OVERVIEW

What is autoerotic asphyxiation?

Autoerotic asphyxiation, also known as "autoerotic death" or "sexual asphyxia," refers to a sexual activity practiced by individuals with specific psychological or behavioral preferences. It involves inducing a degree of hypoxia through certain methods or devices in secluded settings to stimulate sexual desire, enhance arousal, and intensify pleasure. Accidental death by asphyxiation often occurs due to improper or excessive measures^[1].

Deaths from autoerotic asphyxiation are often mistaken for suicide or homicide, potentially leading to disputes over insurance or inheritance.

Is autoerotic asphyxiation common?

No, it is rare.

A 25-year retrospective case analysis in Canada reported an incidence of approximately 0.2–0.5 per million^[2], while data from Xi'an, China, indicated a rate of 0.59 per million^[3]—roughly 1 case per million people. However, some cases may go unreported due to family shame, suggesting actual numbers could be higher.

What are the characteristics of autoerotic asphyxiation?

Deaths result from asphyxiation methods such as hanging, binding, plastic bag suffocation, or chemical use^[4-5]. Common features include:

1. Scenes are typically secluded and enclosed;
2. Victims are often found standing with neck restraints; some wear cross-dressing attire;
3. Mirrors, pornography, masturbatory tools, or adult toys are frequently present;
4. Some practitioners employ safety mechanisms to reduce risks^[2].

Which medical department handles autoerotic asphyxiation?

Psychiatry or psychology.

SYMPTOMS

What are the signs of someone who engages in autoerotic asphyxiation before death?

Individuals who engage in autoerotic asphyxiation may not exhibit particularly unusual behavior in daily life, but most share the following characteristics:

1. They tend to be somewhat educated.
2. They are often introverted, reserved, shy around people, and struggle with interacting with the opposite sex. A small minority may be extroverted, outgoing, articulate, and enjoy engaging with the opposite sex.
3. The vast majority exhibit varying degrees of paraphilias such as transvestism, fetishism, or autoerotic masochism.

CAUSES

What is the cause of autoerotic asphyxiation?

This unusual method of asphyxiation reflects abnormal sexual psychology and behavior. The psychological activities of patients are complex, and their behaviors are highly concealed, often only discovered after death, making it difficult to provide precise psychological evaluations. The exact cause remains unclear. Foreign scholars believe that autoerotic asphyxiation is a deviant sexual behavior resulting from paraphilia^[7].

Some scholars consider it a mental disorder and classify it under the International Classification of Diseases (ICD). However, others argue that individuals who die from paraphilia often exhibit borderline personality disorder, which does not fall under the diagnostic criteria for mental disorders or the ICD^{[8, 9]}.

Who is most commonly affected by autoerotic asphyxiation?

Currently, reported cases in China are predominantly male, with females being extremely rare. In terms of age, young to middle-aged single males are the most affected^[10], which may be related to long-term unmet sexual needs in single men.

Most patients have a certain level of education. Domestic and international reports indicate that the deceased often include actors, artists, and others with educational backgrounds, while illiteracy is rare^{[3, 11]}. Therefore, the incidence rate is higher in urban areas than in rural areas, possibly due to differences in education and social experiences.

Is autoerotic asphyxiation hereditary?

Uncertain.

Current research suggests that autoerotic asphyxiation may be related to genetics, but evidence is insufficient.

DIAGNOSIS

How to determine sexual asphyxiation? What tests are needed?

Diagnosing sexual asphyxiation in living individuals is extremely difficult.

Such individuals often choose quiet, secluded locations with little to no foot traffic, such as single-person rooms, deep forests, warehouses, private bathrooms, basements, or abandoned restrooms, making them hard to detect. The patients themselves are aware of the obscene nature of this behavior and feel ashamed, yet struggle to control it. Combined with deliberate concealment in daily life, identifying such individuals is nearly impossible.

Only after death from sexual asphyxiation, when forensic experts intervene, can the cause be determined. However, if family members discover the deceased first, they may attempt to cover it up by removing female-related or obscene items from the scene, which can interfere with the investigation.

Overall, if the deceased exhibits the following characteristics, sexual asphyxiation may be a possibility—though this is only a reference, as a thorough and rigorous process involving scene examination, autopsy, and background investigation is required for a definitive conclusion.

1. Gender: Mostly young or middle-aged males
2. Location: Often in remote or isolated places
3. Scene: The deceased is usually fully or partially naked, with female-related or obscene items present
4. Evidence: No signs of suicide or homicide
5. Medical history: Often a history of sexual paraphilias

TREATMENT

How to treat sexual asphyxiation?

Currently, there is very limited clinical research evidence on the treatment of sexual asphyxiation.

The main reason is that sexual asphyxiation is a private activity, and due to stigma, family and friends often struggle to understand the specific behaviors involved, with very few individuals seeking treatment voluntarily. Even when discovered, treatment is extremely difficult, causing distress for both patients and their families.

Given that most patients exhibit varying degrees of paraphilias such as transvestism, fetishism, or autoerotic asphyxia, the following outlines potential treatment measures for paraphilic behaviors for reference.

1. **Medication**: Such as fluoxetine or medroxyprogesterone acetate. Fluoxetine has not been approved for treating psychosexual disorders but is commonly used in Europe and North America to reduce sexual fantasies like fetishism. Medroxyprogesterone acetate is an anti-androgen drug, colloquially known as "chemical castration," and is used with extreme caution. The duration of medication remains undetermined and depends on the patient's individual circumstances, requiring personalized evaluation.
2. **Cognitive Behavioral Therapy (CBT)**: Aims to modify inappropriate sexual behaviors and establish healthy sexual attitudes.
3. **Deep Brain Stimulation (DBS)**: Targeting the posterior hypothalamus or ventromedial regions may show some efficacy.

Can sexual asphyxiation be cured?

It is quite challenging.

Treating sexual asphyxiation is difficult, causing significant distress for patients and families. However, consulting a psychologist for symptomatic and supportive therapy may still be beneficial.

DIET & LIFESTYLE

What should people with sexual asphyxiation fetishes pay attention to in daily life?

Individuals should correctly understand the dangers of sexual asphyxiation. If it is difficult to control this behavior and causes extreme distress, it is advisable to actively seek help from psychologists or doctors to avoid tragedies.

Is follow-up examination necessary during the treatment of sexual asphyxiation?

If a diagnosis has been confirmed, it is necessary to follow medical advice for regular follow-up examinations. Particularly, the use of treatment medications may cause other side effects, and doctors prescribe them very cautiously, making regular follow-ups even more essential.

PREVENTION

Can Erotic Asphyxiation Be Prevented? How to Prevent It?

The exact cause of erotic asphyxiation remains unclear, and there are no definitive preventive measures.

In daily life, if you experience setbacks in relationships, try to self-reflect, communicate with friends, and shift your focus. Avoid dwelling on the emotional pain of a failed relationship for too long. Establishing healthy ways to fulfill sexual needs may help reduce the risk of erotic asphyxiation.

If you witnessed or experienced sexual abuse during childhood, it is crucial to take it seriously. Maintain communication with a psychologist and seek treatment if necessary to prevent erotic asphyxiation.

If you or your partner exhibit unusual sexual preferences during intimacy, remain highly vigilant and seek medical attention promptly to avoid harm or death.