The American Journal of Forensic Medicine and Pathology 22(2):180–183, 2001. ©2001 Lippincott Williams & Wilkins, Inc.
Inc., Philadelphia
Complete Autoerotic Asphyxiation
Suicide or Accident?
Gilles Tournel, M.D., Nicolas Hubert, M.D., Clotilde Rougé, M.D., Valéry Hédouin, M.D., Ph.D.,
Downloaded from http://journals.lww.com/amjforensicmedicine by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3c9CHBlrWfCqahyZUy/cxXIxyTTjBJK0If7LZ09leVW0K0uMtC2T91Q== on 03/27/2019
and Didier Gosset, M.D., Ph.D.
A case of a typical form of sexual asphyxiation is de-
scribed, involving a young man hanging, in a context of
autoerotic asphyxia. Multiple and different parameters
are included in the definition.
Key Words: Asphyxia—Autoeroticism—Hanging.
Manuscript received June 1, 2000; accepted August 2, 2000.
From the Institut de Médecine Légale de Lille, Place Théo
Varlet, Lille 59000, France.
Address correspondence and reprint requests to D. Gosset,
Institut de Médecine Légale de Lille, Place Théo Varlet, Lille
59000, France.
180
Autoerotic activity sometimes consists of the
practice of self-induced cerebral anoxia, usually by
hanging, strangulation, or suffocation during mas-
turbation. Autoerotic asphyxiation and accidental
ligature strangulation by a partner are well-known
phenomena described in medical literature, particu-
larly in forensic medicine reports (1–5). This is a
very ancient behavior. In French classical literature,
Jean Giono describes traditional autoerotic asphyx-
iation with a leather cowl among mountain people
in the 19th century (6). The sexual asphyxia is al-
most exclusively created by men; only a few re-
ports 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, con-
sideration of the death scene is important in an un-
derstanding of the motivation and behavior of the
young decedent.
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 grand-
mother 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 sit-
ting in front of a mirror. He wore a jellaba and fe-
male underclothes (bra, panties, and sanitary towel
with red coloring), and clothespins nipping the two
nipples (Figs. 1 and 2). Chains and padlocks were
 COMPLETE AUTOEROTIC ASPHYXIATION 181

that movie was not established, unlike many cases

reported in the literature (8,9). There was no psy-
chiatric background and no known previous suici-
dal behavior. Additionally, the victim had a normal
heterosexual relationship with a 21-year-old girl-
friend. He was reported to like risks and to have
frequently engaged in extreme behavior (e.g., dri-
ving very fast, diving in deep water). The manner
of death was finally considered to be an accident.

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 re-
ports. Sexual asphyxiation is described in de Sade’s
Justine, and other authors have described sexual
perversion associated with hanging (11). The Eski-
mos have been known to perform sexual asphyxia-
tion as a form of solitary or group activity (12).
Jean Giono, a French novelist, described the prac-
tice of autoerotic asphyxiation in the 19th century

FIG. 1. Jellaba and clothespins.

present on the body (Fig. 3). There were no porno-

graphic 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.
During external examination, blood was discov-
ered 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.
Autopsy revealed ligature abrasions around the
victim’s neck. Rope marks were located on the an-
terior 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 carti-
lage 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.
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 FIG. 2. Underclothes.

Am J Forensic Med Pathol, Vol. 22, No. 2, June 2001

182 G. TOURNEL ET AL.

FIG. 4. Radiograph showing hat-peg.

scribed 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: irrita-
tion of the vagus nerve by hanging and rectal di-
latation by a foreign body (hat-peg). Asphyxia was
secondary to the vagal uneasiness. All investiga-
FIG. 3. Chains and padlocks.
tions—death scene, external examination, context,
autopsy findings—resulted in a conclusion of acci-
among French mountain people, who used a leather dental hanging provoking fatal autoerotic asphyxia.
cowl.
The basic mechanism of sexual asphyxias is the
production of cerebral hypoxia, which in some men
appears to produce hallucinations of an erotic na-
ture. This hypoxia is most often achieved by con-
striction of the neck by a ligature (a rope, in the
case reported here).
Bondage is common, sometimes involving elabo-
rate and bizarre methods. Classically, the use of
chains and padlocks is described. Anal self-stimula-
tion with foreign bodies and self-observation with a
mirror or camera are correlated with transvestism.
Transvestism commonly involves a female appara-
tus (jellaba, sanitary towel, and panties in this
case). Masochism is often seen, and rectal dilata-
tion is sought by victims.
In our case, hanging was accidental and not sui-
cidal. 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 de- FIG. 5. Hatpeg.

Am J Forensic Med Pathol, Vol. 22, No. 2, June 2001

 COMPLETE AUTOEROTIC ASPHYXIATION
FIG. 6. Rope marks on the anterior part of the neck.
This case is interesting because of the many
characteristics frequently described only in auto-
erotic asphyxia. It associates transvestism, the use
of electric current, sexually oriented bondage, anal
self-stimulation with a foreign body, and mas-
ochism (clothespins). This behavior is encountered
in people of culture and education, as was true of
this young student in a scientific field.
183
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 conscious-
ness occurs.
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