Non-Natural Death Associated with Sexual Activity: Results of a 25-Year Medicolegal Postmortem Study

Abstract

Introduction Non-natural deaths associated with sexual activity may occur either with or without the involvement of other persons. Aim The present study provides an overview of cases of non-natural death related to sexual activities as well as recommendations of how to handle these cases and to identify potentially dangerous pleasure-enhancing techniques. Methods This medicolegal, postmortem, retrospective, and prospective study is based on data of autopsies performed at the Institute of Legal Medicine at University Hospital, Goethe University, Frankfurt, Germany. Main Outcome Measure Identification of circumstances, sexual practices, and gender distribution of cases of non-natural death in this context. Results Between 1993 and 2017 (25 years), 16,437 medicolegal autopsies were performed, of which 74 cases (43 males, 31 females) of non-natural death were found to relate to sexual activities (0.45%). One female and 21 males had died in the course of autoerotic practices (group I, n = 22). Nine males and 14 females had performed sexual practices with mutual consent (group II, n = 23), and 13 males and 16 females without mutual consent (group III, n = 29). The average age in group I was 45.4 years; in group II, 40.6 years; and in group III, 39.2 years. Most of the deceased were found in their own apartments. Forms of stimulation included vaginal, anal, and oral intercourse; insertion of foreign bodies; use of chemical substances; and tools for respiratory depression/hypoxia. Three cases of death occurred during sexual activities involving bondage and discipline, sadism, and masochism (BDSM). Death due to strangulation was the main cause in group I, whereas intoxications were predominant in group II. Sharp force (eg, knife) was mainly responsible for death in group III. Anogenital injuries were documented in all groups in approximately equal percentages. Clinical Implications The cases presented show a high variety of circumstances in which non-natural death connected to sexual activity may occur. Strengths & Limitations This study presents a large postmortem collection of non-natural death cases with associated sexual activity. As the main limiting factor, it must be stated that mutual consent for a sexual practice or consumption of substances was presumed based on the information provided and a lack of evidence against this assumption. Conclusion In cases of death associated with sexual activity, medical staff should perform thorough unbiased examinations and documentations. Strangulation and the consumption of stimulants should be classified as life-threatening, pleasure-enhancing techniques. Patients and young people should be informed about these risks.

How safe is BDSM? A literature review on fatal outcome in BDSM play

“…These results show that fatalities correlate with the usage of alcohol and drugs. The numbers correspond with the results from Bunzel et al for autoerotic fatalities [8].…”

“…A 25-year medicolegal postmortem study from 1993 to 2017 on 16,437 autopsies was conducted in Germany. Of the 74 cases of non-natural death associated with sexual activity, 3 cases (4.05%) were associated with BDSM activities [ 8 ]. The 17 cases are described in Table 2 .…”

“…The study by Bunzel et al showed that of 16,437 autopsies from 1993 to 2017, 0.018% (3 cases) were non-natural deaths related to sexual activity involving BDSM. On the other hand, 0.13% of cases were non-natural deaths in autoerotic practices [ 8 ]. Similar numbers of autoerotic fatalities can be found in other studies conducted in Germany (0.1%) [ 18 ] or Canada (0.2%) [ 19 ].…”

Hypoxia-Associated Changes in Striatal Tonic Dopamine Release: Real-Time in vivo Measurements With a Novel Voltammetry Technique

“…The phenomenon of massive dopamine release in hypoxia followed by resumption of tonic levels drew our attention to a little discussed clinical and forensic problem, namely autoerotic asphyxiation (AEA) behaviors (Quinn and Twomey, 1998;Bunzel et al, 2019). Increase in striatal and nucleus accumbens dopamine transmission has been shown during sexual activity (Pfaus et al, 1990(Pfaus et al, , 1995.…”

Rates of Injury and Healthcare Utilization for Kink-Identified Patients

“…There are a few empirical studies of injury rates related to specific consensual BDSM practices, including medical case reports that are clearly linked to BDSM activities. Bunzel and colleagues 30 examined 16,437 medicolegal autopsies performed between 1993 and 2017 at the Institute of Legal Medicine at University Hospital, Goethe University in Frankfurt, Germany. Researchers found that 3 deaths were related to partnered consensual BDSM activities.…”