Two extraordinary autoerotic fatalities

The shame of truth - death due to accidental autoerotic asphyxia

Autoerotic deaths occur in the context of sexual activity when different devices and objects are used to increase stimulation and sexual pleasure, resulting in unintentional deaths. A common feature of autoerotic deaths s the presence of a self-rescue mechanism to ensure survival and escape a dangerous situation. By definition, autoerotic deaths are accidental. Thus, it is essential to exclude suicide or homicide. An atypical case of autoerotic asphyxia is presented, in which the victim showed a ligature mark produced by a soft belt with maximum pressure on the posterior aspect of the neck and the point of suspension located anteriorly. A detailed scene investigation and the autopsy findings helped determine the manner of death. Determining the manner of death in AADs can be challenging and has a significant legal, social, and economic impact. A multidisciplinary approach is required to reach the correct conclusion. We present a case of AAD with atypical findings.

Rates of Injury and Healthcare Utilization for Kink-Identified Patients

BACKGROUND

Kink-involved people engage in atypical erotic activities such as bondage, rough sex, and other fetish activities that might risk injury or medical complication. To date, however, no one has examined the rate of injury or healthcare utilization for people who engage in these activities.

AIM

To describe the type and rate of injuries from kink activities, and the use of healthcare by kink-involved people, including how many people disclose their involvement in kink when seeking care.

METHODS

A survey of 1,398 kink-involved or kink-identified people, using a convenience sampling method.

OUTCOMES

The study is the first to report on rates of injury and disclosure of kink involvement to care providers using a large community sample of kink-involved people.

RESULTS

A high number of participants did not disclose their kink behavior to their physical healthcare clinician (58.3%) or to their mental healthcare clinician (49.6%). Past experiences of kink-related injuries were relatively common (13.5%), as was the number of people who reported delaying or avoiding healthcare because of anticipated or perceived stigma for kink involvement (19.0%).

CLINICAL TRANSLATION

The findings of the current study point to the need for clinicians to address barriers to culturally competent care for kink-involved people. Anticipated stigma leads to non-disclosure of kink involvement and delay in seeking care, thereby creating barriers to health and well-being.

STRENGTHS & LIMITATIONS

Strengths include a sample size large enough to examine regression models to predict disclosure to care providers, and lifetime rates of injury from kink activities overall. Limitations include the use of a convenience sampling method and self-report survey design, which affect the generalizability of the results.

CONCLUSION

The patterns of anticipated stigma, delay or avoidance of care, and concealment of kink and/or BDSM involvement fit the Minority Stress Model, and we argue that kink-identified people should be considered a sexual minority for the purposes of healthcare. Sprott RA, Randall A, Smith K et al. Rates of Injury and Healthcare Utilization for Kink-Identified Patients. J Sex Med 2021;18:1721-1734.

Fatal strangulation during consensual BDSM activity: three case reports

Autoerotic accidents are well-known occurrences in forensic casework. Reports about unintentional deaths in a sexual context involving other persons are much rarer. Three cases of fatal incidents related to asphyxiophilia during consensual BDSM activity are reported. Two men died while visiting a dominatrix, the third one in the presence of a male casual sexual partner. Paraphernalia associated with BDSM/fetishism were found at the scene in all cases. Autopsy findings were compatible with death by strangulation. The cases are compared with published autoerotic accidents and similar unintentional deaths involving other individuals. The difficulties concerning the forensic assessment and reconstruction of the cases are discussed.

Hanging disguised as bondage: accidental or suicidal death?

The concept of autoerotic asphyxiation refers to the use of devices or substances intended to enhance one's arousal by inducing cerebral hypoxia, which can involuntarily lead to death. Although in most cases death occurs accidentally, it is nonetheless true that the same devices might be used by the practitioners in order to attempt suicide. The case of a 34-year-old practitioner of autoerotic asphyxiation found dead in his apartment with bondage-like ligatures and masking is reported here. The case raised some issues concerning the accidental or suicidal nature of the act. The aspects taken into account in the management of the case are discussed, along with a compared approach to the data provided by literature.

Autoerotic Deaths in Hamburg, Germany: Autoerotic accident or death from internal cause in an autoerotic setting? A retrospective study from 2004-2018

INTRODUCTION

Autoerotic deaths are rare events. The death scene is often bizarre and the death unexpected, thus often requiring forensic autopsies. Our analysis will provide an overview of the expected range of causes and manners of death in cases of autoerotic deaths.

METHODS

A retrospective analysis was carried out on all scientific and forensic autopsies and postmortem examinations performed at the Department of Legal Medicine in Hamburg, Germany, over the period of 2004-2018.

RESULTS

25 cases of autoerotic fatalities were identified over this 15-year-period or one to two cases per year, respectively. Autopsies were carried out on 23 of these cases. 16 (64%) of the cases involved autoerotic accidents and 7 (28%) from internal causes of death during an autoerotic act. Two cases had not undergone an autopsy. On average, those who were involved in autoerotic accidents had been younger in age (average age: 37 years) than the individuals who died from internal disease (average age: 61 years). Only one woman was involved. The most common cause of death in autoerotic accidents was strangulation (hanging: 8 cases, ligature strangulation: 1 case), followed by smothering of the respiratory tract (4 cases). Fatal intoxication was diagnosed in three of the cases. Fatalities with natural cause of death solely involved cardiovascular causes of death.

CONCLUSIONS

Autoerotic deaths involved a wide range of natural and non-natural causes of death. The reconstruction of such unusual cases and detection of non-natural fatalities requires thorough investigation of the scene of death as well as a postmortem external and internal examination including a chemical toxicological and blood alcohol analysis.

An examination of autoerotic asphyxiation in a community sample

Autoerotic asphyxiation (AEA) is a sexual interest that involves heightening sexual arousal by deliberately self-inducing a reduced supply of oxygen to the brain. Most of the literature on AEA is comprised of case studies and research based on people who have died from the practice. The present study explored information about AEA practices and the degree of overlap between AEA and other paraphilias in community participants. Participants (n = 395) were recruited through different online platforms to complete an anonymous survey and 165 were classified as having AEA by reporting mild to strong sexual arousal in AEA. These individuals reported that their interest emerged in late adolescence, and many reported that they discovered AEA via the internet. Regarding safety precautions people take during their AEA practice, 19% of participants reported that they did not use safety precautions. Most people (> 80%) were not distressed by their AEA interest. Additionally, significant relationships were found between AEA interest and many paraphilic interests with masochism being the only paraphilia associated with AEA when considering other paraphilic interests. These results suggest that most individuals engage in less risky manifestations of AEA than what is reported in the clinical literature and that AEA is appropriately conceptualized as a subtype of masochism. The results underscore the importance of gathering information about alternative sexual practices in community samples.