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Complete Autoerotic Asphyxiation: Suicide or Accident?

Tournel, Gilles M.D.; Hubert, Nicolas M.D.; Rougé, Clotilde M.D.; Hédouin, Valéry M.D., Ph.D.; Gosset, Didier M.D., Ph.D.

The American Journal of Forensic Medicine and Pathology: June 2001 - Volume 22 - Issue 2 - p 180-183
Articles

A case of a typical form of sexual asphyxiation is described, involving a young man hanging, in a context of autoerotic asphyxia. Multiple and different parameters are included in the definition.

From the Institut de Médecine Légale de Lille, Place Théo Varlet, Lille 59000, France.

Manuscript received June 1, 2000; accepted August 2, 2000.

Address correspondence and reprint requests to D. Gosset, Institut de Médecine Légale de Lille, Place Théo Varlet, Lille 59000, France.

Autoerotic activity sometimes consists of the practice of self-induced cerebral anoxia, usually by hanging, strangulation, or suffocation during masturbation. Autoerotic asphyxiation and accidental ligature strangulation by a partner are well-known phenomena described in medical literature, particularly in forensic medicine reports (1–5). This is a very ancient behavior. In French classical literature, Jean Giono describes traditional autoerotic asphyxiation with a leather cowl among mountain people in the 19th century (6). The sexual asphyxia is almost exclusively created by men; only a few reports exist concerning women. Male subjects tend to create a complex apparatus and environment, whereas female subjects are usually simply found naked with only a ligature around the neck (7).

This case report supports the creation of complex sexual scenes by male subjects. In this case, consideration of the death scene is important in an understanding of the motivation and behavior of the young decedent.

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CASE REPORT

In northern France, a young male student, aged 21, was found dead one morning in May of 1999. The victim lived with his grandmother, who had discovered him dead in the living room. The grandmother had last seen the victim alive the previous day at 9 pm. The victim had known he was alone on the ground floor because his grandmother had gone to sleep. The body was found hanging by a rope tied around the neck, sitting on the upper part of the divan. The divan was situated under a beam, to which the rope was fastened. The body was sitting in front of a mirror. He wore a jellaba and female underclothes (bra, panties, and sanitary towel with red coloring), and clothespins nipping the two nipples (Figs. 1 and 2). Chains and padlocks were present on the body (Fig. 3). There were no pornographic pictures close to the body. In a room near the living room, electrical devices (electrodes) were found. The noose was padded with a towel, which protected the skin of the neck from ridging.

FIG. 1.

FIG. 1.

FIG. 2.

FIG. 2.

FIG. 3.

FIG. 3.

During external examination, blood was discovered at the anal margin. Radiographs revealed a hat-peg, which was subsequently removed from the rectum (Figs. 4 and 5). This hat-peg had provoked rectal and anal bleeding.

FIG. 4.

FIG. 4.

FIG. 5.

FIG. 5.

Autopsy revealed ligature abrasions around the victim’s neck. Rope marks were located on the anterior part of the neck (Fig. 6). The groove was very faint. Facial petechial hemorrhages were present. Pulmonary edema was present in the lungs. There was no fracture of the hyoid bone or thyroid cartilage and no deep muscle bruises of the neck. No other significant autopsy findings were present. The cause of the death was attributed to asphyxia by hanging.

FIG. 6.

FIG. 6.

On the Sunday preceding the event, a TV movie about erotic asphyxiation by a sexual partner had been shown. The relationship between our case and that movie was not established, unlike many cases reported in the literature (8,9). There was no psychiatric background and no known previous suicidal behavior. Additionally, the victim had a normal heterosexual relationship with a 21-year-old girlfriend. He was reported to like risks and to have frequently engaged in extreme behavior (e.g., driving very fast, diving in deep water). The manner of death was finally considered to be an accident.

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DISCUSSION

Asphyxophilia has been defined as the desire for a state of oxygen deficiency to elicit or enhance sexual excitement and orgasm (10). Forensic cases are numerous, and the literature contains some reports. Sexual asphyxiation is described in de Sade’s Justine, and other authors have described sexual perversion associated with hanging (11). The Eskimos have been known to perform sexual asphyxiation as a form of solitary or group activity (12). Jean Giono, a French novelist, described the practice of autoerotic asphyxiation in the 19th century among French mountain people, who used a leather cowl.

The basic mechanism of sexual asphyxias is the production of cerebral hypoxia, which in some men appears to produce hallucinations of an erotic nature. This hypoxia is most often achieved by constriction of the neck by a ligature (a rope, in the case reported here).

Bondage is common, sometimes involving elaborate and bizarre methods. Classically, the use of chains and padlocks is described. Anal self-stimulation with foreign bodies and self-observation with a mirror or camera are correlated with transvestism. Transvestism commonly involves a female apparatus (jellaba, sanitary towel, and panties in this case). Masochism is often seen, and rectal dilatation is sought by victims.

In our case, hanging was accidental and not suicidal. Examination of the autoerotic death scene showed a secluded location, where nobody could disturb the victim. He was in a classic position, with an incomplete hanging. Application of an electric current to the genitals is frequently described but was not the cause of death in this case. A vagal uneasiness was probably the starting point of a loss of consciousness. The vagal uneasiness may have been provoked by two phenomena: irritation of the vagus nerve by hanging and rectal dilatation by a foreign body (hat-peg). Asphyxia was secondary to the vagal uneasiness. All investigations—death scene, external examination, context, autopsy findings—resulted in a conclusion of accidental hanging provoking fatal autoerotic asphyxia.

This case is interesting because of the many characteristics frequently described only in autoerotic asphyxia. It associates transvestism, the use of electric current, sexually oriented bondage, anal self-stimulation with a foreign body, and masochism (clothespins). This behavior is encountered in people of culture and education, as was true of this young student in a scientific field.

People need to be informed about the risks of such activities and of the danger of being unable to stop the asphyxial process before loss of consciousness occurs.

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REFERENCES

1. Cooper J. Autoerotic asphyxiation: three case reports. J Sex Marital Ther 1996; 22:47–53.
2. Clark MA, Kerr F. Unusual hanging deaths. J Forensic Sci 1986; 31:747–55.
3. Wessellus C, Bally RA. Male with autoerotic asphyxia syndrome. Am J Forensic Med Pathol 1983; 4:341–5.
4. Blanchard R, Hucker SJ. Age, transvestism, bondage, and concurrent paraphilic activities in 117 fatal cases of autoerotic asphyxia. Br J Psychiatry 1991; 159:371–7.
5. Hazelwood R, Dietz P, Burgess A. The investigation of autoerotic fatalities. J Police Sci Adm 1981; 9:404–11.
6. Giono J. Faust au village. In Oeuvres complètes, Tome V. Collection de la Plétade, Paris: Edition Gallimard; 1928, 182–93.
7. Byard R, Hucker S, Hazelwood R. A comparison of typical death scene features in cases of male and female autoerotic asphyxia with a review of literature. Forensic Sci Int 1990; 48:113–21.
8. O’Halloran R, Lovell J. Autoerotic asphyxial death following television broadcast. J Forensic Sci 1988; 33:1491–2.
9. Dietz PE. Television-inspired autoerotic asphyxiation. J Forensic Sci 1989; 34:528–9.
10. Innala S, Ernulf K. Asphyxophilia in Scandinavia. Arch Sex Behav 1989; 18:181–9.
11. Ober W. The sticky end of Frantisek Koczwara, composer of “The Battle of Prague.” Am J Forensic Med Pathol 1984; 5:145–9.
12. de Coccola R, King P. The incredible Eskimo. Blaine, WA: Hancock House, 1986:184–91.
Keywords:

Asphyxia; Autoeroticism; Hanging

© 2001 Lippincott Williams & Wilkins, Inc.