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Pathology (1994), 26, pp.

276-280

AUTOEROTIC DEATHS: FOUR CASES


C L I V E TREVOR COOKE, G E R A R D A N D R E W C A D D E N AND
KARIN ANN MARGOLIUS

Forensic Pathology, State Health Laboratory Services, Queen Elizabeth H Medical Centre,
Nedlands, Western Australia

Summary The body was dressed in female clothing, including panties, a bras-
siere, camisole, suspenderbelt and black stockings, and was partly seated
We describe the circumstances and post mortem medical on a chair (Fig. 1). Suspension was from a roof rafter, with a petticoat
findings of 4 unusual fatalities where death occurred during extendingfrom the neck of the deceased to a wire which was tied around
autoerotic practice. Three cases occurred in young to middle- the rafter. The left leg was also suspended from the rafter, by a separate
aged men - - hanging, electrocution and inhalation of a zucchini. ligatureof further femaleclothing. The penis and scrotum were exposed,
The manner of death in each was accidental. The fourth case with a belt and 6 elasticized bands tied around the scrotum. Alongside
was an elderly man who died of ischemic heart disease, the body were ladies' underwear, hair wigs and 2 pornographic maga-
zines, one depicting sexual activity.
apparently whilst masturbating with a vacuum cleaner and a hair
The autopsy showed the body of a middle-agedman of normal build.
dryer.
The facial skin was suffused. There were numerous petechiae, around
and on the eyes. A ligature mark encircled the neck. The penis was
Key words:Autoeroticdeaths, electrocution,asphyxia,inhaledforeignbody.
engorged and semi-erect.
Accepted 15 February, 1994 Internal examination showed mild pulmonary congestion but no
further abnormality. There was no injury to the neck tissues. There
were no epicardial or visceral pleural petechiae.
INTRODUCTION Toxicological study showed a blood alcohol level of 0.131 g%;
S u d d e n death occurring d u r i n g autoerotic sexual activity common drugs were not detected.
is a well recognized p h e n o m e n o n . It appears that the most Further enquiry revealed that the deceased was born the youngest
of 3 children, and had suffered from enuresis until his early teens. He
c o m m o n type o f a u t o e r o t i c d e a t h is a s p h y x i a t i o n due to
had been married for '18 yrs: The year prior to his death his wife had
neck c o m p r e s s i o n c o n s e q u e n t to h a n g i n g , with m a n y found female clothing and pornographic magazines amongst his
reports defining this condition.t-19 Other case reports a n d belongings, which she had disposed of by burning. The basement of
series have d r a w n a t t e n t i o n to m o r e u n u s u a l a u t o e r o t i c the house where his body was found was freely accessible from the
deaths, sometimes referred to as " a t y p i c a l " because outside. Although the house was owned by the local church and used
a s p h y x i a t i o n is n o t a feature. 2 These include deaths due as a child care centre during the day, the basement was apparently a
to electrocution, 21-23 a b d o m i n a l c o m p r e s s i o n , z4 i n h a l a - well-known evening haunt of the local homosexual community.
t i o n oof v o l a t i l e a g e n t s , 2'2s'26 w r a p p i n g , s'27-a
submersion, al self-catheterization,32 a n d the use o f power
hydraulics. 33 C o m m o n to all o f those o f course, is the
use of artificial m e a n s to heighten sexual arousal, with
a fatal result. T h e r e are also rare reports of deaths of a
n a t u r a l cause, u s u a l l y ischemic heart disease, d u r i n g
a u t o e r o t i c sexual activity. 6'34 Little has b e e n p u b l i s h e d
a b o u t a u t o e r o t i c deaths i n A u s t r a l a s i a . a'21
I n W e s t e r n A u s t r a l i a d u r i n g the 8 yr period 1985-92
there were 7 deaths which were recognized to be related
to a u t o e r o t i c practice. As each o f the deaths was u n -
expected, a report was m a d e to the Coroner. I n each case,
post m o r t e m medical e x a m i n a t i o n was u n d e r t a k e n by a
forensic p r a c t i t i o n e r o f this office. O f the 8 cases, 4 were
a c c i d e n t a l h a n g i n g s , o n e o f which is herein described as
representative. A d d i t i o n a l l y , there were 3 n o n - h a n g i n g
deaths which will each be described - - one due to electro-
c u t i o n , a n o t h e r due to c h o k i n g following i n h a l a t i o n o f
a zucchini, a n d the third o f ischemic heart disease.

CASE REPORTS
Case t: Hanging
The body of a 48 yr-old man was found suspended by the neck in the Fig. 1 Accidental asphyxiation due to hanging. There is a cross-
cellar of a suburban house. He had been last seen alive5 days previously. dressing of the male victim.
AUTOEROTIC DEATHS: FOUR CASES 277

Figs. 2a and 2b Patterned, superficial electric burn marks on the skin of the abdomen (2a: magnification 0.5) and penis (2b: magnification x 1.5).

Case 2: Electrocution the base of the penis. The negative wire of the electric cord was in contact
The body of a 32 yr old man was found lying supine on the bed in his with the chest of the deceased; the earth wire was tucked into the
quarters, in a country mining town. He had been last seen alive 3 days rubber/fabric shroud of the cord. At the site of contact with the negative
previously, when he had been drinking in the bar. wire on the chest was an electric burn to the skin extending into
The body was naked, showing changes of decomposition. A braided subcutaneous fat. A further, patterned, superficial electric burn mark
flexible electric cord extended from a wall-mounted electric plug extended down the left side of the abdomen and around the base of
(switched " o n " ) to the left side of the chest. The cord had been taken the penis, the pattern corresponding to that of the neck chain (Figs.
from an electrical appliance; the appliance plug had been removed from 2a and 2b).
the cord, bare wires being thus exposed. Attached to one of the live Autopsy examination showed changes of decomposition, but was
wires of the electric cord was a 45 cm long metal neck chain, extending otherwise unremarkable. Identification was established by fingerprint
down the left side of the abdomen to a single loop wrapped around comparison.
Toxicological study demonstrated the presence of alcohol in the blood
(0.229 g%) and bile (0.205 g%). It is unlikely that all of this is explained
by post mortem generation due to decomposition.
The electrical apparatus was assessed by professional inspectors. The
metal chain had an electrical resistance of about 100 megohms, greater
when the chain was slack but less when straightened and taut; skin
contact with either the bared wires or more proximal part of the chain
was expected to be particularly dangerous.
Further enquiry revealed the man to be separated from his wife; he
lived in single-mens quarters of a mining company. He had recently
travelled overseas where it is believed he learnt of the autoerotic use
of electricity. The electric voltage overseas was less than half that of
the mining town (110 V as compared with 240 V throughout Australia).

Case 3: Choking
Early one afternoon a middle-aged couple were disturbed by frantic
knocking at the front door of their home. At the door was their neigh-
bout, a 29 yr old man, holding his abdomen and trying unsuccessfully
to talk. The man collapsed to the ground, and died despite attempts
at resuscitation.
The autopsy showed a young man of normal build. The body was
dressed only in trousers, with the waist button unfastened. Removal
of the trousers showed the penis to be semi-erect; around the base of
the penis was a rubber band. On the lower abdomen and in the groin
was dried, white coloured material, subsequently identified as semen.
There were no petechiae on the facial skin or on the eyes.
Internal examination showed a zucchini impacted in the larynx and
oropharynx, totally occluding the airway (Fig. 3). The laryngeal mucosa
showed minor, fresh bruising but was otherwise unremarkable. General
internal examination revealed occasional petechiae on the visceral pleura
of both lungs, but no further evident abnormality'. There were no
epicardial petechiae.
Toxicological study did not identify alcohol or common drugs.
Further enquiry revealed that the deceased had been married for 2
yrs at the time of his death. He was casually employed but, unlike his
Fig. 3 Posterior view of tongue, larynx and trachea, showing wife, was not working on that day. The couple grew zucchinis in their
impacting of' zucchini. backyard garden.
278 COOKEet aL Pathology (1994), 26, July

activity. Correct definition of the nature of the death rests


largely on adequate examination of the scene. Typical
features include: a degree of undressing, commonly with
exposure of the genitalia; cross-dressing or evidence of
female clothing fetishism; pornographic literature; the
presence of a mirror; penile engorgement or semen consis-
tent with recent ejaculation; and some form of
bondage. L4'6 When the body is discovered by a family
member, an attempt to hide the true nature of the death
may be made. as Correct identification of the nature of
the death is essential, not least because of possible life
insurance consequences if the manner of death is
mistakenly held as suicide rather than accident. 4
A recently published monograph described 157
autoerotic fatalities, a7 Of these, 132 (84%) died by
asphyxiation - - that is, mechanical interference with
respiration or cerebral oxygenation - - making this the
most common mechanism of death. In 105 cases the
asphyxia was induced by self-suspension; other methods
included self-strangulation, plastic bag suffocation, chest
compression and body inversion. Indeed, the majority
of other publications on fatal autoeroticism are of similar
asphyxial deaths, focusing particularly on hanging. There
are, however, isolated case reports of more unusual
asphyxiation techniques, including use of an abdominal
ligature, 24 wrapping s'27-3 and inhalation of irrespirable
g a s 20,25, 26
Of the 7 autoerotic fatalities in Western Australia
during the 8 yrs 1985-92 there were 4 autoerotic hanging
deaths, representing approximately 1.5070 of the total
banging fatalities. The selected case is representative of
the standard features of these deaths, although somewhat
older than most; that is, a man suspended by the neck
Fig. 4 Scene photograph showing the body of an elderly man, in a discrete location, showing cross dressing, and an
adjacent to a vacuum cleaner.
"escape" mechanism to the ligature which, if properly
activated, enables rapid release of the rope. The ligature
is typically padded to prevent marking of the skin of the
Case 4: Ischemic heart disease neck.
The naked body of this 77 yr old widower was found in the bathroom As the body is usually incompletely suspended,
of his home (Fig. 4). Adjacent to the body, and switched on and commonly in the sitting position, there is little or no
working, were a vacuum cleaner and a hair dryer. A pair of men's under- injury to the neck tissues. As with most hanging fatali-
pants was impacted in the hose of the vacuum cleaner. ties the mechanism of death is believed to be carotid artery
Autopsy examination showed the body of an elderly man o f normal obstruction resulting in cerebral hypoxia. It would appear
build. There was no evident injury; in particular there were no apparent that, at the moment of orgasm, the fine line between a
marks of electrical injury. state of transient cerebral hypoxia and unconsciousness
Internal examination showed enlargement of the heart with exten-
may occasionally be crossed; once unconscious, the
sive ischemic fibrous scarring of the thickened left ventricular
individual is naturally helpless and, unless assisted by
myocardium. Extensive calcified coronary arteriosclerosis was present,
with no thrombosis. There was no significant valvular disease. The lungs
others, succumbs to fatal cerebral hypoxia.
were mildly congested and there was benign hypertensive nephrosclerosis. In the third case we describe, death resulted from
Toxicological analysis was unremarkable. choking on a foreign body (zucchini) in the upper airway.
The vacuum cleaner and hair dryer, together with the electric circuitry We have found no similar autoerotic death in the forensic
of the house, were assessed by an electrical inspector and cleared of medical literature, although one case in a series of 43 cases
malfunction. died from airway obstruction due to a gag in the mouth. 4
The cause of death was therefore believed to be combined arterio- In this latter case the gag was apparently being used for
sclerotic and hypertensive heart disease. The scene examination suggested the purposes of asphyxiation to heighten sexual response.
the likelihood that the electrical appliances were being used
In our case it appears more likely that the deceased was
autoerotically.
using the foreign body to simulate fellatio.
A separate group of "atypical" autoerotic deaths are
DISCUSSION those of electrocution, where electricity is used for sexual
Autoerotic deaths are typically unwitnessed, the death stimulation.2a-23 These 3 reports include 2 men who had
usually occurring in a discrete or isolated setting, electrical wiring taped to the nipples and extending into
reflecting the secretive nature of this type of sexual the rectum, 2a a passive homosexual with electrical circuitry
AUTOEROTIC DEATHS: FOUR CASES 279
connected to the scrotum and ano-rectal region, 22 and the thrill-seeking being associated with arousal and exhila-
a man electrocuted by a "live" table lamp, possibly being ration. 39 Others have suggested an association between
used to warm the genital area. 23 In one case 22 it may have autoerotic behaviour and strict, punitive parenting,
been that the deceased was electrocuted whilst attempting leading to the suggestion that an association between
to rectify a problem in the autoerotic electrical circuitry. cruelty and sexuality is formed, the former manifested
The electrical device is often connected to a voltage as sadomasochism with self-directed pain and humilia-
regulator, to enable deliberate variation of current flow tion. 12 Alternatively, is there eroticization of helplessness
and hence the degree of stimulation. In our case (Case and risk-taking, victory and a sense of success resulting
2) the amount of current flow could be changed by from survival? 14As indicated by Sheenan and Garfinke112
making contact with various parts of the neck chain, with "male and female, punishing conscience and guilty
lesser stimulation from the more distal parts of the chain. sinner, sadist and masochist, pain and pleasure, victim
The majority of deaths occur when the electrical gadg- and voyeur all seem to converge in a single act".
etry malfunctions, or when there is accidental contact
with a more active part of the circuit. It is probable that ACKNOWLEDGEMENTS Thanks are offered to Mr D. A.
the relative thinness of the skin of the genitalia, and McCann, Perth City Coroner, and Professor J. M. N.
indeed mucosal surfaces, may enable fatality at relatively Hilton. Mrs Lorraine Kinsey kindly typed the manuscript.
low voltages.
Sudden deaths due to a natural disease process, such Address for correspondence: C.T.C., Chief Forensic Pathologist, Forensic
as heart disease, are not well described in association with Pathology, State Health Laboratory Services, QEII Medical Centre,
autoeroticism; there are 2 case reports, both in men who Nedlands, WA 6009.
at autopsy showed significant arteriosclerotic cardio-
vascular disease. One was the case of a 61 yr old man References
who died whilst bound with chain restraints; a vibrator 1. Resnik HLP. Erotized repetitive hangings: a form of self-destructive
was nearby. 6 The second case was of a 57 yr old man behavior. Am J Psychother 1972; 26: 4-21.
whose body was found naked alongside a running 2. Sass FA. Sexual asphyxia in the female. J For Sci 1975; 20: 181-5.
vacuum cleaner; the testicles, thighs and buttocks were 3. Scott B. Sexual asphyxia. Aust Pol J 1975 (Apr); 85-90.
tightly bound with pantyhose. 34 Such deaths are prob- 4. Walsh FM, Stahl C J, Unger HT et al. Autoerotic asphyxial deaths:
ably less frequent than suddent natural death associated a medicolegal analysis of forty-three cases. In: Wecht CH, ed. Leg
with heterosexual or homosexual activity, particularly if Man Ann. New York, NY: Appleton-Century Crofts, 1977; 157-82.
with a novel partner. 35 5. Knight B. Fatal masochism - - accident or suicide? Med Sci Law
Although the first description of autoerotic asphyxial 1979; 19: 118-20.
deaths appeared in the American literature in the 1950s, 6. Hazelwood RR, Dietz PE, Burgess AW. The investigation of
the use of asphyxia as a means of enhancing sexual gratifi- autoerotic fatalities. J Pol Sci Admin 1981; 9: 404-11.
cation was apparently previously well-known. As 7. Hazelwood RR, Burgess AW, Groth AN. Death during dangerous
examples, neck compression with heterosexual activity autoerotic practice. Soc Sci med 1981; 15E: 129-33.
was known to generations of Eskimos, and the Marquis 8. Emson HE. Accidental hanging in autoeroticism. An unusual case
de Sade described the induction of erotic sensations by occurring outdoors. Am J For Med Path 1983; 4: 337-40.
self-suspension in his book "Justine", published in 1791 9. Wesselius CL, Bully R. A male with autoerofic asphyxia syndrome.
(see 1). Am J For Med Path 1983; 4: 341-5.
There is little information available on how knowledge 10. Hiss J, Rosenberg SB, Adelson L. "Swinging in the park"; an inves-
of the techniques is first learnt by participants. It would tigation of an autoerotic death. Am J For Med Path 1985; 6: 250-5.
appear, however, that descriptions occasionally appear 11. O'Halloran RL, Lovell FW. Autoerotic asphyxial death following
in sex manuals, pornographic literature, detective maga- television broadcast. J For Sci 1988; 33: 1491-2.
zines and the news media; fatalities have occurred 12. Sheehan W, Garfinkel BD. Adolescent autoerofic deaths. J Am
following television broadcasts on autoeroticism. 36"a7 Acad Chil Adolesc Psychiatry 1988; 27: 367-70.
The psychopathology of potentially life-threatening 13. Garza-Leal JA, Landron FJ. Autoerotic asphyxial death initially
autoerotic behaviour is not well understood. The gener- misinterpreted as suicide and a review of the literature. J For Sci
ally held view is that constriction of the neck heightens 1991; 36: 1753-9.
sensation, and hence the pleasure of orgasm, as a con- 14. Bell MD, Tate LG, Wright RK. Sexual asphyxia in siblings. Am
sequence of cerebral hypoxia and hypercapnia. However, J For Med Path 1991, 12: 77-9.
alternative proposals have been expressed. In 1972, 15. Byard RW, Bramwell NH. Autoerotic death: a definition. Am J
Edmondson suggested that autoerotic hanging reflected For Med Path 1991; 12: 74-6.
guilt about masturbation, the suspension being a form 16. Boglioli LR, Tuff ML, Stephens PJ et al. A case of autoerotic
of self punishment, as In that same year Resnik 1 suggested asphyxia associated with multiplex paraphilia. Am J For Med Path
1991; 12: 64-73.
these hangings were a result of either castration anxiety
(constriction of the neck symbolizing penile amputation) 17. Hazelwood RR, Dietz PE, Burgess AW. Autoerotic fatalities.
Lexington Books. DC Health and Company, 1983.
or oral conflict (the activity simulating infantile feeding,
rebirth or maternal reunion). He considered the act of 18. Byard RW, Hucker SJ, Hazelwood RR. A comparison of typical
death scene features in cases of fatal male and female autoerotic
masturbation as confirming the presence of the penis, asphyxia with a review of the literature. For Sci Intl 1990; 48:
thereby denying the amputation. Alternatively, it has been 113-21.
suggested that autoerotic activity may be a reflection of 19. Byard RW, Bramwell NH. Autoerotic death in females: an under-
the erotically arousing effect of danger and .risk, diagnosed syndrome? Am J For Meal Path 1988; 9: 252-4.
280 COOKEet aL Pathology (1994), 26, July

20. Gowitt GT, Hanzlick RL Atypical autoerotic deaths, Am J For 30. Sinn LE. The silver bullet. Am J For Med Path 1993; 14: 145-7.
Med Path 1992; 13: 115-9.
31. Sivaloganathan S. Aqua-eroticum - - a case of auto-erotic drowning.
21. Cairns FJ, Rainer SP. Death from electrocution during auto-erotic Med Sci Law 1984; 24: 300-2.
procedures. NZ Med J 1981; 94: 259-60.
32. Sivaloganathan S. Catheteroticum: fatal late complication following
22. Sivaloganathan S. Curiosum eroticum - - a case of fatal electrocu- autoerotic practice. Am J For Med Path 1985; 6: 340-2.
tion during auto-erotic practice. Med Sci Law 1981; 21: 47-50.
33. O'Halloran RL, Dietz PE. Autoerotic fatalities with power
23. Tan CTT, Chao TC. A case of fatal electrocution during an unusual hydraulics. J For Sci 1993; 38: 359-64.
autoerotic practice. Med Sci Law 1983; 23: 92-5.
34. Imami RH, Kemal M. Vacuum cleaner use in autoerotic death. Am
24. Thibault R, Spencer JD, Bishop JW et al. An unusual autoerotic J For Med Path 1988; 9: 246-8.
death: asphyxia with an abdominal ligature. J For Sci 1984; 29:
679-84. 35. Malik MOA. Sudden coronary deaths associated with sexual
activity. J For Sci 1979; 224: 216-20.
25. Cordner SM. An unusual case of sudden death associated with
masturbation. Med Sci Law 1983; 23: 54-6. 36. O'Halloran RL, Lovell FW. Autoerotic asphyxial death following
television broadcast. J For Sci 1988; 33: 1491-2.
26. Leadbeatter S. Dental anesthetic death: an unusual autoerotic
episode. Am J For Med Path 1988; 9: 60-3. 37. Dietz PE. Television inspired autoerotic asphyxiation. J For Sci
1989; 34: 528.
27. Minyard F. Wrapped to death: unusual autoerotic death. Am J
For Med Path 1985; 6: 151-2. 38. Edmondson JS. A case of sexual asphyxia without fatal termin-
ation. Br J Psych 1972; 121: 437-8.
28. Eriksson A, Gezelius C, Bring G. Rolled up to death: an unusual
autoerotic fatality. Am J For Med Path 1987; 8: 263-5. 39. Grumley M. Hard core: Studies in leather masochism. New York:
EP Dutton, 1977.
29. Ikeda N, Harada A, Umetsu K et al. A case of fatal suffocation
during an unusual auto-erotic practice. Med Sci Law 1988; 28: 40. Litman RR, Swearingen C. Bondage and suicide. Arch Gen Psych
131-4. 1972; 27: 80-5.