Erotic asphyxiation

Concerning hallucinogenic states brought about by chronic hypoxia, Dr. E. L. Lloyd notes that they may be similar to the hallucinations experienced by climbers at altitude. He further notes that no such state occurs in hypoxia brought about by sudden aircraft decompression at altitude. These findings suggest to him that they do not arrive purely from a lack of oxygen. Upon examining the studies on hypoxia he found that "abnormalities in the cerebral neurochemistry involving one or more of the interconnected neurotransmitters, dopamine, serotonin, and beta-endorphin had been reported in all the conditions associated with hallucinations."{{cite journal|title= Points: Hallucinations, hypoxia, and neurotransmitters|author=Dr. E L Lloyd|journal=British Medical Journal | date=29 March 1986|volume=292 |issue=6524 |page=903|pmc=1340016|doi=10.1136/bmj.292.6524.903-d}}

Practitioners describe a number of physiological responses including "pleasurable sensations/euphoria (81.7%), a head rush (43.8%), feeling like they could not breathe (43.0%), difficulty swallowing (38.9%), unable to speak (37.6%), and watery eyes (37.2%). About 15% had noticed neck bruising and 3% had lost consciousness from being choked."{{cite journal |last1=Herbenick |first1=Debby |last2=Fu |first2=Tsung-chieh |last3=Eastman-Mueller |first3=Heather |last4=Thomas |first4=Sally |last5=Valdivia |first5=Dubravka Svetina |last6=Rosenberg |first6=Molly |last7=Guerra-Reyes |first7=Lucia |last8=Wright |first8=Paul |last9=Kawata |first9=Keisuke |last10=Feiner |first10=John |title=Frequency, Method, Intensity, and Health Sequelae of Sexual Choking Among U.S. Undergraduate and Graduate Students |journal=Archives of Sexual Behavior |date=July 28, 2022 |volume=51 |issue=6 |pages=3121–3139 |doi=10.1007/s10508-022-02347-y |pmid=35902430 |pmc=9333342 }}

Historically, the practice of autoerotic asphyxiation has been documented since the early 17th century. It was first used as a treatment for erectile dysfunction. The idea for this most likely came from subjects who were executed by hanging. Observers at public hangings noted that male victims developed an erection, sometimes remaining after death (a death erection), and occasionally ejaculated when being hanged.{{cite web|url=http://sataniclust.com/04_06/pro_0406_asphyxiation.htm|title=Erotic Asphyxiation|work=Lust Magazine|year=1997|access-date=2 September 2006|archive-url=https://web.archive.org/web/20060831011633/http://www.sataniclust.com/04_06/pro_0406_asphyxiation.htm|archive-date=31 August 2006|url-status=dead}}

Various methods are used to achieve the level of oxygen depletion needed, such as a hanging, suffocation with a plastic bag over the head, self-strangulation such as with a ligature, gas or volatile solvents, chest compression, or some combination of these. Complicated devices (such as hydraulics) are sometimes used to produce the desired effects.{{cite journal | last1 = O'Halloran | first1 = R. L. | last2 = Dietz | first2 = P. E. | year = 1993 | title = Autoerotic fatalities with power hydraulics | journal = Journal of Forensic Sciences | volume = 38 | issue = 2| pages = 359–364 | doi = 10.1520/JFS13416J | pmid = 8454997 }} The practice can be dangerous even if performed with care and has resulted in a significant number of accidental deaths. Uva (1995) writes "Estimates of the mortality rate of autoerotic asphyxia range from 250 to 1000 deaths per year in the United States."{{Cite journal | last1 = Uva | first1 = J. L. | year = 1995 | title = Review: Autoerotic asphyxiation in the United States | journal = Journal of Forensic Sciences | volume = 40 | issue = 4| pages = 574–581 | pmid = 7595293 | doi = 10.1520/JFS13828J }} Cases have also been reported in Scandinavia{{Cite journal | doi = 10.1007/BF01543193 | last1 = Innala | first1 = S. M. | last2 = Ernulf | first2 = K. F. | year = 1989 | title = Asphyxiophilia in Scandinavia | journal = Archives of Sexual Behavior | volume = 18 | issue = 3| pages = 181–189 | pmid = 2787626 | s2cid = 42384991 }} and Germany.{{Cite journal | last1 = Janssen | first1 = W. | last2 = Koops | first2 = E. | last3 = Anders | first3 = S. | last4 = Kuhn | first4 = S. | last5 = Püschel | first5 = K. | year = 2005 | title = Forensic aspects of 40 accidental autoerotic death in Northern Germany | doi =10.1016/j.forsciint.2004.09.093 | journal = Forensic Science International | volume = 147S | pages = S61–S64 | pmid=15694733}}{{Cite journal | last1 = Koops | first1 = E. | last2 = Janssen | first2 = W. | last3 = Anders | first3 = S. | last4 = Püschel | first4 = K. | year = 2005 | title = Unusual phenomenology of autoerotic fatalities | doi = 10.1016/j.forsciint.2004.09.095 | journal = Forensic Science International | volume = 147S | pages = S65–S67 | pmid=15694734}} Swedish police reported in 1994 that the number of autoerotic asphyxiation fatalities in the Stockholm area (c. 1.7 million inhabitants) were at least five annually, but the number of unrecorded cases was assumed to be high.Olof Westerberg: "Sexlekar allt vanligare dödsorsak", Vasabladet 31 August 1994. Autoerotic asphyxiation may often be mistaken for suicide, which is a major cause of death in teenagers.{{cite web | last = Downs | first = Martin | title = The Highest Price For Pleasure: A Deadly Turn-On | website = WebMD | date = 1 January 2005 | url = http://www.medicinenet.com/script/main/art.asp?articlekey=51776 | access-date = 4 October 2011 | archive-date = 28 December 2011 | archive-url = https://web.archive.org/web/20111228035100/http://www.medicinenet.com/script/main/art.asp?articlekey=51776 | url-status = dead }}

In a 2021 survey of US students, women and transgender/nonbinary/gender nonconforming individuals are more likely to have been choked during sex than men.

{{Main|Autoerotic fatality}}

Deaths often occur when the loss of consciousness caused by partial asphyxia leads to loss of control over the means of strangulation, resulting in continued asphyxia and death. While often asphyxiophilia is incorporated into sex with a partner, others enjoy this behaviour by themselves, making it potentially more difficult to get out of dangerous situations.[http://www.soc.ucsb.edu/sexinfo/article/autoerotic-asphyxiophilia Autoerotic Asphyxiophilia] {{Webarchive|url=https://web.archive.org/web/20090515161226/http://www.soc.ucsb.edu/sexinfo/article/autoerotic-asphyxiophilia |date=15 May 2009 }} on 'Sexinfo' website, University of Santa Barbara, Ca.

In some fatality cases, the body of the asphyxiophilic individual is discovered naked or with genitalia in hand, with pornographic material or sex toys present, or with evidence of having orgasmed prior to death. Bodies found at the scene of an accidental death often show evidence of other paraphilic activities,{{Cite journal | doi = 10.1097/00000433-199103000-00012 | last1 = Bogliolo | first1 = L. R. | last2 = Taff | first2 = M. L. | last3 = Stephens | first3 = P. J. | last4 = Money | first4 = J. | year = 1991 | title = A case of autoerotic asphyxia associated with multiplex paraphilia | journal = American Journal of Forensic Medicine and Pathology | volume = 12 | issue = 1| pages = 64–73 | pmid = 2063821 }} such as fetishistic cross-dressing and masochism.{{Cite journal | doi = 10.1192/bjp.159.3.371 | last1 = Blanchard | first1 = R. | last2 = Hucker | first2 = S. J. | year = 1991 | title = Age, transvestism, bondage, and concurrent paraphilic activities in 117 fatal cases of autoerotic asphyxia | journal = British Journal of Psychiatry | volume = 159 | issue = 3| pages = 371–377 | pmid = 1958948 | s2cid = 20137589 }} In cases involving teenagers at home, families may disturb the scene by "sanitizing" it, removing evidence of paraphilic activity. This can have the consequence of making the death appear to be a deliberate suicide, rather than an accident.Downs, Martin. [http://www.medicinenet.com/script/main/art.asp?articlekey=51776 The Highest Price for Pleasure] {{Webarchive|url=https://web.archive.org/web/20111228035100/http://www.medicinenet.com/script/main/art.asp?articlekey=51776 |date=28 December 2011 }}, featured by WebMD

The great majority of known erotic asphyxial deaths are male; among all known cases in Ontario and Alberta from 1974 to 1987, only 1 out of 117 cases was female. Some individual cases of women with erotic asphyxia have been reported.{{Cite journal | doi = 10.1097/00000433-198006000-00004 | last1 = Danto | first1 = B. | year = 1980 | title = A case of female autoerotic death | journal = American Journal of Forensic Medicine and Pathology | volume = 1 | issue = 2| pages = 117–121 | pmid = 7246503 | s2cid = 40463465 }}{{Cite journal | doi = 10.1007/s00414-001-0271-x | last1 = Behrendt | first1 = N. | last2 = Buhl | first2 = N. | last3 = Seidl | first3 = S. | year = 2002 | title = The lethal paraphilic syndrome: Accidental autoerotic deaths in four women and a review of the literature | journal = International Journal of Legal Medicine | volume = 116 | issue = 3| pages = 148–152 | pmid = 12111317 | s2cid = 24969597 }}{{Cite journal | doi = 10.1177/1534650103002003006 | last1 = Martz | first1 = D. | year = 2003 | title = Behavioral treatment for a female engaging in autoerotic asphyxiation | url = http://libres.uncg.edu/ir/asu/f/Martz_Denise_2003_Behavioral_Treatment_for_a_Female.pdf| journal = Clinical Case Studies | volume = 2 | issue = 3| pages = 236–242 | s2cid = 145098915 }}{{Cite journal | last1 = Sass | first1 = F. | year = 1975 | title = Sexual asphyxia in the female | journal = Journal of Forensic Sciences | volume = 2 | pages = 181–185 | doi = 10.1520/JFS10256J }} The main age of accidental death is mid-20s,{{Cite journal | doi = 10.1111/j.1939-0025.1983.tb03361.x | last1 = Burgess | first1 = A. W. | last2 = Hazelwood | first2 = R. R. | year = 1983 | title = Autoerotic deaths and social network response | journal = American Journal of Orthopsychiatry | volume = 53 | issue = 1| pages = 166–170 | pmid = 6829721 }} but deaths have been reported in adolescents{{Cite journal | doi = 10.1007/BF01564363 | last1 = Shankel | first1 = L. W. | last2 = Carr | first2 = A. C. | year = 1956 | title = Transvestism and hanging episodes in a male adolescent | journal = Psychiatric Quarterly | volume = 30 | issue = 3| pages = 478–493 | pmid = 13359556 }}{{Cite journal | doi = 10.1097/00004583-198805000-00017 | last1 = Sheehan | first1 = W. | last2 = Garfinkel | first2 = B. D. | year = 1987 | title = Adolescent autoerotic deaths | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 27 | issue = 3| pages = 367–370 | pmid = 3379021 }}{{Cite journal | doi = 10.1192/bjp.121.4.437 | last1 = Edmondson | first1 = J. S. | year = 1972 | title = A case of sexual asphyxis without fatal termination | journal = British Journal of Psychiatry | volume = 121 | issue = 563| pages = 437–438 | pmid = 5077101 | s2cid = 35353344 }} and in men in their 70s.

Lawyers and insurance companies have brought cases to the attention of clinicians because some life insurance claims are payable in the event of accidental death, but not suicide.{{Cite journal | last1 = Cooper | first1 = A. J. | year = 1995 | title = "Auto-erotic asphyxial death: Analysis of nineteen fatalities in Alberta": Comment | journal = Canadian Journal of Psychiatry | volume = 40 | issue = 6| pages = 363–364 | doi = 10.1177/070674379504000626 | pmid = 7585413 | s2cid = 41699554 }}{{Cite journal | last1 = Cooper | first1 = A. J. | year = 1996 | title = Auto-erotic asphyxiation: Three case reports | journal = Journal of Sex and Marital Therapy | volume = 22 | issue = 1| pages = 47–53 | pmid = 8699497 | doi = 10.1080/00926239608405305 }}{{Cite journal | last1 = Garza-Leal | first1 = J. A. | last2 = Landrom | first2 = F. J. | year = 1991 | title = Autoerotic death initially misinterpreted as suicide and a review of the literature | journal = Journal of Forensic Sciences | volume = 36 | issue = 6| pages = 1753–1759 | pmid = 1770343 | doi = 10.1520/JFS13200J }}

{{more citations needed|date=September 2018}}

The sensational nature of erotic asphyxiation often makes it the subject of urban legends. It has also been mentioned specifically in a number of works of fiction.

• In the Marquis de Sade's famous novel Justine, or The Misfortunes of the Virtue, Justine is subjected to this by one of her captors. She survives the encounter.
• In the Guts short story in Chuck Palahniuk's novel Haunted, one the characters discusses parents who discover the accidental deaths of their sons to autoerotic asphyxiation. They are said to cover up the deaths before police or coroners arrive to save the family from shame.
• In the novel (and later movie adaptation) Rising Sun, death as a result of this type of sexual arousal is explained when it is offered as a possible cause for a murder victim's death.
• In the film World's Greatest Dad, the protagonist's teenage son accidentally kills himself with asphyxiation whilst sexually aroused. The protagonist then stages his son's death as a suicide, which gives him the opportunity to rise to infamy through a literary hoax.
• It is a reoccurring theme in the fiction to William S Burroughs especially Naked Lunch, where hanging is depicted in resulting in instant ejaculation.

• Cerebral hypoxia
• Choke hold
• Choking game
• Facesitting
• Hypoxia
• Self-bondage
• Sexual fetishism

{{Reflist}}

• Robert R. Hazelwood, Park Elliot Dietz, Ann Wolbert Burgess: Autoerotic Fatalities. Lexington, Mass.: LexingtonBooks, 1983.
• Sergey Sheleg, Edwin Ehrlich: Autoerotic Asphyxiation: Forensic, Medical, and Social Aspects, Wheatmark (15 August 2006), trade paperback, 208 pages {{ISBN|1587366045}} {{ISBN|978-1587366048}}
• John Money, Gordon Wainwright and David Hingsburger: The Breathless Orgasm: A Lovemap Biography of Asphyxiophilia. Buffalo, New York: Prometheus Books, 1991.

{{Commons category|Breath play}}

• [https://web.archive.org/web/20080311153542/http://www.altpenis.com/penis_news/autoerotic_asphyxia.shtml Well Hung: Death By Orgasm]
• [https://web.archive.org/web/20190315224128/http://www.corpus-delicti.com/auto.html Turvey B. "An Objective Overview of Autoerotic Fatalities"]
• [http://www.evilmonk.org/A/breath.cfm The Medical Realities of Breath Control Play By Jay Wiseman]
• [http://www.slate.com/articles/news_and_politics/explainer/2009/06/strangle_with_care.html Is there a safe way to perform autoerotic asphyxiation? - Slate Magazine]

{{Masturbation}}

{{Paraphilia}}

{{BDSM}}

{{Authority control}}

{{DEFAULTSORT:Erotic Asphyxiation}}

Category:BDSM terminology

Category:Paraphilias

Category:Respiration