brand logo

‘Establishing manner of death in autoerotic asphyxia challenging’ 

02 Jun 2021

  • Scene visits imperative, notes local case report 

By Ruwan Laknath Jayakody    Since establishing the manner of death, whether it is accidental, suicidal or homicidal, is a challenging task for the forensic pathologist in deaths such as those resulting from autoerotic asphyxia, it is imperative that scene visits are conducted in order to determine the manner of death.  This was noted by J. Warushahennadi and U.G.B. Jayarathna (attached to the Department of Forensic Medicine of the University of Ruhuna) and L.K.C.D. Ariyarathna (attached to the Base Hospital, Elpitiya) in a case report titled Death due to autoerotic asphyxia which was published recently in the Sri Lanka Journal of Forensic Medicine, Science and Law. According to Addiction to Autoerotic Asphyxia by A. Ameller, Y.L. Start, M. Cadranel, C. Portlier and C. Dubertret, autoerotic asphyxia is described as an activity inducing hypoxia (a condition in which the body or a region of the body is deprived of the adequate supply of oxygen at the tissue level) in order to increase sexual excitement. Asphyxiation following the compression of the neck subsequent to hanging, has been reported, as noted by G. Tournel, N. Hubert, C. Rouge, V. Hedouin and D. Gosset in Complete autoerotic asphyxiation: suicide or accident?, as the commonest form of autoerotic asphyxia. R. Fedakari, O. Akan and B. Eren point out in Autoerotic asphyxia by hanging that while this practice is commonly observed in adolescents and young adult males, in addition to being a solitary practice, it may also be a group activity. Fedakari et al., further explain that it occurs in secluded places, with sexual aids such as pornographic pictures and videos being commonly found at the scene. Further, Fedakari et al., note that transvestitism or gaining intense sexual arousal from crossdressing too is commonly seen in such cases while the masturbating individuals may also fantasise about fetish objects. Knowing the danger involved in the activity, practitioners, as pointed out by C. Capatina, S. Hostiuc, C. Dragoteanu and G.C. Curca in Autoerotic asphyxia hanging - case presentation, take precautions by creating self rescue mechanisms such as padding (protective padding of the ligature/s).  Warushahennadi et al., emphasised that according to the available literature, deaths due to autoerotic asphyxia have not been reported in Sri Lanka. In the instant case, Jayarathna had conducted the autopsy with contributions from Ariyarathna who also visited the scene. The case Warushahennadi et al., present here is one where a young adult had died due to hanging with sexual paraphernalia being found at the scene.  Case History  A 22-year-old male was found dead at home. He was living alone. The doors were locked from the inside. The body was in the bedroom where the windows and the door were closed. The deceased was clad in a T-shirt and the lower half of the body was naked and an undergarment was on the floor, close to the body. There was a mobile phone and scattered pieces of a shattered mirror, on the floor, all close to the body. A dried, thick, silver coloured secretion was seen on the web between the left thumb and the index finger and on the floor under the body. The last action played on the mobile phone, a search of the information revealed, was a pornographic video.  The external examination of the body had revealed a congested face, petechial (tiny red or purple spots in the tissues in or around a capillary/small blood vessel) haemorrhages on conjunctivae and fixed hypostasis (the accumulation of fluid or blood in the lower parts of the body or organs under the influence of gravity) on the lower half of the forearms, hands, both thighs and the frontal aspects of both the legs, below the knees. There was an imprint abrasion encircling the upper part of the neck on the left side which extended upwards, on and towards the right side where the knot was situated, from the front and the back. The mark was absent on the right side of the neck, below the right ear, where the knot was present. The body of the hyoid (a horseshoe shaped bone situated in the anterior midline of the neck between the chin and the thyroid cartilage) bone was fractured, with bleeding (haemorrhage) into the surrounding soft tissues.  The internal examination revealed multiple petechial haemorrhages over the pericardium (a double walled sac containing the heart and the roots of the great vessels), and on the lungs. Toxicological screening for alcohol and substance use was negative. The swabs obtained from the stains on the finger webs and the floor revealed seminal fluid.  The cause of death being asphyxia had been determined by Warushahennadi et al., by considering the scene, the nature of the ligature, and the presence of congestion and petechial haemorrhages above the ligature mark which are indicative of the compression of the veins of the neck.  The circumstantial evidence as per Warushahennadi et al., demonstrated the engagement of the deceased in autoerotic manoeuvres.  However, the prolonged compression of the neck or the failure of the self rescue mechanisms had, as explained by Fedakari et al., led to unconsciousness and death.  “The deceased may have reached the point of suspension by standing on the chair. By encircling the ligature around the neck and by keeping the body in a partial hanging state, he may have engaged in sexual activity. It is possible that he controlled the state of asphyxia by keeping the body in a partially seated position. The presence of seminal fluid on the hand indicates the act of masturbation. Self rescue mechanisms were not observed at the scene. Features like transvestitism, bondage as described by M. Arun, V. Palimar, G.N.P. Kumar and R.G. Menezes in Unusual methods of suicide: Complexities in investigation, and padding as mentioned by Capatina et al., were not observed. The prolonged compression of the neck or the lack of self rescue mechanisms may have led to hypoxia and an unconscious state, resulting in the gravitational drag of the weight of the body, causing asphyxia and death,” Warushahennadi et al., further explained.  Tournel et al., point out that due to the unusual methods used by the victims to create the state of partial asphyxia, it becomes a challenging task for the forensic pathologist to establish the manner of death (accidental or suicidal or homicidal).  According to Arun et al., between 5% and 20% of deaths due to autoerotic asphyxia in the United States of America are considered equivocal while the manner of death in the majority of such deaths remain undetermined as to whether they were accidental or suicidal in nature. Therefore, in suspicious cases, Warushahennadi et al., observe, the possibility of homicide too should be ruled out.

Kapruka

Discover Kapruka, the leading online shopping platform in Sri Lanka, where you can conveniently send Gifts and Flowers to your loved ones for any event. Explore a wide range of popular Shopping Categories on Kapruka, including Toys, Groceries, Electronics, Birthday Cakes, Fruits, Chocolates, Automobile, Mother and Baby Products, Clothing, and Fashion. Additionally, Kapruka offers unique online services like Money Remittance, Astrology, Medicine Delivery, and access to over 700 Top Brands. Also If you’re interested in selling with Kapruka, Partner Central by Kapruka is the best solution to start with. Moreover, through Kapruka Global Shop, you can also enjoy the convenience of purchasing products from renowned platforms like Amazon and eBay and have them delivered to Sri Lanka.Send love straight to their heart this Valentine's with our thoughtful gifts!

Discover Kapruka, the leading online shopping platform in Sri Lanka, where you can conveniently send Gifts and Flowers to your loved ones for any event. Explore a wide range of popular Shopping Categories on Kapruka, including Toys, Groceries, Electronics, Birthday Cakes, Fruits, Chocolates, Automobile, Mother and Baby Products, Clothing, and Fashion. Additionally, Kapruka offers unique online services like Money Remittance, Astrology, Medicine Delivery, and access to over 700 Top Brands. Also If you’re interested in selling with Kapruka, Partner Central by Kapruka is the best solution to start with. Moreover, through Kapruka Global Shop, you can also enjoy the convenience of purchasing products from renowned platforms like Amazon and eBay and have them delivered to Sri Lanka.Send love straight to their heart this Valentine's with our thoughtful gifts!


More News..