Physiology Author John Curra wrote, "The carotid arteries (on either side of the neck) carr y oxygen-rich

blood from the heart to the brain. When these are compressed, as i n strangulation or hanging, the sudden loss of oxygen to the brain and the accum ulation of carbon dioxide can increase feelings of giddiness, lightheadness, and pleasure, all of which will heighten masturbatory sensations."[1] Author George Shuman describes the effect as such, "When the brain is deprived o f oxygen, it induces a lucid, semi-hallucinogenic state called hypoxia. Combined with orgasm, the rush is said to be no less powerful than cocaine, and highly a ddictive."[2] Concerning hallucinogenic states brought about by chronic hypoxia, Dr. E L Lloyd notes that they may be similar to the hallucinations experienced by climbers at altitude. He further notes that no such state occurs in hypoxia brought about b y sudden aircraft decompression at altitude. These findings suggest to him that they do not arrive purely from a lack of oxygen. Upon examining the studies on h ypoxia he found that "abnormalities in the cerebral neurochemistry involving one or more of the interconnected neurotransmitters, dopamine, 5-hydroxytryptamine, and -endorphin had been reported in all the conditions associated with hallucina tions."[3] History Historically, the practice of autoerotic asphyxiation has been documented since the early 17th century. It was first used as a treatment for erectile dysfunctio n.[4] The idea for this most likely came from subjects who were executed by hang ing. Observers at public hangings noted that male victims developed an erection, sometimes remaining after death (death erection), and occasionally ejaculated w hen being hanged. However, ejaculation occurs in hanging victims after death bec ause of disseminated muscle relaxation; this is a different mechanism from that sought by autoerotic asphyxiation practitioners. Practice Various methods are used to achieve the level of oxygen depletion needed, such a s a hanging, suffocation with a plastic bag over the head, self-strangulation su ch as with a ligature, gas or volatile solvents, chest compression, or some comb ination of these.[5] Sometimes, complicated devices are used to produce the desi red effects.[6] The practice can be dangerous even if performed with care and ha s resulted in a significant number of accidental deaths. Uva (1995) writes Estima tes of the mortality rate of autoerotic asphyxia range from 250 to 1000 deaths p er year in the United States. [7] Cases have also been reported in Scandinavia[8] and Germany.[9][10] Autoerotic asphyxiation may often be mistaken for suicide, w hich is a major cause of death in teenagers.[11] Accidental death See also: Autoerotic fatality Deaths often occur when the loss of consciousness caused by partial asphyxia lea ds to loss of control over the means of strangulation, resulting in continued as phyxia and death. While often asphyxiophilia is incorporated into sex with a par tner, others enjoy this behaviour by themselves, making it potentially more diff icult to get out of dangerous situations.[12] Victims are often found to have ri gged some sort of "rescue mechanism" that has not worked in the way they anticip ated as they lost consciousness.[citation needed] In some fatality cases, the body of the asphyxiophilic individual is discovered naked or with genitalia in hand, with pornographic material or sex toys present, or with evidence of having orgasmed prior to death.[9] Bodies found at the scen e of an accidental death often show evidence of other paraphilic activities,[13] such as fetishistic cross-dressing and masochism.[5] In cases involving teenage

rs at home, families may disturb the scene by "sanitizing" it, removing evidence of paraphilic activity. This can have the consequence of making the death appea r to be a deliberate suicide, rather than an accident.[14] The great majority of known erotic asphyxial deaths are male; among all known ca ses in Ontario and Alberta from 1974 to 1987, only one out of 117 cases was fema le.[5] Some individual cases of women with erotic asphyxia have been reported.[1 5][16][17][18] The mean age of accidental death is mid-20s,[5][19] but deaths ha ve been reported in adolescents[20][21][22] and in men in their 70s.[9][19] Autoerotic asphyxiation has at times been incorrectly diagnosed as murder and es pecially so when a partner is present. Some hospitals have teaching units specif ically designed to educate doctors in the correct diagnosis of the condition.[ci tation needed] Lawyers and insurance companies have brought cases to the attention of clinician s because some life insurance claims are payable in the event of accidental deat h, but not suicide.