Accidental autoerotic deaths between 1978 and 1997: Institute of Legal Medicine, Medical School Hannover

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Abstract

Between 1978 and 1997 the Institute of Legal Medicine of the Hannover Medical School examined 17 fatal autoerotic deaths. The incidence for the Hannover region was 0.49 cases per million inhabitants per year. The victims included 17 men with an average age of 36.8 years; a peak in the age distribution was seen between 20 and 29 years. Twelve of the men were found by friends or family in a domestic environment, while other situations in which the victims were found included the victim’s own car, a hotel room, a canal embankment, a public parking lot as well as the holding cell of the youth detention center. The men were of varying socioeconomic status and held a number of different types of jobs or still attended school. Five of the men were found completely nude, while five were only undressed below the waist. Four men wore women’s clothes and two were fully clothed with exposed genitals. Besides women’s clothes, other objects found at the scene included various types of sexual aids, including ropes, chains, metal bars, locks, sex magazines, condoms, plastic bags, rubber items, etc. In four cases blood alcohol levels between 0.1 and 2.5‰ (urine alcohol levels between 0.2 and 2.5‰) were found. Toxicologic examination revealed chloroform, ketamin, a propane–butane gas mixture in one case each, and in two cases cocaine and morphine. Causes of death included central paralysis after strangulation (seven cases), asphyxiation (4), subarachnoid hemorrhage (2), intoxication (1), hypothermia (1), left heart failure (1), and drowning (1). The history, findings at scene, and autopsy findings and, in individual cases, other investigations are of utmost importance to accurately reconstruct a fatal autoerotic accident.

Introduction

A portion of autoerotic accidents results in serious injury of varying degree; many of these injuries are not recognized or not reported [1]. Fatal autoerotic accidents that are not specially designated in the cause-of-death statistics, are often found in the forensic literature in the form of case reports. These deaths are also partially labelled as suicides [7], [8], [9], [10] due to the in part unusual circumstances in which the body is found [2], [3], [4], [5], [6]. Homicides have also been known to be disguised as an autoerotic accident [11]. However, despite the frequent description of these accidents, little is known about their incidence.

The aim of this work was to retrospectively gather epidemiologic data and to describe the characteristics of the circumstances in which the body was found as well as autopsy results for fatal autoerotic accidents in the jurisdiction of the Institute for Legal Medicine at the Hannover Medical School between 1978 and 1997.

Section snippets

Materials and methods

All cases of legally-mediated autopsies and viewings of bodies in the Institute for Legal Medicine at the Hannover Medical School as well as the case files of district attorney’s offices were evaluated. This work considers all fatalaties occurring during autoerotic activity as accidental autoerotic deaths (AAD), regardless whether the death is natural or not.

Results

Between 1978 and 1997 the Institute of Legal Medicine of the Hannover Medical School performed 15,687 forensic examinations (autopsies, viewing of bodies). The analysis of this data revealed seventeen fatal autoerotic deaths. An autopsy was performed in 15 cases, in two cases the body was only viewed (Cases 1–17). Eleven victims died in the Hannover region, six within the jurisdiction of the Institute for Legal Medicine in the areas around Hannover. All victims were males between the ages of 16

Discussion

Since not all regions fell under the jurisdiction of the Institute for Legal Medicine of the Hannover Medical School for the entire study period, the frequency of fatal autoerotic accidents was only calculated for the City and County of Hannover. The 11 cases of autoerotic accidents occurring in this region, for which the average population was 1,127,000 over the 20 years study period, results in an incidence of 0.49 cases per million inhabitants per year. A similar or slightly higher incidence

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