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Schori A, Jackowski C, Schön CA. How safe is BDSM? A literature review on fatal outcome in BDSM play. Int J Legal Med 2022; 136:287-295. [PMID: 34383118 PMCID: PMC8813685 DOI: 10.1007/s00414-021-02674-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/20/2021] [Indexed: 11/14/2022]
Abstract
A noteworthy number of people are interested in BDSM (bondage and discipline, dominance and submission, sadism, and masochism). Fatal outcomes while participating in BDSM activities occur. The aim of this literature review is to give a better insight into potential dangerous BDSM play by summarizing published data on BDSM fatalities. A literature search was conducted. It was searched for non-natural death related to BDSM activity. Seventeen cases were found. The age of the deceased ranged between 23 and 49 years (mean age 34.9 years). Strangulation in the course of erotic asphyxiation was the most common cause of death (88.2%). In 13 cases, a toxicology report for the deceased was mentioned, of which in eight cases (61.5%) toxicology analysis was positive. In four of these cases, the BDSM partner was also tested positive with the same substance. Drugs or alcohol was involved in 64.3% of fatal BDSM play. In nine cases, the level of experience in BDMS activity of the deceased and the partner was described, and in all of them, the deceased and the partner were not new to BDSM play. Fatal outcomes of BDSM plays are rarer than autoerotic fatalities and natural deaths related to sexual activities. Safeguards and education on medical aspects exist in the BDSM communities. If they are followed by the practitioners, the risks of BDMS play can be reduced. Cases of non-natural death connected to BDSM are rare incidents and can be prevented.
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Affiliation(s)
- Anouk Schori
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, 3012, Bern, Switzerland.
| | - Christian Jackowski
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, 3012, Bern, Switzerland
| | - Corinna A Schön
- Institute of Forensic Medicine, University of Bern, Bühlstrasse 20, 3012, Bern, Switzerland
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Lohner L, Sperhake JP, Püschel K, Burandt EC, Heinemann A, Anders S. Vaginal laceration leading to air embolism during consensual sexual intercourse. Int J Legal Med 2020; 135:341-346. [PMID: 33033843 DOI: 10.1007/s00414-020-02433-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/30/2020] [Indexed: 11/24/2022]
Abstract
Vaginal injuries with clinical complications apart from local bleeding following sexual intercourse are thought to be rare events that have recently fostered a discussion on the topic. We report a case of a vaginal laceration resulting in death caused by air embolism in a non-pregnant woman during consensual sexual intercourse with digital and penile penetration. Hysterectomy and a preexisting vaginal injury were additional risk factors present in this case. Besides case history and autopsy findings, histological examination of the vaginal lesion and postmortem computer tomography (PMCT) helped in diagnosing the cause of death and underlying pathophysiological mechanisms.
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Affiliation(s)
- L Lohner
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - J-P Sperhake
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Püschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E-C Burandt
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Heinemann
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Anders
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Urethral Polyembolokoilamania: An Unusual Manifestation of Behavioral and Psychological Symptoms of Dementia (BPSD). Case Rep Psychiatry 2018; 2018:3018378. [PMID: 30595936 PMCID: PMC6282118 DOI: 10.1155/2018/3018378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/12/2018] [Indexed: 11/18/2022] Open
Abstract
Behavioral and psychological symptoms of dementia (BPSD) have varied presentations and frequently occur throughout the trajectory of dementia. Hypersexuality and general disinhibition of societal and cultural norms are commonly documented in all types of dementia. However, sparse literature exists on polyembolokoilamania (insertion of foreign objects in bodily orifices) without a sexual component as a dementia-related symptom. We review an unusual case of a 94-year-old man who presented with urethral polyembolokoilamania without hypersexuality or other behavioral disinhibition. We highlight clinical considerations of managing urethral polyembolokoilamania in an elderly patient without a previous neurocognitive disorder diagnosis. A multidisciplinary team approach with input from Internal Medicine, Urology, Psychiatry, and Neurology lead to a comprehensive assessment of a patient that could have been managed solely as a surgical case. This spearheaded a formal diagnosis of neurocognitive disorder—guiding successful management, follow-up, caregiver education, and reduction of further harm.
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Simon G, Rácz E, Mayer M, Heckmann V, Tóth D, Kozma Z. Suicide by Intentional Air embolism. J Forensic Sci 2016; 62:800-803. [PMID: 27907236 DOI: 10.1111/1556-4029.13320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/14/2016] [Accepted: 08/06/2016] [Indexed: 01/05/2023]
Affiliation(s)
- Gábor Simon
- Department of Forensic Medicine; Faculty of Medicine; University of Pécs; 12 Szigeti street Pécs, H-7624 Hungary
| | - Evelin Rácz
- Department of Forensic Medicine; Faculty of Medicine; University of Pécs; 12 Szigeti street Pécs, H-7624 Hungary
| | - Mátyás Mayer
- Department of Forensic Medicine; Faculty of Medicine; University of Pécs; 12 Szigeti street Pécs, H-7624 Hungary
| | - Veronika Heckmann
- Department of Forensic Medicine; Faculty of Medicine; University of Pécs; 12 Szigeti street Pécs, H-7624 Hungary
| | - Dénes Tóth
- Department of Forensic Medicine; Faculty of Medicine; University of Pécs; 12 Szigeti street Pécs, H-7624 Hungary
| | - Zsolt Kozma
- Department of Forensic Medicine; Faculty of Medicine; University of Pécs; 12 Szigeti street Pécs, H-7624 Hungary
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Abstract
Deaths in an autoerotic setting are usually due to accidental asphyxia, in which the individual accidently hangs or strangles themselves while inducing hypoxia for the purpose of heightened arousal. Death occurs when the level of hypoxia causes the individual to lose consciousness and is thus unable to prevent the neck compression from becoming lethal. In some cases there is an "escape" mechanism incorporated into the set-up which may fail. In rare cases, death is not as an immediate result of the autoerotic activity and is as a result of natural causes, which may or may not be related to the process. This case demonstrates the death of a 69 year old male which has occurred in the setting of a complex autoerotic environment, not as a result of asphyxiation, but rather as a result of natural causes which is likely to have been brought about by repeated similar activity. The autopsy revealed pulmonary emboli and lower limb deep vein thrombosis. There was no other natural disease of note and no features considered typical of asphyxiation.
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Affiliation(s)
- Yeliena Baber
- Victorian Institute of Forensic Medicine and the Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Melbourne, Australia.
| | - Eleanor Bott
- Victorian Institute of Forensic Medicine and the Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Melbourne, Australia
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Affiliation(s)
- R. Nolen-Walston
- New Bolton Center; University of Pennsylvania; Kennett Square USA
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Abstract
Accidental autoerotic asphyxia occurring during autoerotic activity is usually considered the unanticipated failure of a sexual stimulation device to induce hypoxia during solitary sexual arousal. Here, we provide the first reported case of autoerotic death in Korea. In the present case, a young man died from asphyxiation as a result of being suspended with his head in a plastic bag. The death was considered accidental and not suicidal. The diagnosis of autoerotic death may be difficult when typical features are absent.
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Affiliation(s)
- Sung-Kook Jung
- Seoul Metropolitan Police Agency, Seoul, Republic of Korea
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Affiliation(s)
- Ji Eun Kim
- Daegu Child Sexual Assault Response Team, Daegu, Korea
| | - Young Ran Cho
- Daegu Child Sexual Assault Response Team, Daegu, Korea
| | - Sang Han Lee
- Department of Forensic Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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Unruh BT, Nejad SH, Stern TW, Stern TA. Insertion of foreign bodies (polyembolokoilamania): underpinnings and management strategies. Prim Care Companion CNS Disord 2012; 14:11f01192. [PMID: 22690353 DOI: 10.4088/pcc.11f01192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/18/2011] [Indexed: 12/17/2022] Open
Abstract
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. Such consultations require the integration of medical and psychiatric knowledge. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss the diagnosis and management of conditions confronted. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Dr Unruh is an attending psychiatrist at McLean Hospital, Belmont, Massachusetts, and an instructor in psychiatry at Harvard Medical School, Boston, Massachusetts. Dr Nejad is an instructor in psychiatry at Harvard Medical School, Boston, Massachusetts, an attending physician on the Psychiatric Consultation Service at Massachusetts General Hospital, Boston, and the director of the Burns and Trauma Psychiatric Consultation Service at Massachusetts General Hospital, Boston. Mr Stern is a research assistant in the Department of Psychiatry at Massachusetts General Hospital, Boston. Dr Stern is chief of the Psychiatric Consultation Service at Massachusetts General Hospital, Boston, and a professor of psychiatry at Harvard Medical School, Boston, Massachusetts.Dr Stern is an employee of the Academy of Psychosomatic Medicine, has served on the speaker's board of Reed Elsevier, is a stock shareholder in WiFiMD (Tablet PC), and has received royalties from Mosby/Elsevier and McGraw Hill. Drs Unruh and Nejad and Mr Stern report no financial or other affiliations relevant to the subject of this article.
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Moreschi C, Da Broi U. Paradoxical air embolism through patent foramen ovale during consensual intercourse in a non-pregnant young female. J Forensic Leg Med 2009; 16:482-5. [DOI: 10.1016/j.jflm.2009.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Revised: 04/08/2009] [Accepted: 07/01/2009] [Indexed: 01/05/2023]
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Abstract
Autoerotic death refers to the accidental death of individuals of either sex due to failure of devices, or unexpected effect of materials, that were being used to enhance the sexual experience. Although asphyxia from hanging has been described most frequently, a wide variety of other lethal situations have been reported. As there is great variability in the number and types of sexual aids that may be used by individuals, careful death scene examination is essential in helping to exclude suicide and more rarely homicide. The clandestine nature of this paraphilia may, however, make subsequent identification and diagnosis difficult unless the death scene features are typical. This is particularly so in the rare cases involving women. In the following paper the typical features of this disorder are reviewed with a description of less obvious cases and possible diagnostic pitfalls.
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Affiliation(s)
- R W Byard
- Department of Histopathology, Women's & Children's Hospital, 72 King William Road, North Adelaide, SA, Australia, 5006
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Truhlar A, Cerny V, Dostal P, Solar M, Parizkova R, Hruba I, Zabka L. Out-of-hospital cardiac arrest from air embolism during sexual intercourse: Case report and review of the literature. Resuscitation 2007; 73:475-84. [PMID: 17291667 DOI: 10.1016/j.resuscitation.2006.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2006] [Revised: 09/28/2006] [Accepted: 10/11/2006] [Indexed: 10/23/2022]
Abstract
We report the successful resuscitation of a 38-year-old woman in cardiac arrest following heterosexual intercourse 7 days after spontaneous abortion and an instrumental uterine evacuation. The collapse was thought to be due to venous air embolism (VAE). Her survival neurologically intact was attributed to appropriate first aid, pre-hospital and subsequent hospital intensive care. Neither a case of an out-of-hospital air embolism where the patient made a good recovery, nor a case of miscarriage followed by collapse from air embolism has been reported in the literature. Air embolism is a very infrequent cause of out-of-hospital cardiac arrest with a high mortality rate. Predominant causal reasons are severe penetrating neck or thoracic injuries and sexual activities in pregnancy, when air can pass into the damaged veins in the wall of the uterus and lead to total obstruction in the heart. Diagnostics and management techniques for venous air embolism are discussed. Air embolism should be included in the differential diagnosis for all young women in cardiac arrest, particularly when occurring during sexual activity. Instructions in risks of sexual intercourse during pregnancy and the puerperium should become part of pregnant women's education.
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Affiliation(s)
- Anatolij Truhlar
- Helicopter Emergency Medical Service Christoph 6 Hradec Kralove, Hradec Kralove Region Emergency Medical Services, Czech Republic.
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Yacobi Y, Tsivian A, Sidi AA. Emergent and Surgical Interventions for Injuries Associated With Eroticism: a Review. ACTA ACUST UNITED AC 2007; 62:1522-30. [PMID: 17563678 DOI: 10.1097/ta.0b013e3180341f8f] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To review the consequences of sexual activities that can cause severe morbidity and the current emergent and surgical measures for treating them. METHODS A computerized search of the English and non-English MEDLINE database (January 1973 to October 2005) identified the major sexual activities that caused injuries requiring emergent or surgical intervention, or both. These activities were grouped by type, pathologic findings, and sites of injury. Cause and symptoms are discussed, as are the radiologic, emergent and surgical interventions employed worldwide. RESULTS Two major groups of sexual-erotic activities, whether self-inflicted or accidental, emerged as culpable for most of the injuries. One was hetero-homosexual relations that were associated with penile fracture and Peyronie's disease. The other was related to the sequelae of autoeroticism and included penile constriction devices, anorectal, urethra-bladder, and vaginal foreign bodies as well as autoerotic asphyxiation. Injuries in both groups affected men more than women (e.g., 1.7:1 for foreign bodies in the urethra and 99:1 for anorectal). Complications were either immediate or delayed. Predisposing factors for injury are described. Emergent medical management and corrective surgical measures (usually by urologists and gynecologists for genital involvement and proctologists and general surgeons for rectal involvement) were similar worldwide and the need for them was surprisingly limited. CONCLUSIONS Most erotic activity-related injuries are medically or surgically treatable, although some sexual practices can be lethal. Dissemination of information on risk of injury is the best preventive measure.
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Affiliation(s)
- Yacov Yacobi
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Israel.
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Abstract
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.
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Affiliation(s)
- Anny Sauvageau
- Laboratoire de Sciences Judiciaires et de Médecine Légale, Edifice Wilfrid-Derome, Montreal, Quebec, Canada H2K 3S7.
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Gei AF, Vadhera RB, Hankins GDV. Embolism during pregnancy: thrombus, air, and amniotic fluid. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2003; 21:165-82. [PMID: 12698839 DOI: 10.1016/s0889-8537(02)00052-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pulmonary embolism is the primary cause of acute respiratory decompensation during pregnancy. Regardless of the nature of the embolism, a high index of suspicion, early diagnosis, and aggressive resuscitation need to be instituted to achieve a successful maternal and fetal outcome. Several clinical characteristics will assist practitioners to distinguish among the different forms of embolism and to institute specific measures of treatment.
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Affiliation(s)
- Alfredo F Gei
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX 77555-0587, USA.
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Sadler DW, Pounder DJ. Fatal air embolism occurring during consensual intercourse in a non-pregnant female. ACTA ACUST UNITED AC 1998; 5:77-9. [PMID: 15335543 DOI: 10.1016/s1353-1131(98)90058-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Death from air embolism during pregnancy has been reported following sexual activity, particularly vaginal insufflation. We report a death from air embolism in a non-pregnant woman during consensual penile intercourse, in a position with the pelvis elevated above heart level. Air is thought to have entered the veins via a vaginal laceration, which occurred during digital foreplay.
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Affiliation(s)
- D W Sadler
- University Department of Forensic Medicine, Dundee Royal Infirmary, Barrack Road, Dundee, DD1 9ND, UK
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