Autoerotic death: incidence and age of victims--a population-based study

A Case of Accidental Autoerotic Death by Hanging Linked to Erotic Photography

Autoerotic death, as a subtype of mechanical asphyxia, refers to a person's fatal outcome while engaging in solitary sexual activity using various devices and methods to reduce oxygen supply and induce cerebral hypoxia, leading to increased sexual gratification. These asphyxial deaths are accidental and sporadic. In cases of sexual asphyxia, especially when strangulation methods such as hanging or ligature are used, thorough crime scene investigation is crucial to determine the type of asphyxia and the manner of death. Inadequate information about specific crime scene findings can lead to significant errors in determining the manner of death and the type of strangulation, potentially leading to cases being mistaken for ligature strangulation in a homicidal manner or hanging in a suicidal manner.

Electrocuted to death: A case of an autoerotic fatality with body wrapping, anal masochism, and low abdomen mechanical stimulation

Autoerotic paraphilic manipulations may be not only incredibly unusual but also hazardous and possibly fatal. Autoerotic experimenters sometimes combine several paraphilic mechanisms, both potentially lethal and non-lethal. A tragic outcome is usually a direct consequence of the life-threatening paraphilic mechanism(s); however, it may also result from an accidental complication arising from the constellation of the paraphilic realization. In this report, we present a case of an autoerotic death of a 30-year-old man who applied two potentially lethal paraphilic mechanisms-body wrapping and foreign body anal insertion-together with two other non-lethal paraphilic activities, autofetishism and transvestitism. However, the man's death ultimately occurred due to another associated autoerotic activity-stimulation of the lower abdomen with an electric massager, which accidentally short-circuited and caused fatal electrocution. Such autoerotic fatalities constitute a distinct subcategory of accidental autoerotic death.

The Mental Capacity Act 2005 and autoerotic asphyxiation: pleasure versus the risk of harm

There has been a series of judgments in recent years emanating from the Court of Protection in England and Wales involving sexual relations. One such judgment is unique in that it is the first time the court has assessed capacity in the sexual practice of autoerotic asphyxiation in a person with a diagnosis of autism spectrum disorder. This article reviews the judgment and specifically the key section of the Mental Capacity Act 2005, section 27, which applies to capacity decisions in the context of family relationships, including sexual relationships. The practice of autoerotic asphyxia can be a complex and emotive subject and dangerous to individuals undertaking it. The judgment provides guidance and a framework for applying the Act to assess the capacity of someone practising autoerotic asphyxia that can be used in clinical practice for people with any mental disorder.

How safe is BDSM? A literature review on fatal outcome in BDSM play

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.

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.

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.

Non-Natural Death Associated with Sexual Activity: Results of a 25-Year Medicolegal Postmortem Study

INTRODUCTION

Non-natural deaths associated with sexual activity may occur either with or without the involvement of other persons.

AIM

The present study provides an overview of cases of non-natural death related to sexual activities as well as recommendations of how to handle these cases and to identify potentially dangerous pleasure-enhancing techniques.

METHODS

This medicolegal, postmortem, retrospective, and prospective study is based on data of autopsies performed at the Institute of Legal Medicine at University Hospital, Goethe University, Frankfurt, Germany.

MAIN OUTCOME MEASURE

Identification of circumstances, sexual practices, and gender distribution of cases of non-natural death in this context.

RESULTS

Between 1993 and 2017 (25 years), 16,437 medicolegal autopsies were performed, of which 74 cases (43 males, 31 females) of non-natural death were found to relate to sexual activities (0.45%). One female and 21 males had died in the course of autoerotic practices (group I, n = 22). Nine males and 14 females had performed sexual practices with mutual consent (group II, n = 23), and 13 males and 16 females without mutual consent (group III, n = 29). The average age in group I was 45.4 years; in group II, 40.6 years; and in group III, 39.2 years. Most of the deceased were found in their own apartments. Forms of stimulation included vaginal, anal, and oral intercourse; insertion of foreign bodies; use of chemical substances; and tools for respiratory depression/hypoxia. Three cases of death occurred during sexual activities involving bondage and discipline, sadism, and masochism (BDSM). Death due to strangulation was the main cause in group I, whereas intoxications were predominant in group II. Sharp force (eg, knife) was mainly responsible for death in group III. Anogenital injuries were documented in all groups in approximately equal percentages.

CLINICAL IMPLICATIONS

The cases presented show a high variety of circumstances in which non-natural death connected to sexual activity may occur.

STRENGTHS & LIMITATIONS

This study presents a large postmortem collection of non-natural death cases with associated sexual activity. As the main limiting factor, it must be stated that mutual consent for a sexual practice or consumption of substances was presumed based on the information provided and a lack of evidence against this assumption.

CONCLUSION

In cases of death associated with sexual activity, medical staff should perform thorough unbiased examinations and documentations. Strangulation and the consumption of stimulants should be classified as life-threatening, pleasure-enhancing techniques. Patients and young people should be informed about these risks. Bunzel L, Koelzer SC, Zedler B, et al. Non-Natural Death Associated with Sexual Activity: Results of a 25-Year Medicolegal Postmortem Study. J Sex Med 2019;16:1547-1556.

The utility of medico-legal databases for public health research: a systematic review of peer-reviewed publications using the National Coronial Information System

BACKGROUND

Medico-legal death investigations are a recognised data source for public health endeavours and its accessibility has increased following the development of electronic data systems. Despite time and cost savings, the strengths and limitations of this method and impact on research findings remain untested. This study examines this issue using the National Coronial Information System (NCIS).

METHODS

PubMed, ProQuest and Informit were searched to identify publications where the NCIS was used as a data source for research published during the period 2000-2014. A descriptive analysis was performed to describe the frequency and characteristics of the publications identified. A content analysis was performed to identify the nature and impact of strengths and limitations of the NCIS as reported by researchers.

RESULTS

Of the 106 publications included, 30 reported strengths and limitations, 37 reported limitations only, seven reported strengths only and 32 reported neither. The impact of the reported strengths of the NCIS was described in 14 publications, whilst 46 publications discussed the impacts of limitations. The NCIS was reported to be a reliable source of quality, detailed information with comprehensive coverage of deaths of interest, making it a powerful injury surveillance tool. Despite these strengths, researchers reported that open cases and missing information created the potential for selection and reporting biases and may preclude the identification and control of confounders.

CONCLUSIONS

To ensure research results are valid and inform health policy, it is essential to consider and seek to overcome the limitations of data sources that may have an impact on results.