A case of female autoerotic death

Behavioral Treatment for a Female Engaging in Autoerotic Asphyxiation

Once thought to be a phenomenon only practiced by men, autoerotic asphyxiation, a form of sexual masochism that is life-threatening, has been documented in women. This case study presents a 22-year-old college female with comorbid depression and avoidant personality disorder complaining of the use of autoerotic asphyxiation during masturbation. This female was a virgin and reported that asphyxiation by use of a ligature had always been used since puberty during masturbation and was necessary for her to obtain orgasm. This behavior was conceptualized within an obsessive-compulsive cycle. Covert systematic desensitization using her written sexual fantasy across 10 psychotherapy sessions was able to neutralize the power of the fantasy to elicit orgasm. Subsequent behavioral deterrents and experimentation with a vibrator enabled this female to reach orgasm without engaging in asphyxiation. Following this success, psychotherapy continued to focus on managing her depression and avoidance tendencies.

Autoerotic asphyxiation: secret pleasure--lethal outcome?

OBJECTIVE

Voluntary asphyxiation among children, preteens, and adolescents by hanging or other means of inducing hypoxia/anoxia to enhance sexual excitement is not uncommon and can lead to unintended death. This study addresses autoerotic asphyxiation (AEA) with the intent of increasing pediatricians' knowledge of the syndrome and awareness of its typical onset among young patients. AEA is characteristically a clandestine and elusive practice. Provided with relevant information, pediatricians can identify the syndrome, demonstrate a willingness to discuss concerns about it, ameliorate distress, and possibly prevent a tragedy.

METHODS

A retrospective study was undertaken of published cases both fatal and nonfatal and included personal communications, referenced citations, clinical experience, and theoretical formulations as to causation. Characteristic AEA manifestations, prevalence, age range, methods of inducing hypoxia/anoxia, and gender weighting are presented. All sources were used as a basis for additional considerations of etiology and possibilities for intervention.

RESULTS

AEA can be conceptualized as a personalized, ritualized, and symbolic biopsychosocial drama. It seems to be a reenactment of intense emotional feeling-states involving an identification and sadomasochistic relationship with a female figure. Inept AEA practitioners can miscalculate the peril of the situation that they have contrived and for numerous reasons lose their gamble with death.

CONCLUSIONS

Pediatricians should be alert to the earliest manifestations of AEA. Awareness of choking games among the young and, of those, a subset who eventually progress to potentially fatal AEA is strongly encouraged among all primary care professionals who may be able to interrupt the behavior.

Autoerotic death--characteristic features and diagnostic difficulties

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.

Autoerotic Deaths in the Literature from 1954 to 2004: A Review

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.

Accidental electrocution during autoeroticism: a shocking case

A case of atypical autoerotic death is described. An 18-year-old white man clad in two brassieres was found dead in his bedroom by his brother. Two wet green terry cloths were under the brassiere cups, connected to the house current via two metal washers and a bifid electrical cord. Literature depicting nude women was found near the victim. Autopsy revealed second-degree and third-degree burns of the mammary regions. Death was attributed to accidental self-electrocution. The authors will discuss typical and atypical forms of autoerotic death.

Suicide by proxy: a case report of juvenile autoerotic sexual asphyxia disguised as suicide. A common occurrence?

The confusion and embarrassment felt by a person discovering a body who has died through sexual asphyxia is likely to be considerable. Attempts may be made to disguise the nature of the death to medical attendants and to investigating police officers. A high level of suspicion and a knowledge of the characteristic findings seen in sexual asphyxia are important for the correct determination of the cause of death. This report describes the death of a 12-year-old boy in the Midlands, UK, in 1977. An open verdict had been recorded by the coroner. I Further evidence coming to light 17 years later appears to suggest that death was in fact due to autoerotic sexual asphyxia.

Autoerotic Asphyxiation: A Challenge to Death Educators and Counselors

Autoerotic asphyxiation is a form of erotic activity that has been practiced in many cultures for many years. It has been estimated that approximately 250–1000 deaths each year in the United States are the result of hangings that were intended to enhance sexual excitement. Educators and counselors may be called upon to respond to concerns about autoerotic asphyxiation both in general and in its sometimes lethal consequences. Family members and friends of people who have died in this way may have complicated grief responses because of the unanswered questions and anxieties that are likely to be aroused by autoerotic asphyxiation. Professional caregivers may also be disturbed by this seldom-discussed connection between sexuality and death. There may also be mistakes made in determining whether the death was accidental or the result of suicidal intent. Attention needs to be given to the individual's self-rescue mechanism. This article reviews the scattered literature on autoerotic asphyxiation and includes observations by two psychiatrists and a medical examiner. Much remains to be learned about this practice and the circumstances that lead to a fatal outcome.

The emergency department management of near-hanging victims

A 7-year retrospective review was performed to assess the complications of near-hangings injuries. Thirty-nine cases of near hanging were seen during this period. There were no hanging drops greater than 5 feet and no cervical spine fractures. One patient required intubation for soft tissue swelling. The adult respiratory distress syndrome (ARDS) occurred in three patients. All victims with field Glasgow Coma Scale levels >3, and three of eight with GCS = 3 survived to discharge with a normal mental status. We conclude that aggressive resuscitation and treatment of postanoxic brain injury is indicated even in patients without evident neurologic function in the field, as full recovery may still occur. Cervical spine fractures have not been reported in near-hanging victims and should only be considered if there is a possibility of a several foot drop or if a focal neurologic deficit is present. Injury to the anterior soft tissues of the neck may cause respiratory obstruction. Close attention to the development of pulmonary complications is required.

Sexual asphyxiophilia (Koczwarism) in women and the biological phenomenon of female ejaculation

Life threatening eroticizing behavior, asphyxiophilia (sexual asphyxia) is practiced in women, as in men, in order to heighten sexual excitement and to achieve orgasm, which is in some women accompanied by expulsions of fluid (ejaculation) from the urethra. The relatively easily achieved orgasm induced by the mechanism of asphyxia is hypothesized to be the common reason for repetitive deviant asphyxiophilic behavior. Moreover, in women of the ejaculatory type (female ejaculators), the desire to induce ejaculatory orgasm by asphyxia may also come into play as this kind of orgasm is usually assessed as sensation of greater delight than orgasm without ejaculation.

Autoerotic asphyxial deaths: analysis of nineteen fatalities in Alberta, 1978 to 1989

This paper presents an unusual form of sexual (masturbatory) activity and brings this unusual cause of death to wider medical attention and understanding. All 19 cases of autoerotic asphyxial death that occurred between 1978 and 1989 in the province of Alberta, Canada were reviewed. The fatal victim of autoerotic asphyxia is typically a single male aged 15 to 29 years. Autoerotic sexual activity is typically performed in isolation; often there is evidence of repetitive practice. The accidental death usually results when the "safety" mechanism designed to alleviate neck compression fails. Often the first sign of the activity (usually a surprise to family and friends) is death itself. Physicians who are alert to the practice may suggest counselling when patients present with sexual concerns, unusual marks around the neck or evidence of abrasions to limbs suggesting bondage or other masochistic practices.

A comparison of typical death scene features in cases of fatal male and autoerotic asphyxia with a review of the literature

Autoerotic asphyxia is an increasingly recognised syndrome in which accidental death occurs during solitary sexual activity due to failure of an apparatus that was designed to produce hypoxic augmentation of the victim's sexual response. Evidence of repetitive, secretive behaviour utilizing ropes and ligatures characterizes cases involving either males or females. Here the similarity in reported cases ends with males tending to utilize a far greater range of elaborate devices and props, often designed to cause real or simulated pain with pornographic material and evidence of cross-dressing and fetishism. Females, on the other hand, have usually been found naked with only a single ligature and no unusual or bizarre equipment. To further clarify the similarities and differences between typical cases involving males and females and to assist in the diagnosis of less obvious cases, the literature is reviewed and characteristic findings in both sexes compared and contrasted.

Fatal air embolism during female autoerotic practice

Air embolism has been described in pregnant women and is a classic cause of death during attempted abortion by syringing. Death was caused by the introduction of an amount of air sufficient to cause a substantial air lock in the heart, pulmonary trunk or arteries. If the surface of the placenta has been stripped by the syringe, venous spaces are opened and air can pass into the circulation. Orogenital sex with vaginal insufflation can also cause air embolism during pregnancy. We report a case of air embolism in a 40-year-old non-pregnant woman subsequent to vaginal insertion of a foreign body (carrot) for an autoerotic purpose. The mechanism is roughly similar to syringing, the foreign body acting like a piston to displace a sufficient amount of air. In the present case, the endometrium stripping was probably due to the presence of an intrauterine device. As such risks may often be encountered and as, to our knowledge, no similar case has previously been reported, we may speculate if such air embolisms are underdiagnosed or dissimulated by the partners when questioned by the medical rescue teams.