Editor’s note: This story is about a sexual activity that’s embarrassing – to say the least – and potentially deadly. Participants rarely talk about it and are often not discovered until they are dead. Autoerotic asphyxia is more widespread than we may want to believe and it has claimed several victims in Galesburg and Knox County. It’s not a new phenomenon but it is still, essentially, a secret one.

– NW

Coming upon a death scene is an emotionally wrenching experience even for a police officer or coroner who do so on a semi-regular basis and typically with forewarning. Consider instead the unexpected discovery of a dead loved one by their parent or spouse where the deceased is nude or semi-nude, slumped in a noose and surrounded by pornography or sexual toys. That is a situation most of us will never encounter but must agree would be shocking and painful.

– Mark Thomas

Knox County Coroner

By Mike Kroll

According to national statistics, death by hanging ranks as either the second or third most common suicide method of American males year-in, year-out. Locally, in Knox County, hanging is the number one suicide method for males according to Sheriff Jim Thompson. For these reasons most of us don’t really think twice when we hear of yet another male hanging death – unless we were close to the victim.

However, many would be surprised to know that some of these hangings weren’t suicides, at least not intentional suicides. As one recent Galesburg case demonstrated, some of these hanging deaths are the unanticipated result of autoerotic asphyxiation (AeA) – or clinically as Hypoxyphilia.

In these cases, the intent of these victim isn’t suicide but enhanced sexual pleasure during masturbation through self-strangulation – a bizarre and extremely dangerous sexual practice unfamiliar to most of us and even less understood.

Estimating the occurrence of AeA is extremely difficult owing to the secrecy employed by its practitioners. Estimated annual confirmed deaths from AeA fall between 500 and 1,000 nationwide. Experts believe that this is by necessity an understated statistic as many AeA deaths are mislabeled as suicides. It is important to note that most people engaging in AeA do so without killing themselves in the process and that incidents of AeA deaths can be found across the country in cities, suburbs and rural areas. According to local officials, the recent incident in Galesburg was definitely not the first local AeA death; it was preceded by at least two or three others in recent years.

The scientific literature on the topic confirms the probable underreporting of related "sub-intentional suicide incidents" is due in part to the fact that the victims are most often discovered by family members who, due to the shock, emotionally charged situation or simple embarrassment "clean up" the death scene to mask what actually took place from investigators. It is often easier for loved ones to explain the death as a suicide than to confront their own personal demons and fears regarding sexual conduct that many would find extremely uncomfortable to speak about. It is generally accepted that at least 30 percent of male hanging deaths are related to AeA.

While the possibility of death exists every time someone uses this method of sexual pleasure, we have to remember that most victims have engaged in this for a prolonged period of time before accidentally killing themselves. They have to believe that they will know how to stop before it is too late. There is a very narrow window between achieving maximum gratification and unconsciousness and it is believed that many of these tragic deaths occur due to the victim chasing an even better climax.

– Coroner Mark Thomas

The motivation behind the practice is to heighten or elongate the sexual gratification from masturbation through reducing cerebral blood flow/oxygen (hypoxia) resulting in lightheadedness, giddiness or euphoria. Practitioners report greater sexual sensations, easier to achieve or improved erections, and higher orgasmic intensity. For centuries it has been documented that hanged criminals frequently exhibited spontaneous erections and some experts believe that the incidence of AeA among older males may be motivated by their difficulty in achieving satisfactory erections through traditional masturbation techniques. Apparently the preferred technique varies from practitioner to practitioner with some working to continuously occlude cerebral blood flow just short of unconsciousness while others seek to release the pressure on their neck at the height of their orgasm.

Beyond the direct physiological effects there are also psychological effects related to the thrill related to the inherent risk involved. Many experts see AeA as yet another dangerous practice related to adolescent thrill-seeking. "Teens engage in lots of senseless and dangerous activities for the thrill of it and most never conceive of the possibility that something could go wrong for them," commented Galesburg Police lieutenant David Clague.

One key aspect of AeA is the presence of a safety mechanism intended to mitigate against accidental death. Most intentional suicide victims will arrange a hanging in such a way as to maximize the probability of death such as attaching a noose at a height that permits their full body weight to hang without permitting the use of their feet to recover. Nearly all AeA victims are found in a slumped sitting or kneeling position with their head in a padded noose and an apparent escape method at hand.

"Generally speaking, the position you find such victims in would almost never occur in the event of an intentional suicide," explained Thompson. "Most have rigged up some sort of safety device, but usually it is crude and hardly what a reasonable person would consider fail-safe. Additionally, the hanging is often done from a controlled posture under the presumption that they can simple straighten up to relieve the pressure on their throat. The problem occurs when they push the limits seeking greater satisfaction and go unconscious before they react to save themselves. Few people realize just how little pressure is required against either the carotid artery or jugular to block blood flow to the head; it is just four to six pounds."

Clague agreed with Thompson that it is frequently evident to a trained investigator that a hanging incident was autoerotic asphyxiation rather than suicide. In the early 1980s, researchers from the FBI developed six defining characteristics of a typical AeA death scene distinguishing it from an intentional suicide.

1. Evidence of masturbation or solo sexual activity.

2. The presence of sexual aides, props or pornography.

3. Evidence of a safety mechanism or self-rescue strategy.

4. The presence of padding around the neck to prevent ligature marks from the hanging activity.

5. Evidence of prior autoerotic behavior

6. The absence of any intent to commit suicide.

"Sexual activity is something most of us conduct in private but in the case of autoerotic asphyxia this desire for secrecy is taken to a much greater extent," explained Clague. "Typically there is a great effort put into disguising their sexual activities and the techniques involved."

The largest group of people involved in autoerotic asphyxia are adolescent or young adult, white, middle-class males. Researchers have found that 70 percent are under 30 but the oldest reported case was 77 and the youngest 9. It has been postulated that this is yet another, albeit extreme, example of teenage thrill-seeking behavior. This is not an exclusively male exercise but recorded female deaths are rare as are incidents among African Americans or Hispanics.

"Relatively few are aware of this behavior and many who are presume that it only occurs in young men but there are more cases of men over 40 than you’d think," commented Thomas. "It is extremely rare among women for obvious physiological reasons but it does occur although I am aware of no female victims locally."

It must be remembered that masturbation is usually a private personal activity and not one most people discuss in the normal course of daily life. Like most fetishes, practitioners of AeA have even more reason to be secretive about their actions. Parents and loved ones frequently will have no idea that this behavior is occurring until it is too late.

There are some signs that should cause concern.

Foremost would be evidence of ligature marks or unexplained abrasions on the neck. The presence of ropes or neckties tied in unusual knots or padded ropes should also elicit suspicion. Other physical signs that may accompany AeA but are not exclusive to it are bloodshot eyes and more frequent headaches.

A parent might also pick up on some of the slang phrases for AeA. These include: gasping, gasper, breath play or scarfing. One thing the experts seem to agree upon is that this is a form of sexual fetish that poses no physical danger to anyone other than the practitioner himself. The longer one uses these techniques to achieve sexual release, the more dangerous the practice becomes as they continue to push the envelope to achieve ever-increasing sexual satisfaction.

While every practitioner believes he has devised a safe method, experts say that over time virtually all who continue to engage in autoerotic asphyxia will end up as a fatality and even repeated successful incidents can result in irreversible brain damage.

Like virtually all forms of gambling the long term odds of success are nil but – unlike other forms of gambling – the stakes are enormous.