And he described it as the termination of a dangerous game played by boys. He was later cited by Geberth[4] and Holmes[6] concerning this specific issue. 

This statement is a myth because it is only partly accurate. According to the study of autoerotic asphyxial deaths published by Hazelwood, Burgess, & Dietz[5], operating with the largest subject population of any study to date (N=132), 37 of the subjects were white teenage males. However, 42 of the subjects were white males (plus one black) between the ages of 20 and 29. An additional 28 subjects were white males (plus one Hispanic and two black) between the ages of 30 and 39. This clearly shows that each of those three age clusters are strongly represented by the data. In light of this sampling, the age generalization cannot practically be applied to the occurrence of autoerotic fatalities. When applied to a death investigation, the need for reconciliation of this myth is compounded. 

Example [5]: "A 47 year old divorced dentist was found on the floor of his office by the janitor. He was lying face down on the floor with an anesthesia mask held in place over his mouth and nose by the weight of his head. His shirt was open and his trousers unzipped. He was alleged to have taken sexual advantage of his patients while they were under anesthesia in his office." 

(History, history, and history) Failure to terminate inhalation of the anesthetic agent, nitrous oxide, resulted in the death of this individual. He was an older man; a professional with an education. A man with some intimate understanding of anatomy, physiology, and the potency of the hypoxia caused by nitrous oxide. He was not ignorant to the potential danger of his activities and he was not a teenager engaging in sexual self discovery-type behavior. His age group is not to be ignored for the possibility of autoerotic fatalities. 

MYTH # 2 - GENDER

"Autoerotic Fatalities occur only in men"

This is by far the most concerning myth. It harkens back to a misguided male mind set that females do not have the same sexual desires as males, and therefore do not masturbate. Not only is it supported by Adelson[1], but Geberth[4]. Similarly, DiMaio & DiMaio[3] minimize female occurrences by saying of sexual asphyxia "Such deaths are rare, with the victim virtually always a male. Only a few cases involving a females have been reported,". 

The inferences made by the above authors are entirely misleading. Although female occurrences are not as frequent as male occurrences, they do exist in the data. If the Pathologist or death investigator does not think to look at female cases with the possibility of autoerotic fatality in mind, then something may be overlooked in the examination of the body, the scene or the history. 

In a lecture that the author attended in the winter of this year given by S.A. Max Thiel(ret.)[8] of the FBI on the subject of autoerotic fatalities, there was a marked show of public embarrassment and disbelief in the audience. One female attendee asked how any female could possibly perform an autoerotic act. She seemed unbelieving of the answer that she received. 

Female data are presented by Hazelwood, Burgess, and Dietz[5], Sass[7], and Holmes[6]. Example [5]: "A thirty year old single woman was found dead in her locked apartment. She was nude and lying supine on a blanket on the bedroom floor. A pillow beneath her buttocks elevated them. Her legs were slightly spread, and her arms were by her sides. A blouse was lodged in her mouth and covered her face. Next to the body was a dental plate belonging to the victim. Near her left foot were an empty beer can, an ashtray, and a drinking glass. Neither the body nor the scene exhibited signs of a struggle. The victim's clothes and purse (containing her keys) were on her bed. A vibrator and leather bondage materials were found in her closet. The door was locked with a spring bolt. The autopsy report indicated that she had choked to death." 

Example [5]: "A black woman in her early twenties was discovered in a severely decomposed condition. She was found on a bed in her locked apartment where she had resided alone. She was nude and lay face down with a pillow under her abdomen and her buttocks in the air. Her right hand was beneath her, near her vagina. Her face was turned to one side, and a knife was beneath her cheek. On the bed immediately below her vagina lay a long sausage, which in all probability, fell from her vagina after death. On the kitchen counter a package of similar sausages, once frozen, had since thawed. The apartment door had been locked from within, and no other persons were known to posses a key." 

Hazelwood, Burgess, and Dietz[5] note that the cause of death in this second example remained undetermined due to severe decomposition, but included it because of a similar Japanese case that presented a woman who died while masturbating with a carrot (Tomita & Uchida[9]). The cause of death was determined, in that case, to have been a subarachnoid hemorrhage, which is a form of stroke. 

Example [7]: "This case occurred in a midwestern city...and involved a woman 35 years of age, a divorcee with a nine-year-old daughter. The mother was found deceased by the daughter in the morning after the child arose from a night's sleep in an adjoining room. 

The child had gone to bed at 10:00 p.m....upon awakening noticed a strange humming noise coming from her mother's room. After entering the room, she found her mother hanging deceased in a small closet off the bedroom. 

The victim was found completely nude lying on a small shelved space at the rear of the closet. Her feet were against the wall and her body was extended in a prone position, head downward...There was a folded quilt placed on the front portion of the shelf that was immediately under he abdomen and upper thighs... 

...She died of strangulation. An electric vibrator connected to an extension cord was found running. The vibrator was positioned between her thighs and the hard rubber massage head in contact with the victim's vulva. There was a string-type clothespin on the nipple of her right breast, compressing the nipple, and another clothespin of the same type was found immediately below her left breast. 

...Over the place where the body was lying on this shelved area was a small narrow shelf 66in. above the floor. This was attached to the wall by two steel brackets and the one closest to the shelved area had a nylon hose tied around it which formed a long loop. The victim has placed her head in the loop and placed a hand towel between her neck and the nylon hose. Her face was turned toward the wall and laying against it." 

Women masturbate. Women engage in autoerotic behavior. Women who engage in dangerous forms of autoerotic behavior can die from it. Asphyxia and trauma are not sexually discriminate in their effects on human anatomy. If that tenet of autoerotic fatalities is ignored by a death investigator, or a pathologist, then autoerotic fatalities among women may be overlooked. The belief that it doesn't happen among women may create classification errors in future reporting despite any previous documentation to the contrary. 

MYTH # 3 - NUDITY

"Nudity, or partial nudity, is always a feature in Autoerotic death scenes."

As Thiel[8] reminds us, nudity must be explained at any death scene. Nudity can be a feature of an autoerotic fatality. However, nudity is not a necessary feature of an autoerotic death, as was demonstrated by the example in the section entitled "Why" on page 2 of this work. Many serious researchers make the statement that nudity or partial nudity is an element of an autoerotic fatality; DiMaio & DiMaio[3], Holmes[6], & Thiel[8]. This is misleading, again, because it is only mostly true. 

Nudity or partial nudity can help with a pathologist's determination as to whether or not the decedent was engaged in autoerotic behavior. However there are many documented cases of autoerotic fatalities that do not have a feature of nudity ([2] & [5]). If cases that do not have a feature of nudity are excluded as possible autoerotic fatalities on that basis alone, a classification error may occur. 

MYTH # 4 - TRANSVESTITISM

"Most autoerotic deaths are characterized by transvestitism."

Transvestitism[5]: Recurrent and persistent cross-dressing by a heterosexual male for whom there is no explanation other than sexual excitement for the cross-dressing behavior. 

There are widespread anecdotal reports of male decedents being discovered wearing female undergarments or clothing. A sampling of the literature yields these results: Holmes[6] notes cross-dressing as a typical element in an autoerotic hanging; DiMaio & DiMaio[3], on the other hand, note a less common tendency in decedents to wear female articles of clothing; Adelson[1] takes his conjecture further, saying, "...one aspect of sexual psychopathy is observed occasionally in...fatal hangings involving boys and men who are transvestites...When discovered dead by hanging, they are wearing female undergarments and occasionally, female outer clothing." This demonstrates the diversity of thought on the matter among an array of published experts. This also likely demonstrates that what is typical to these experts is probably a function of personal experience, and not necessarily typical for the entire population of autoerotic asphyxial decedents. 

Hazelwood, Burgess, and Dietz[5] and Thiel[8] are more careful in their reporting of the data. They note that sometimes the decedent is attired in one or more articles of female clothing. 20.5% of their sample population were cross-dressed at death. But Hazelwood, Burgess, and Dietz[5] also note, that this is probably not transvestitism. They hypothesize that individuals found cross-dressed are probably utilizing the female articles for their masochistic value. They diagnosed only 3.9% of their sample population as transvestites. 

Geberth[4] includes their comments in his chapter on the phenomenon of autoerotic fatalities. Not surprisingly, his criterion for making a determination of autoerotic death does not include transvestitism or cross-dressing. Geberth[4] also cites DiMaio & DiMaio[3]. 

The best data does not support the claim that most autoerotic deaths are characterized by transvestitism. Transvestitism occurs in only a slight portion of autoerotic death cases. Cross-dressing is a little more common, but only 1/5 of the time. In either case, the idea that tranvestitism is prevalent in either form is untrue. 

The trained pathologist or death investigator has an obligation to the decedent to resolve these myths and conduct an objective investigation. The failure to resolve any one of these myths is enough to mislead even the most seasoned death investigator. The importance of reconciling personal experience with overall data is equally important. 

There are many laundry lists available that characterize typical elements of an autoerotic death. Unfortunately, they are generalizations. While they are good compasses for a bewildered investigation, they do not apply to every case. 

The following is a list of the objective criteria that should be used to assist the pathologist or death investigator to determine autoerotic death. Recall the definition: 

Autoerotic fatality: Any death that occurs as a result of behavior that is performed as a form of self-gratification. 

CRITERIA[4]; 

1.Evidence of a physiological mechanism for obtaining or enhancing sexual arousal that provides a self-rescue mechanism or allows the victim to voluntarily discontinue its effect. 

2. Reasonable expectation of privacy. 

3. Evidence of solo sexual activity. 

4. Evidence of sexual fantasy aids. 

5. Evidence of prior dangerous autoerotic practice. 

6. No apparent suicidal intent. 

Example[5]: "A twenty-two year old single woman was discovered dead by her sister, who had been staying with the victim temporarily. The sister had been away for two days and returned on Sunday at 9:00 p.m....She went directly to her bedroom and did not discover the victim until the following morning. 

The deceased was found in an arched position with an electrical cord attached to her neck by a slip knot, passing over a doorknob, and wrapped around her ankles. Her abdomen, thighs, and forearms rested on the floor, and her feet were pulled back toward her head. The right side of her head was against the door's edge, and her hair was entangled in the slip knot. She was clothed in a blouse that she normally wore for sleeping. Commercial lubrication cream was found in the victim's vagina, and a battery-operated vibrator was found 4 feet from her body. The only trauma was a 1 1/2-inch contusion above and behind her right ear. The scene was not disturbed, and there was no sign of a struggle. On her bed were a series of drafted letters she had written in response to an advertisement seeking a possible sexual liaison. 

Autopsy revealed no evidence of recent intercourse, and no alcohol or other drugs were detected in the body. The cause of death was determined to be asphyxia due to laryngeal compression. 

The victim had been in excellent physical condition, had made plans for a canoe trip on the day following her death, and had recently been in good spirits. She was sexually active but was reportedly disappointed in her sexual relationships as she had difficulty attaining orgasm. She used contraceptive cream and a diaphragm to prevent pregnancy, and these items were located in her car." 

This case demonstrates all of the above mentioned criteria. Her hands were free to push herself up at any time and interrupt the laryngeal compression, but she clearly passed out before she could do so. She was dating, and concerned about pregnancy, but those items associated with blocking potential pregnancy during sexual intercourse were located in her vehicle. If she were not alone while engaging in her sexual behavior, it would stand to reason that those articles would have been found to be in use at the scene of her death. The presence of the vibrator and the letters on her bed demonstrate the presence of the sexual fantasy aids. The complexity of the bondage involved demonstrates complex fantasy behavior, and is indicative of prior fantasy and therefore represents an escalation of fantasy behavior. Rarely will an individual hog-tie themselves to a doorknob with a slip knot on their first time out. The planning of the canoe trip and the reports of her being in good spirits indicate that she was not suicidal. Also, there was no suicide note. By itself that fact has little meaning as suicide notes are not always left by those who commit suicide. Circumstantially, however, the absence of a suicide note does contribute to the picture of an autoerotic death. If there had been a note present, it would have been helpful in dismissing the possibility of an autoerotic death. 

Example[5]: "An eighteen year-old white male was discovered by his mother in what she believed to be an unconscious state. She drove him to a local hospital where he was pronounced dead. Upon arrival at the hospital, he wore only a pair of red, women's panties. Markings around his chest led to further questioning of his mother who then stated that when she found her son, there had been a plastic bag around his head that was secured around his neck with a rubber band, and he had been wearing a brassiere and a slip. She had removed all of these things before taking him to the hospital. A search of his room at home disclosed an extensive collection of women's clothing and several other plastic bags. The plastic bag he had used during the fatal episode had holes in it that had been repaired with masking tape." 

This case is a good example of suffocation to induce euphoric hypoxia, rather than the more common compression/hanging techniques. His hands were not bound, so he could have punctured the bag at any time to discontinue its effect (as he had obviously done in the past). From all indications, he was alone at the time of death. The female clothing represents a significant fantasy aid. Holes in the one bag, the presence of other bags, and the presence of a collection of women's clothing suggests a great deal of previous engagement in this dangerous autoerotic behavior. The existence of prior incidents using the same repaired bag, in tandem with sexual fantasy material, would suggest that his intention was pleasure, not death. 

The above criteria for determining autoerotic fatalities are fairly objective. They do not exclude on the basis of gender, skin color, age or lifestyle. They also depend heavily on victim history. Adherence to these criteria could assist greatly in keeping each of the four main myths previously mentioned from misleading a death investigation. It would also assist in barricading against other classic personal and political considerations that are prone to interfere with investigations of a private, sexual, and potentially socially embarrassing nature. 

Determining the manner of death is sometimes very problematic for a Medical Examiner or Coroner. A definition is in order. 

Manner of Death [3]: "The manner of death explains how the cause of death came about. Manners of death are generally considered to be natural, homicide, suicide, accident, and undetermined...The manner of death as determined by the forensic pathologist is an opinion based on the known facts concerning the circumstances leading up to and surrounding the death in conjunction with the autopsy findings and the laboratory tests." 

Autoerotic fatalities are, by definition, accidental deaths. They are not suicides. Suicide is the intentional taking of one's own life. Accidents are unforeseen and unintentional. 

Last month, a colleague wrote the author of this work and stated that, "...I would consider it[autoerotic death] (assuming that the pathologist has identified the death as autoerotic asphyxia) as suicide; simply because the action is as voluntary as suicide." This is not an uncommon argument. However, the argument is only sustainable on a superficial level. By that same reasoning, traffic fatalities would be determined as suicides, because everyone knows that being in a car or walking along the side of the road can kill you with more frequency than any dangerous autoerotic behavior. 

DiMaio & DiMaio[3] opine on the case of a 21 year-old white male in their discussion of autoerotic asphyxiation and end their section on the subject with the following: 

"The danger of this[transitory anoxia] is that a few seconds miscalculation can cause loss of consciousness and the individual will hang himself. The key to the diagnosis of this entity is the presence of a towel or some other article of clothing between the noose and the neck...The intention is not to die, but to produce sexual gratification." 

Those who engage in autoerotic behavior are doing so for pleasure. They have no expectation or intention of death. They have made provisions for their future and for future autoerotic behavior. Failure to surmise the intent of sexual arousal in autoerotic fatalities should be avoided in determining manner of death. There is little disagreement among the experts ([1], [2], [3], [4], [5], [6], [7], & [8]) on this issue. 

Dr. Park Dietz[5] begins the second chapter of his work with a statement as to the nature of autoerotic asphyxia that pathologists and other death investigators cannot afford to ignore: 

"For certain individuals, the preferred or exclusive mode of producing sexual excitement is to be mechanically or chemically asphyxiated to or beyond the point at which consciousness or perception is altered by cerebral Hypoxia (diminished availability of oxygen to the brain)." 

There is a diverse population of individuals that find autoerotic asphyxia and other dangerous autoerotic behavior sexually gratifying. Their autoerotic behavior is not criminal. It is a dangerous form of masturbation. Their subsequent death is accidental. For whatever social or personal reasons, death investigators and pathologists can fall into the ignorance of some alluring myths surrounding autoerotic death. This is a failing that cannot be afforded in light of the pathologist's responsibility to the decedent. 

There is a great deal of literature that works against reconciling popular myths in favor of good data. That literature must be reconciled with objective data, and objective criteria for determining autoerotic fatalities. If death investigators and pathologists are to maintain any scientific credibility at all in this area, the need for the more universal, more objective criteria must not be ignored. 

1)Adelson, Lester, The Pathology of Homicide (Springfield, Ill: Charles C. Thomas, Pub., 1973), pp.552-553 

2)Dietz, P.E., & O'Halloran, Ronald,"Autoerotic Fatalities with Power Hydraulics", Journal of Forensic Sciences, No. 2, March 1993, pp. 359-364 

3)DiMaio, D, & DiMaio, V., Forensic Pathology, (Boca Raton: CRC Press, 1993), pp. 246-247 

4)Geberth, Vernon, Practical Homicide Investigation, 2nd Ed., (Boca Raton: CRC Press, 1993) 

5)Hazelwood, Roy, & Burgess, Ann, & Dietz, Park, Autoerotic Fatalities (Lexington, Mass: D.C. Heath & Co., 1983) 

6)Holmes, Ronald, Sex Crimes, (London: Sage Publications, 1991), pp. 62-65 

7)Sass, F.A., "Sexual Asphyxia in the Female" Journal of Forensic Sciences, No. 20, 1973, pp. 181-185 

8)Thiel, Max, S.A.(ret.) Lecture: "Autoerotic Death", University of New Haven, Feb. 2, 1995 

9)Tomita, K. & Uchida, M. "On a Case of Sudden Death While Masturbating," Japanese Journal of Legal Medicine, Vol. 26, 1972, pp.42-45