Autoerotic death: un unusual case of lethal asphyxiophilia associated with autogynephilia

Learning Overview: The goal of this presentation is to expose a case of lethal asphyxiophilia associated with multiple paraphilias, underlying the features that can be useful in a forensic investigation to exclude the possibility of sexual homicide or suicide in a case of suspicious autoerotic asphyxia. Impact on the Forensic Science Community: Cases of autoerotic deaths are relatively rare in the forensic medical practice. In such cases, establishing the cause and manner of death is quite challenging for the forensic professionals. This presentation, due to the unusual methods used by the victim, will impact the forensic science community by providing important support for the management of similar forensic cases. A 56-year-old man was found dead in the bedroom of his house, which was locked from inside, partially suspended over the edge of the bed by the neck and the torso while both the legs and the pelvis were lying on the mattress. The body was discovered with a diving mask over his head, dressed in female’s clothing, including panties, bra, a corsage, and black stockings. Suspension was from a hook fixed to the wall behind the corpse, with a rope attached to a collar around the neck. The torso was suspended from the hook by two separate ligatures, one secured to a metallic wire that held two plastic funnels together fixed around the breast, and the other fastened to a leather belt placed at the waist. Pornographic pictures of bondage, depicting a set-up similar to the victim’s, were displayed on the wall in front of the body. The deceased was divorced with one child, was employed, and had no diagnosed psychiatric illnesses. No suicide note was found at the crime scene. During autopsy, two plastic discs were found under each funnel placed on the breasts. Both of the devices showed numerous pins with the sharp extremities pointed toward the skin. The male genitals were stretched by the means of a string knotted to another belt, fastened at the waist. There was marked facial congestion with massive petechial hemorrhage in the face and conjunctivae. The ligature mark was slightly oblique, pale, approximately cm wide, and encircled the neck above the thyroid cartilage, continuing up both sides of the neck to the occipital region where it ended. The internal examination showed hemorrhage in the area of the ligature mark that penetrated the thyrohyoid muscles. There were no hyoid bone or larynx cartilage fractures. All organs were congested, with petechiae on the epicranium, serosal surfaces of epicardium, and visceral pleura. There were no other significant findings at autopsy. Cause of death was mechanical asphyxia due to hanging while engaged in autoerotic activity. Accidental autoerotic death is defined as a solitary, accidental death caused by a lethal paraphilia, such as asphyxiophilia. It is characterized by the use of a variety of techniques to produce the oxygen depletion needed to enhance sexual arousal, including hanging, self-strangulation, and suffocation with plastic bags or gas masks. This paraphilia could be associated with others, such as bondage, fetishism, and autogynephilia (male’s propensity to be sexually aroused by the thought of himself as a female). In this case, the mechanism of asphyxia involved suffocation by a diving mask over the head and strangulation by neck ligature, combined with pain-stimulating agents, while wearing female’s clothing. The peculiar variety and complexity of these mechanisms, combined together, made it difficult to exclude the possibility of a third-party involvement. However, suicide and homicide were excluded since all the characteristic features for an act of autoerotic asphyxia, described in the forensic medicine literature, were found thanks to a detailed crime scene investigation and the reconstruction of the victim’s psychological history, which are of the uttermost importance in order to correctly establish the nature of an autoerotic death.