AUTO-EROTIC ASPHYXIA

(sexual asphyxia or sex hanging)

Introduction:
• Real origin not known.

• First recorded case in literature in 1791.

• Little is understood, quite unusual.

• Having extremely bizarre picture showing both erotic and asphyxial
elements along with trait of masochism and trans sexualism.

• Death in the course of sexual fantasy in masturbation.

Autoerotic asphyxiation. This young man died from compression of the neck
after he lost consciousness during masturbation. There were pornographic
magazines on the floor and a full-length mirror leaning against the bed.
There was a towel around the neck to prevent abrasions and the ropes were
tied in an elaborate swing-like configuration.
He had devised a slipknot to help him if he needed a quick escape.
This soldier also died during masturbation. He had a bag over his head during
the act and died from a lack of oxygen.
 Characteristics
• Body: Adult or post adult period.
• Nude or partially dressed may be in female clothes.
• Rope is tied all over having one around the neck. Free end of the rope
secured to a fixed object or to one of the extremities.
• Anoxia is produced by placing tension on the rope.
• Such an arrangement is to produce partial obstruction to respiration which
might be causing some erotic excitement.
• Accidentally they may slip and produce complete obstruction without this
being intended.
• Other subjects of same perversion may cover their faces with rubber or
plastic material and some shut themselves in confined spaces.
Scene:
• Typical hidden place, pornographic literature, magazines etc are present.
Medicolegal aspect:-
• Previously interpreted as suicidal death, in fact it is accidental.
 SUFFOCATION
THE PUREST FORM OF ASPHYXIA

DEFINITION:
• It is obstruction to passage of air into respiratory tract caused by closing
the external respiratory orifices.
• OR
• Asphyxial death caused by means other than constriction of neck by
ligature, hands and drowning.

SIX GENERAL FORMS OF SUFFOCATION

• Environmental
• Smothering/Gagging
• Choking
• Mechanical Suffocation
• Mechanical suffocation & Smothering
• Suffocating gases.
 ENVIRONMENTAL SUFFOCATION
It means breathing in vitiated atmosphere (insufficient oxygen in the inspired
air).

A. Deficiency of O 2 in atmosphere is due to depletion rather than

displacement by suffocating gases.
Normal O2 in atmosphere is 20.94% by volume.
•If it is less than 16% by volume potentially dangerous for health.
•If it is less than 5%, consciousness is lost & death occurs in 2-3 minutes.

B. Entrapment
•Inadequate O2 in environment i.e., child entrapped in discarded refrigerator,
trunk.
Gases generally replaces O 2 are CO2, CO, Methane, SO2, H2S.
• CO2 : exhaled (crowded places, poorly ventilated).
• CO2 , CO , SO2 : produced during combustion.
• SO2, Methane, sulphurated Hydrogen (H2S): Produced during
fermentation of organic matter i.e. in sewers, deep wells etc.
The atmosphere generally contains more than one gas.

Mechanism of Death:
• CO2 and Methane reduce O2 from atmosphere.
• SO2 and H2S are strong reducing agents thus prevent Hb from taking O2.
• CO displaces O2 from its combination with Hb.

Autopsy findings:
Nonspecific pathological findings of asphyxia: Cyanosis, Congestion,
petechial haemorrhages, Oedema, fluidity of blood are marked due to
slow asphyxia.
Specific:
• Color of blood is bright cherry red in CO poisoning.
• Specific spectrum in spectroscopic examination.
• Detection of CO Hb in blood.
• Cause of death can not be determined by autopsy alone. Circumstantial
evidence & Exclusion of other causes can help in this respect.
Manner of Death
Usually accidental. Suicidal & homicidal by this method are rare.
 SMOTHERING / GAGGING
• Asphyxia on account of mechanical obstruction/occlusion of external
airways (nose & mouth).
• Mechanism:- Anoxic anoxia
• Manner:- Death is usually homicidal or suicidal. Very rarely accidental.

HOMICIDAL
• ADULT:- Gross physical disparity between assailant & victim.
• Implements:- Pillows, beddings and hands etc.
• Gags can cause death, though unintentional, are still homicidal - strapping
of mouth with adhesive tape to keep back calls for help.
• At autopsy apart from CCFPP, findings of gag over face makes the
diagnosis.
SUICIDAL:
• Seen in mental patients/prisoners.
• But it is impossible as unconsciousness period will save him.
• Age is an important factor.
• Rare variety, circumstances vary according to age of victim.
• Infant:- Weight of bed clothing, pillows, mattres.
• Children:- Space-man game (polythene bags)
• Adults:- Epileptic fits, intoxication.

PLASTIC BAGS: Potential agent for suicide, infanticide and those who are
indulged in auto-erotic & narcotic practices.
• No specific autopsy findings, petechiae over face are seen.
Medicolegal Aspect:
• To determine the manner of death, age of victim is an important factor.
Accidental:
Infant
i. Prone position (improbable as there is reflex movement).
ii. Overlying by elders.
iii. Woman while feeding.

Children
• Space man game helmet of polythene gets moulded firmly to the shape of
face (specific hazard).
Adults
a. Plastic bag.
(sexual asphyxia).
b. Old / infirm/ intoxicated fall in prone position in mud.
Homicidal:
Infants
a. Smothering.
• Commonest method of infant killing (palm/soft pillow over nostrils and
month).
b. Gagging.
• It is less common than smothering.
Adult.
Physical health and age both are important. Victims generally are
weak/old/ill who are unable to offer resistance. Strapping with adhesive
tape to keep back calls for help.(esp. in sexual adventure).
Burking:
This method of killing was practiced by notorious criminals named burke
and hare in Scotland. One used to sit on the chest while other smothers
(forcibly closed the mouth & nose). They sell bodies to medical schools.
Suicidal.
Rarely, by plastic bags.
Mechanism of death: Anoxic anoxia.

Autopsy finding:
Non specific:
Visceral congestion is marked, P.H. on pleura and pericardium.
Specific in homicidal cases
• Abrasions and bruises in region of mouth and nostrils. Which are
produced during struggling.
• Absent in infants and young children and debilitated old persons.
• Injury to soft and hard palate
 CHOKING
DEFINITION:
Impaction of foreign bodies in the pharynx, larynx, trachea, or bronchi.
Medicolegal aspect:
Mostly cases are accidental
• Mentally ill may cram large portions of food in mouth and inhale it.
• Surgical swab when patient is under G.A.
• Dentures in a stuporous alcoholic.
• Cafey Coronary
Homicidal rare except debilitated adults or infants.
Mechanism of death:
• Lodge in larynx and obstruct if large or laryngeal spasm if small.
• Leading to reflex neurogenic cardio vascular failure induced by
reflex para-sympathetic cardiac inhibition.
• Impaction in bifurcation may produce anoxic anoxia or parasympathetic
cardiac inhibition.
• Impaction may precipitate reflex bronchiolar spasm.
• Delayed death from pneumonia, lung abscess or bronchiectasis
 Asphyxiation by occluding the airway with a bag.
This method of suicide is seen more commonly in the elderly
His nose and mouth were occluded by the pillow, and he suffocated. The
autopsy was unremarkable except for signs of alcoholism. The scene
investigation was essential in determining the proper manner of death
(accident).
Another case of positional asphyxiation. This alcoholic fell out of bed and
ended up in a position in which he could not breathe.
His head was bent enough to prevent adequate aeration. Notice the dark
discoloration of his head
Death due to occlusion of the airway. This man fell into a silo while shoveling
corn.
This woman was discovered dead at home by her mother. She was a chronic
alcoholic who was known to swallow large quantities of food and then drink
alcohol. She did this because she felt the food would decrease the absorption
of the alcohol, thereby allowing her to remain drunk for longer periods of
time.
A few fragments of food were in her mouth and on her face.
A bolus of turkey was lodged in her airway
The wad of meat measured over 2” ´ 1.5” in total dimension.
Carbon monoxide poisoning. The man who died in this car ran a hose from
the exhaust into the interior.
Carbon monoxide poisoning causes red livor mortis. Red livor mortis also
occurs in cyanide poisoning and from the cold.