The Science of Sex: Breathless

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“When you find my body hanging . . . with a tight noose around my neck, do not look for a murderer. I have executed myself. I say execute rather than suicide because I didn’t really intend to hang unto death.” This cryptic note was found next to the strung-up, half-naked body of a young Canadian man. Indeed, it was not murder, nor was it suicide. It was autoerotic asphyxia: a climax-intensifying chokehold, taken a step too far.


Those who self-strangle do it in order to heighten orgasm by constricting the flow of blood to the brain during masturbation. The practitioners of this behavior, nearly all male, tighten a belt around their necks or suspend themselves by a noose, often using a closet rail, rafter or tree. The cerebral cortex is partially knocked out by the lack of oxygen, and its normal inhibitory influence on the thalamus and the hypothalamus (the areas of the brain which stimulate sensations of pleasure) is removed. This state of breath deprivation is known as cerebral anoxia, and it apparently results in a woozy heightened orgasm similar to that which one may experience when using nitrate inhalers, a.k.a. “poppers.” Giddiness, dizziness, and exhilaration combine with orgasmic sensations and fantasy elements to produce a powerful climax. But autoerotic asphyxiation carries a dire risk of accidental death, since the person performing it may pass out before he has time to release the constricting ligature.


One of the most famous cases of suspected autoerotic asphyxiation was pop star Michael Hutchence of INXS, who died of strangulation back in 1997, a death that was eventually ruled to be a suicide. (Hutchence hung himself from a closet rail, using a belt.) According to David Barrie, the director of a documentary on Hutchence, numerous details point toward autoerotic self-strangulation as the cause of death. “Perhaps the most interesting aspect of the tragedy is that, in the absence of any conclusive evidence, people have made up their own narrative as to the cause of death,” he muses. “And because autoerotic asphyxiation is taboo, the authorities do little to cast light on it all. Paula Yates, Hutchence’s girlfriend [who recently committed suicide], thought it was autoerotic asphyxiation — and wanted the world to believe it because she didn’t like the idea of her lover being a cliché victim of rock ‘n roll suicide. Hutchence’s family thought it suicide — wanting the world to believe that their son was anything other than a pervert. He was depressed, not kinky. A private act becomes an epic morality tale.”


This moral component is precisely what keeps the subject of autoerotic asphyxiation so taboo. It’s no wonder the subject is charged, linked as it is with subjects like masturbation and fetishism. Indeed, for many practitioners, autoerotic asphyxia is about more than experiencing a super-normal orgasm. To judge by the death scenes of victims, it is often linked with ritualized fantasy elements, including bondage, punishment and death. The victim’s body may be tied up around the ankles and genitals as well as the neck, and sado-masochistic literature or images are often found in the vicinity. Transvestism can also play a role: one victim was found dressed in women’s clothes and surrounded by documents containing passages such as “the law of the land for any man dressed as a woman and found guilty is that he be hanged.” Other victims have been found wearing make-up, or with shaved legs.


As with Hutchence, many suspected cases of autoerotic asphyxiation come to light only after the person has died. But on the basis of a few studies of living practitioners, it seems that the behavior typically begins experimentally, in adolescence. In some men the behavior becomes their only possible sexual outlet. A few studies suggest that experience of sexual abuse in childhood may provoke the behavior, but these are far from conclusive.


In a sense, the taboo against discussing the practice is as dangerous as the behavior itself, since it prevents people from seeking help. Autoerotic asphyxiation is not at all rare as a cause of death among young men. According to a study by Stephen Hucker and Ray Blanchard of the Clarke Institute of Psychiatry in Toronto, about ten known deaths per year in the Canadian provinces of Alberta and Ontario result from the practice. According to Mark Clark, a police officer who conducted a detailed study of autoerotic asphyxia after his own brother fell victim to it, five hundred to a thousand young men die in this way in the U.S. annually, and about thirty percent of adolescent hanging deaths can be attributed to it. (Clark’s findings are available at


As frightening as these numbers are, accurate statistics are difficult to amass, since so many cases are misidentified as suicides, either because the family covers up the evidence that the deceased was masturbating, or because the authorities make a default assumption that a hanging is a suicide. But even if there are no obvious clues such as magazines or bondage gear, an alert pathologist may spot other indications of the true cause of death: the victim may place a thick cloth between the ligature and his neck in order to prevent rope burns, or the closet rail may show wear from repeated use.


Somewhat more benign — and common — than solitary self-strangulation is the practice of partial suffocation during sex with a partner. This kink, which has a long history in world literature, may have physiological effects similar to those of self-strangulation, but with much less risk of a fatal outcome. And while it’s hard to know the exact numbers of participants, anecdotal evidence suggests that women as well as men participate in this activity, often as part of dominant/submissive role-playing. (Still, as a neuroscientist I have to say that depriving your brain of oxygen is never a good idea.)


Anyone for whom autoerotic asphyxia has developed into a compulsive behavior should seek psychotherapeutic treatment and attempt to rechannel their sexual energy: unlike many sexual kinks, this act is simply too dangerous to be a reasonable risk. At the very least, practitioners should find a partner with whom they can more safely engage in the practice. Unfortunately, the secrecy with which most people practice autoerotic asphyxia usually ensures that medical examiners, not psychiatrists, are the first to find out about it.

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© 2000 Simon LeVay and, Inc.