Forensic Sci Med Pathol DOI 10.1007/s12024-016-9753-5
LETTER TO THE EDITOR
Manner of death associated with autoerotic practice Roger W. Byard1
Accepted: 3 February 2016 Ó Springer Science+Business Media New York 2016
Autoerotic death refers to an accidental lethal event that occurs during solitary sexual activity due to a malfunction or an unexpected effect of a device/material or substance that was being used to augment the experience [1]. Most cases involve asphyxia, usually by neck compression from hanging [2], although positional asphyxia, wedging, and suffocation from covering of the face with plastic or rubber have all been described. Other less common lethal mechanisms include exsanguination, sepsis, electrocution, and hyperthermia, or have involved inhalants [1, 3]. Accidental death that is completely unrelated to autoerotic practice must also be considered [4]. Although determining the manner of death in most cases may seem relatively straightforward, the case described by Babor and Bott [5] in this issue of the journal demonstrates that possibilities other than accidents need to always be considered. In the reported case death resulted from pulmonary thromboembolism arising from deep venous thrombi possibly caused by venous stasis related to repetitive binding of the legs. If this were so, then the case is very unusual in that it represents a natural disease caused directly by props integral to the decedent’s autoerotic practice. As the authors note, the case is not, by definition an autoerotic death but is instead a death associated with autoerotic activity. The distinction is important as it separates natural from unnatural manners of death. Myocardial ischemia and subarachnoid hemorrhage are other conditions that may be associated with sexual practice. Natural
& Roger W. Byard [email protected] 1
Discipline of Anatomy and Pathology, Level 3 Medical School North Building, School of Medicine, The University of Adelaide, Frome Road, Adelaide 5005, Australia
death occurring during autoerotic endeavors may, of course also be completely coincidental to the activity. Suicide must always be considered, particularly if there is a history of depression. It is recognized that individuals often choose a method of suicide from materials or situations that are familiar to them [6] and suicide using autoerotic devices by practitioners is known [7]. Cases may be mistaken for homicides, particularly if typical death scene features are not present, as with female victims [8], or where the scene may have been altered to disguise the true nature of the event. Cases have also occurred where attempts have been made to disguise a homicide as an autoerotic accident [1]. Finally, the manner of death in cases of autoerotic events may be inaccurately recorded if there are situations where families would prefer a finding of suicide rather than autoerotic misadventure, or if there are insurance ramifications. Thus, as the reported case shows, determining the manner of death in cases that appear to involve autoerotic activity may not be as straightforward as it would initially appear.
References 1. Byard RW. Deaths—autoerotic deaths. In: Payne-James J, Byard RW, editors. Encyclopedia of forensic and legal medicine, vol. 2. 2nd ed. Oxford: Academic Press; 2016. p. 59–66. 2. Shields LB, Hunsaker DM, Hunsaker JC 3rd. Autoerotic asphyxia: part I. Am J Forensic Med Pathol. 2005;26:45–52. 3. Byard RW, Eitzen DA, James R. Unusual fatal mechanisms in nonasphyxial autoerotic death. Am J Forensic Med Pathol. 2000;21: 65–8. 4. Egge MK, Berkowitz CD, Toms C, Sathyavagiswaran L. The choking game. A cause of unintentional strangulation. Pediatr Emerg Care. 2010;26:206–8.
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Forensic Sci Med Pathol 5. Baber Y, Bott E. Natural death in the setting of autoerotic practice. Forensic Med Pathol. 2016. doi:10.1007/s12024-016-9751-7 6. Byard RW, Markopoulos D, Prasad D, Eitzen D, James RA, Blackbourne B, Krous HF. Early adolescent suicide: a comparative study. J Clin Forensic Med. 2000;7:6–9.
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7. Byard RW, Botterill P. Autoerotic asphyxial death—accident or suicide? Am J Forensic Med Pathol. 1998;19:377–80. 8. Byard RW, Bramwell NH. Autoerotic death in females. An underdiagnosed syndrome? Am J Forensic Med Pathol. 1988;9: 252–4.
LETTER TO THE EDITOR
Manner of death associated with autoerotic practice Roger W. Byard1
Accepted: 3 February 2016 Ó Springer Science+Business Media New York 2016
Autoerotic death refers to an accidental lethal event that occurs during solitary sexual activity due to a malfunction or an unexpected effect of a device/material or substance that was being used to augment the experience [1]. Most cases involve asphyxia, usually by neck compression from hanging [2], although positional asphyxia, wedging, and suffocation from covering of the face with plastic or rubber have all been described. Other less common lethal mechanisms include exsanguination, sepsis, electrocution, and hyperthermia, or have involved inhalants [1, 3]. Accidental death that is completely unrelated to autoerotic practice must also be considered [4]. Although determining the manner of death in most cases may seem relatively straightforward, the case described by Babor and Bott [5] in this issue of the journal demonstrates that possibilities other than accidents need to always be considered. In the reported case death resulted from pulmonary thromboembolism arising from deep venous thrombi possibly caused by venous stasis related to repetitive binding of the legs. If this were so, then the case is very unusual in that it represents a natural disease caused directly by props integral to the decedent’s autoerotic practice. As the authors note, the case is not, by definition an autoerotic death but is instead a death associated with autoerotic activity. The distinction is important as it separates natural from unnatural manners of death. Myocardial ischemia and subarachnoid hemorrhage are other conditions that may be associated with sexual practice. Natural
& Roger W. Byard [email protected] 1
Discipline of Anatomy and Pathology, Level 3 Medical School North Building, School of Medicine, The University of Adelaide, Frome Road, Adelaide 5005, Australia
death occurring during autoerotic endeavors may, of course also be completely coincidental to the activity. Suicide must always be considered, particularly if there is a history of depression. It is recognized that individuals often choose a method of suicide from materials or situations that are familiar to them [6] and suicide using autoerotic devices by practitioners is known [7]. Cases may be mistaken for homicides, particularly if typical death scene features are not present, as with female victims [8], or where the scene may have been altered to disguise the true nature of the event. Cases have also occurred where attempts have been made to disguise a homicide as an autoerotic accident [1]. Finally, the manner of death in cases of autoerotic events may be inaccurately recorded if there are situations where families would prefer a finding of suicide rather than autoerotic misadventure, or if there are insurance ramifications. Thus, as the reported case shows, determining the manner of death in cases that appear to involve autoerotic activity may not be as straightforward as it would initially appear.
References 1. Byard RW. Deaths—autoerotic deaths. In: Payne-James J, Byard RW, editors. Encyclopedia of forensic and legal medicine, vol. 2. 2nd ed. Oxford: Academic Press; 2016. p. 59–66. 2. Shields LB, Hunsaker DM, Hunsaker JC 3rd. Autoerotic asphyxia: part I. Am J Forensic Med Pathol. 2005;26:45–52. 3. Byard RW, Eitzen DA, James R. Unusual fatal mechanisms in nonasphyxial autoerotic death. Am J Forensic Med Pathol. 2000;21: 65–8. 4. Egge MK, Berkowitz CD, Toms C, Sathyavagiswaran L. The choking game. A cause of unintentional strangulation. Pediatr Emerg Care. 2010;26:206–8.
123
Forensic Sci Med Pathol 5. Baber Y, Bott E. Natural death in the setting of autoerotic practice. Forensic Med Pathol. 2016. doi:10.1007/s12024-016-9751-7 6. Byard RW, Markopoulos D, Prasad D, Eitzen D, James RA, Blackbourne B, Krous HF. Early adolescent suicide: a comparative study. J Clin Forensic Med. 2000;7:6–9.
123
7. Byard RW, Botterill P. Autoerotic asphyxial death—accident or suicide? Am J Forensic Med Pathol. 1998;19:377–80. 8. Byard RW, Bramwell NH. Autoerotic death in females. An underdiagnosed syndrome? Am J Forensic Med Pathol. 1988;9: 252–4.
