Autoerotic asphyxiation

Erotic asphyxiation refers to intentionally cutting off oxygen to the brain for sexual arousal. It is also called asphyxiophilia, autoerotic asphyxia, or breath control play. Colloquially, a person engaging in the activity is sometimes called a gasper. The erotic interest in asphyxiation is classified as a paraphilia in the Diagnostic and Statistical Manual of the American Psychiatric Association. Psychiatrist Joseph Merlino stated that it meets the criteria for a disorder "because it has the potential for lethality or serious injury."

History
Historically, the practice of autoerotic asphyxiation has been documented since the early 1600s. It was first used as a treatment for erectile dysfunction and impotence. The idea for this most likely came from subjects who were executed by hanging. Observers at public hangings noted male victims developed an erection, sometimes remaining after death (death erection), and occasionally ejaculated when being hanged. Note that, however, ejaculation occurs in hanging victims after death because of disseminated muscle relaxation; this is a different mechanism from that sought by AEA (autoerotic asphyxiation) practitioners.

Practice
Various methods are used to achieve the level of oxygen depletion needed, such as a hanging, suffocation with a plastic bag over the head, self-strangulation such as with a ligature, gas or volatile solvents, chest compression, or some combination of these. Sometimes, complicated devices are used to produce the desired effects. The practice can be dangerous even if performed with care and has resulted in a significant number of accidental deaths. Uva (1995) writes “Estimates of the mortality rate range of autoerotic asphyxia between 250 to 1000 deaths per year in the United States.” Cases have also been reported in Scandinavia and in Germany.

Accidental death
Deaths often occur when the loss of consciousness caused by partial asphyxia leads to loss of control over the means of strangulation, resulting in continued asphyxia and death. While often asphyxiophilia is incorporated into sex with a partner, others enjoy this behaviour by themselves, making it potentially more difficult to get out of dangerous situations. Victims are often found to have rigged some sort of "rescue mechanism" that has not worked in the way they anticipated as they lost consciousness.

In some fatality cases, the body of the asphyxiophilic individual is discovered naked or with genitalia in hand, with pornographic magazines nearby, with dildos or other sex toys present, or with evidence of having orgasmed prior to death. Bodies found at the scene of an accidental death often show evidence of other paraphilic activities, such as fetishistic cross-dressing and masochism. However, in many cases families of these victims may disturb these sites by "sanitizing" them, removing evidence of such paraphilic activities.

The great majority of known erotic asphyxial deaths are male; among all known cases in Ontario and Alberta from 1974 to 1987, only one out of 117 cases was female. Some individual cases of women with erotic asphyxia have been reported. The mean age of accidental death is mid-20s,, but deaths have been reported in adolescents  and in men in their 70s.

Autoerotic asphyxiation has at times been incorrectly diagnosed as murder and especially so when a partner is present. Some hospitals have teaching units specifically designed to educate doctors in the correct diagnosis of the condition.

Lawyers and insurance companies have brought cases to the attention of clinicians because some life insurance claims are payable in the event of accidental death, but not suicide.

Famous cases

 * David Carradine, actor, Lumpini police found him curled up inside a closet with one end of a shoelace tied around his penis and the other end fastened around his neck.
 * Frantisek Kotzwara, composer, died from erotic asphyxiation in 1791, which is probably the first recorded case.
 * Sada Abe killed her lover, Kichizo Ishida, through erotic asphyxiation in 1936, proceeding to cut off his testicles and carry them in her handbag for a number of days. The case caused a sensation in 1930s Japan and has remained one of the most famous Japanese murder cases of all time.
 * Albert Dekker, stage and screen actor, was found in 1968 with his body graffitized and a noose around his neck in his bathroom.
 * Vaughn Bodé, artist, died from this cause in 1975.
 * Stephen Milligan, a British Conservative MP for Eastleigh, died from autoerotic asphyxiation combined with self-bondage in 1994.
 * Kevin Gilbert, a songwriter, musician, composer, producer and collaborator, died of apparent autoerotic asphyxiation in 1996.
 * Michael Hutchence, lead singer of INXS, may have died from autoerotic asphyxiation in 1997, although suicide was the official cause of death.
 * Kristian Etchells, British National Front party member, in 2005.
 * On March 28, 2007, The New York Times had a front-page story on a teenager who had suffered a heart attack and spent three days in a coma after hanging himself for a "rush"., in what appeared to be an instance of a choking game.
 * In Herceg v. Hustler, Diane Herceg sued Hustler magazine for the death of her 14-year-old son, Troy D., who had experimented with autoerotic asphyxia after reading about it in that publication.