Erotic asphyxiophilia, also known as “choking” and “breath control play,” is the intentional and consensual restriction of oxygen to the brain for the purpose of sexual arousal. Autoerotic asphyxiophilia is when an individual does this form of sexual act onto themselves. Some people find that reducing or severing air flow via strangulation or suffocation can heighten sexual arousal and orgasmic pleasure. Erotic asphyxiation can be performed with a partner, but autoerotic asphyxiation is most often performed alone. 

Safety Warning

The act of erotic asphyxiation can be extremely dangerous if it is not performed with the correct precautions and knowledge of safety. Cutting off oxygen to the brain can potentially lead to brain damage, hemorrhaging, or even death. If an individual is interested in erotic asphyxiation, it is important they learn about the safety and risks involved before doing any breath control play. Furthermore, autoerotic asphyxiation requires extensive knowledge on safety, as it is a high-risk form of sexual play. It is highly recommended that the practice of sexual hanging be avoided unless there is a consensual supervisor and the individuals are informed on the potential risks and dangers involved.

History of Erotic Asphyxiation

Erotic asphyxiation and hanging have been performed for centuries. Early references to this act have been found in Mayan relics as well as depicted in Renaissance art. Further references can be found in historical literature, such as William Shakespeare’s Twelfth Night written in the 16th  century and 18th-19th century medical literature which regularly corroborates the link between asphyxiation and sexual arousal.¹ The historical popularity of autoerotic asphyxiation and sexual hanging may be attributed to the natural arousal of sexual organs visible during the corporeal punishment of hanging. During these public hangings, many individuals would witness the subject with an erection and associate the act of hanging with the positive sensations of the sexual response cycle, leading them to explore this new means to intensify sexual pleasure. In addition, it was historically used as a treatment for erectile dysfunction.¹ The theory was that oxygen restriction and then a sudden influx of oxygen supply helped engorge blood vessels in the penis. As waves of publications in the 18th century mainstreamed the practice and medical texts highlighted the success of it in the following century, autoerotic asphyxiation began to grow in popularity.¹ Contemporary research does not consider autoerotic asphyxiophilia as a treatment for erectile dysfunction.

However, most of these historical representations of erotic asphyxiophilia are implicit and fantastical. The lack of a realistic and genuine representation of this sexual act has led to social taboos and shame surrounding erotic asphyxiophilia in modern times. Because of the many societal stigmas related to sex, this practice has lost much of the traction it had throughout history. Unfortunately, this leads many individuals interested in erotic asphyxiation to explore this act without sufficient knowledge on safety and oftentimes with a feeling of shame or inclination to hide their interests.

The Natural Appeal of Erotic Asphyxiation

The exact reasons why individuals engage in erotic asphyxiophilia are unknown.  However, some physiological responses to the reduction of oxygen to the body and brain might help explain the appeal of this sexual activity. Author and professor John Curra writes:

“The carotid arteries (on either side of the neck) carry oxygen-rich blood from the heart to the brain. When [the arteries] are compressed, as in strangulation or hanging, the sudden loss of oxygen to the brain and the accumulation of carbon dioxide can increase feelings of giddiness, lightheadedness, and pleasure, all of which will heighten masturbatory sensations.”²

Furthermore, author George Shuman describes the effect as such:

“When the brain is deprived of oxygen, it induces a lucid, semi-hallucinogenic state called hyposia [a condition in which the body as a whole or a region of the body is deprived of adequate oxygen supply]. Combined with orgasm, the rush is said to be no less powerful than cocaine, and highly addictive.”³ 

Erotic asphyxiation is also a common practice in the BDSM community. It appeals to individuals who practice sadomasochism or enjoy the power exchange between the individual being choked and the individual doing the choking; the loss of control that accompanies the loss of oxygen can be a desired feeling for many participants. This sexual play can range from light oxygen deprivation to hanging, with many other variations in between.

Modern Erotic Asphyxiation

Although the use of sexual hanging has become less explicitly popular, other mainstream forms of erotic asphyxiophilia have emerged. Choking is a common example of breath control play and can create many interesting physiological and psychological responses. Physiologically, the lack of oxygen may increase sensation; the release of pressure after being choked also causes oxygen and blood to flow again, which can stimulate a rush of adrenaline and pleasure. Psychologically, choking is used as a power exchange between partners. It is typically an exchange between a dominant and submissive partner, with the dominant partner controlling the submissive through their access to oxygen and breathing. Some individuals may prefer light choking while others may prefer heavy choking; choking should always be consensual, and partners involved in the sexual act should discuss their limits beforehand.

Various tactics are used to achieve the level of oxygen depletion needed. Some of these include hanging, suffocation with a plastic bag over the head, self-strangulation, chest compression, or a combination of these.⁵ Sometimes, complicated devices are used to produce the desired effects. When performing autoerotic asphyxiation, participants oftentimes rig some version of a “rescue mechanism” as a safety release in case they lose consciousness. 

Erotic Asphyxiophilia Safety

Choking during sexual encounters with at least two individuals can be a safer alternative to performing autoerotic asphyxiation solitarily. Individuals should always be safe, continually communicate with each other, and obtain affirmative consent. Never choke around the windpipe, as it can break or cause damage; instead, choking should be a light squeeze at the lower neck under the windpipe. Communicating includes discussing boundaries with all partners involved; gaining awareness of what people are comfortable with can make the encounter more enjoyable and fluid for everyone. Obtaining affirmative consent is crucial throughout the entire sexual experience; the best way to get consent is through clear verbal communication, but clear nonverbals can also be used.

Complications with Autoerotic Asphyxiophilia

Because of the risks involved with oxygen deprivation, erotic asphyxiophilia is considered a risky form of sexual play that requires experience and thorough knowledge of safety precautions. Autoerotic asphyxiophilia is particularly dangerous when it involves any form of hanging, which explains the varying complications that can accompany this sexual act.

The use of a rescue mechanism is encouraged when doing any form of sexual hanging. However, sometimes the rescue mechanism or safety release does not function correctly, or the individual is not able to accurately measure the correct amount of oxygen restriction; complications like these may lead to serious brain injury or death. If an individual’s use of autoerotic asphyxiophilia results in death, it is often referred to as suicide instead of an accidental death. Parents or other family members often try to disguise or do not recognize autoerotic behaviors of the victim, therefore confounding autoerotic asphyxiation with suicide.

Considering that autoerotic asphyxiation is almost always reported as suicide, there is very limited knowledge and research on the topic. This information is so minimal that accurate statistics on the autoerotic asphyxiation death rate cannot be determined. Furthermore, accurate statistics are difficult to find due to the social taboos surrounding this sexual act. Although it is challenging to quantify autoerotic asphyxiation, autoerotic deaths in Western countries are estimated to comprise 0.5 deaths per million people per year. Of these 0.5 deaths, 70% to 80% are due to autoerotic asphyxia by hanging and 10% to 30% are due to plastic bags or chemicals.⁵ However, these statistics are likely much higher considering that they do not account for incidents that escape death or the autoerotic deaths that are mistaken for suicides.

Typical Features of an Autoerotic Death

Most autoerotic deaths are reported as suicides. Therefore, it is critical that the public, physicians, and investigators be able to recognize features of an autoerotic death so that these mistakes are not made. Typical features of an autoerotic death include:

• The body is discovered in an isolated or secure environment
• Evidence of recent masturbation
• Demonstrable failure of a device that was integral to the sexual activity and capable of causing death
• Ligatures are arranged so that the neck, chest, or abdominal compression could be voluntarily produced or relaxed
• Padding or ropes around the neck
• Unusual props such as bindings, pornography, fetishistic materials, sadomasochistic images or devices, mirrors, or other sexual aids
• Evidence of similar past activity
• No history of suicidal intention or no suicide note

Similarly, there are distinguished criteria which are especially useful for physicians and investigators when identifying an autoerotic death:

• The asphyxiation is a result of strangling or hanging
• Body positioning supports asphyxiation as the cause of death
• Asphyxiation death seemed accidental
• Evidence proving that the hanging mechanism failed its function
• Proof that the sexual activity was solitary
• Proof of sexual fantasy materials (e.g. pornography)
• Proof of previous acts of autoerotic asphyxiation
• Missing intent of an apparent suicide

When examining a body that may have been a result of autoerotic asphyxiation, physicians and investigators should determine the presence of these criteria and report the death as autoerotic if the crime scene fits all or most of these criteria.

Concluding Remarks

Erotic asphyxiophilia is considered a risky sexual act, but it can be performed to many varying intensities. Autoerotic asphyxiophilia typically refers to the act of solitary sexual hanging; this form of asphyxiation is the most dangerous of all and can result in brain damage, hemorrhaging, or death. A more common form of erotic asphyxiophilia is choking, which many individuals partake in to derive sexual pleasure. Overall, knowledge of safety, communication, and affirmative consent are crucial when practicing any level of erotic asphyxiophilia.

References

1. Tarr, C. C. (2015). Pleasurable Suspension: Erotic Asphyxiation in the Nineteenth Century. Nineteenth-Century Contexts, 38(1), 55–68. 
2. Curra, J. (2017). The relativity of deviance (4th ed.). Los Angeles: SAGE.
3. Shuman, G. D. (2008). Last breath: a Sherry Moore novel. New York: Pocket Star Books.
4. Uva, J. L. (1995). Review: Autoerotic asphyxiation in the United States. Journal of Forensic Sciences, 40(4): 574–581.
5. Coluccia, A., Gabbrielli, M., Gualtieri, G., Ferretti, F., Pozza, A., & Fagiolini, A. (2016). Sexual Masochism Disorder with Asphyxiophilia: A Deadly yet Underrecognized Disease. Case Reports in Psychiatry, 2016, 1–4.

Last Updated: 5 November 2019.