Accidental autoerotic deaths between 1978 1997

Institute of Legal Medicine, Medical School Hannover

D. Breitmeier a,*, F. Mansouri a, K. Albrecht a, U. Bhm b, H. D. Trger a, W. J. Kleemann b
a

Institute of Legal Medicine, Medical School Hannover, Carl-Neuberg-Str. 1,

D-30625 Hannover, Germany

b

Institute of Legal Medicine, University of Leipzig, Johannisallee 28,

D-04103 Leipzig, Germany

Abstract
Between 1978 and 1997 the Institute of Legal Medicine of the Hannover Medical School
examined 17 fatal autoerotic deaths. The incidence for the Hannover region was 0.49 cases
per 1 million inhabitants per year. The victims included 17 men with an average age of 36.8
years; a peak in the age distribution was seen between 20 and 29 years. 12 of the men were
found by friends or family in a domestic environment, while other situations in which the
victims were found included the victims own car, a hotel room, a canal embankment, a
public parking lot as well as the holding cell of the youth detention center. The men were of
varying socioeconomic status and held a number of different types of jobs or still attended
school. 5 of the men were found completely nude, while 5 were only undressed below the
waist. 4 men wore womens clothes and 2 were fully clothed with exposed genitals.
Besides womens clothes, other objects found at the scene included various types of sexual
aids, including ropes, chains, metal bars, locks, sex magazines, condoms, plastic bags,
rubber items, etc. In four cases blood alcohol levels between 0.1 and 2.5 (urine alcohol
levels between 0.2 and 2.5 ) were found. Toxicologic examination revealed chloroform,
ketamin, a propane-butane gas mixture in one case each, and in two cases cocaine and
morphine. Causes of death included central paralysis after strangulation (7 cases),
*

Corresponding author: Tel.: 0511 532 4599, Fax: 0511 532 5635, e-mail: breitmeier.dirk@mh-hannover.de

asphyxiation (4), subarachnoid hemorrhage (2), intoxication (1), hypothermia (1), left heart
failure (1), and drowning (1). The history, findings at scene, and autopsy findings and, in
individual cases, other investigations are of utmost importance to accurately reconstruct a
fatal autoerotic accident.
Keywords: autoerotic accident, accidental autoerotic death, cause of death, death scene,
psychical and social personality
Introduction
A portion of autoerotic accidents results in serious injury of varying degree; many of these
injuries are not recognized or not reported [1]. Fatal autoerotic accidents that are not
specially designated in the cause-of-death statistics, are often found in the forensic
literature in the form of case reports. These deaths are also partially labelled as suicides [710] due to the in part unusual circumstances in which the body is found [2-6]. Homicides
have also been known to be disguised as an autoerotic accident [11]. However, despite the
frequent description of these accidents, little is known about their incidence.
The aim of this work was to retrospectively gather epidemiologic data and to describe the
characteristics of the circumstances in which the body was found as well as autopsy results
for fatal autoerotic accidents in the jurisdiction of the Institute for Legal Medicine at the
Hannover Medical School between 1978 and 1997.
Materials and Methods
All cases of legally-mediated autopsies and viewings of bodies in the Institute for Legal
Medicine at the Hannover Medical School as well as the case files of district attorneys
offices were evaluated. This work considers all fatalaties occurring during autoerotic
activity as accidental autoerotic deaths (AAD), regardless whether the death is natural or
not.

Results
Between 1978 and 1997 the Institute of Legal Medicine of the Hannover Medical School
performed 15,687 forensic examinations (autopsies, viewing of bodies). The analysis of this
data revealed seventeen fatal autoerotic deaths. An autopsy was performed in fifteen cases,
in two cases the body was only viewed (Case 1-17). Eleven victims died in the Hannover
region, six within the jurisdiction of the Institute for Legal Medicine in the areas around
Hannover. All victims were males between the ages of 16 and 76 years (Table 1). One of
the men was widowed, three were married, and thirteen were single. The cases included
five employed men, four were unemployed, two engineers, two repairmen and one retiree,
one school-age boy, and one architect. In one case it was not possible to identify the
victims occupation.
Twelve men died in their own or their parents apartments. Other locations in which the
victims were found included: car, a jail cell of the juvenile jail, a hotel room, a frozen canal
and a parking lot. Ten of the victims were known by friends and family. The other seven
victims were found by police, firemen, a jail guard, a colleague at work, a passerby as well
as a maid.
Four of the victims were wearing womens clothes when they were found (Table 2).
Sexual aids that were found on or around the corpse are listed in Table 3. Traces of sperma
was found on the body or clothes of nine victims.
Sexually deviant behavior prior to the fatal incident could be identified in 3 of the men. In
one case a videotape was found, in which the man had filmed himself during autoerotic
activity. In a second case a married man was involved in sexual contact with prostitutes,
with whom he undertook unusual techniques; one homosexual man undertook increasingly
aggressive sadomasochistic techniques in the time before his death. Friends and family
questioned by police indicated they had noticed no clues of any autoerotic activity while the
victims were still alive.

The influence of alcohol could be shown in 4 of the men. The following blood-alcohol
concentrations (BAC) and urine-alcohol concentrations (UAC) could be determined:
Case 1

BAC 1.4

UAC 1.9

Case 4

BAC 1.3

UAC 2.5

Case 5

BAC 0.1

UAC 0.2

Case 14

BAC 0.6

UAC not measured

Toxicologic analysis revealed the following substances: the anesthetic Ketamin in the
therapeutic range (1-6 g/ml) was found in Case 16 (2.5 g/ml), chloroform in Case 11, a
propane-butane gas mixture inhaled from a plastic bag was found in Case 17. Cocaine or
morphin derivatives were found in two cases (13, 14). Three men (Cases 9, 13, 14) were
known to police as consumers of illegal drugs.
Seven men (41.2%) died as a result of strangulation, four (23.4%) died secondary to
asphyxiation due to rebreathing, and two died of a subarachnoid hemorrhage after ruptur of
an aneurysm of a congenital vascular abnormality in the Circle of Willis. Other courses of
death included acute left heart failure, intoxication, hypothermia, and drowning.
Discussion
Since not all regions fell under the jurisdiction of the Institute for Legal Medicine of the
Hannover Medical School for the entire study period, the frequency of fatal autoerotic
accidents was only calculated for the City and County of Hannover. The eleven cases of
autoerotic accidents occurring in this region, for which the average population was
1,127,000 over the 20-year study period, results in an incidence of 0.49 cases/million
inhabitants per year. A similar or slightly higher incidence was also calculated for other
regions [2-17]. In light of our calculations and those found in the literature, the death rate in
Germany attributable to autoerotic accidents is approximately 40 to 80 deaths per year.

However, a certain number of cases may be missed, as the circumstances surrounding the
discovery of the victim might not always be clear; evidence may even be destroyed by
family or friends of the victim out of shame [13, 18]. Unfortunately not every case
underwent autopsy. In the literature one report describes a case in which a homicide was
framed as an autoerotic accident [11, 19].
Almost all victims were found in a location that was either familiar to them or in which
they felt they would not be disturbed or watched. The doors at the scene were often locked.
Access to the corpse was often uncomplicated if the victim lived alone.
As reported in the literature [12, 18, 24], our study found approximately 30% of the men
were not clothed, while approximately 25% were wearing womens clothes (often
underwear) when they were found. This type of attire presumably provides additional erotic
energy, thereby increasing the level of arousal. [26].
A total of eight men were under the influence of alcohol, drugs, medications, or other
chemical substances in our study. The medication found in Case 16, Ketamin, is used in the
field of Emergency Medicine, and creates a state of dissociative anesthesia [27]. Case 17
involved the inhalation of the aliphatic hydrocarbone propane and butane via a plastic bag;
these gases can precipitate often fatal arrhythmias through stimulation of the vagus nerve
[28]. Recent reports have describe an increased incidence of the abuse of gas inhalation in
either pure form or as a mixture [20, 29, 30]. Inhalation of a local anesthetic [31], propane,
laughing gas, and tetrachlorethylene [32-34] have been described. Toxicologic analysis
revealed cocaine metabolites and morphine derivates in one case. The change in mental
status and decreased reaction time associated with these substances could also play a role in
the failure of safety mechanisms and the lack of the victims ability to save themselves
[24]. In six of seven cases such safety mechanisms were in evidence. The men therefore
setainly seemed aware of the danger inherent in self-strangulation. States of oxygen
deprivation were created not only by strangulation, but also through the introduction of
various objects into the oral cavity (socks, rubber balls, etc.) or by enclosing the victims

head in plastic bags, which in some cases were even fastened closed in some manner. Often
you can only speculate about the victims prior experience regarding autoerotic fantasies
[12]. The presence of sexually explicit magazines and pamphlets detailing, for example,
bondage methods, provides evidence that the victim had previous experience with these
topics.
Strangulation was the most common cause of death in our study. The fact that the
strangulation results in a relatively rapid state of hypoxia, which subsequently leads to an
increase in sexual excitement and/or a more intensely experienced orgasm, as well as the
methods ease of use, is in our opinion largely responsible for the high incidence of selfinflicted hypoxia in the setting of autoerotic acts. This form of autoeroticism is also known
as hypoxiphila, sexual asphyxiation or autoerotic asphyxiation [12, 36, 37]. These
behaviors are categorized as masochism or tranvestic fetishism if the victim wears clothes
of the opposite sex [38].
Because of the complexity of each individual case, it is often difficult to differentiate
whether the case should be considered a homicide, an accident, or a suicide. The evidence
gathered during an autopsy can often only be evaluated as a whole when analyzed together
with the history. Therefore it is of utmost importance that the circumstances in which the
victim was found, evaluation of data gathered at crime scene by an experienced forensic
pathologist, and elucidation of the victimss social situation should be considered together
in the evaluation of these types of cases.

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Table 1: Age distribution

Table 2: Clothing worn by victims at discovery
Table 3: Unusual circumstances found upon discovery of the victim

10

Table 1
Age distribution
Age (Years)
> 20
20-29
30-39
40-49
50-59
60-69
70-79

Number of
cases
1
6
5
3
0
0
1

11

Table 2
Clothing worn by victims at discovery
Clothing
None
Naked lower body half
Wearing women's
clothes
Exposed genitals
Fully dressed

Number of cases
5
5
4
2
1

12

Table 3
Unusual circumstances found upon discovery of the victim
Objects and/ or aids found
on or around the body

Aids found on or in direct

proximity of the body

Other items found in the

surrounding area

women's clothes:
bras
nylon and net pantyhose
women's lace underwear
stiletto heels

gauze
eye patches
foley urinary catheters
syringes
handcuffs
metal bars/ chains
belts
oxygen/ other gas tanks

narrow bore metal chains

sex magazines
rubber vagina
opened vaseline container
aluminium ladder as support
mirrors
condoms
pressure cuff for the male sexual
organ
handcuff keys
medications

padlocks
tennis balls
gym socks (as breast substitute)
condoms
electric cables
plastic bags
leather balls

13