From dying of pleasure to the pleasure of dying: two cases of accidental asphyptic deaths, during autoerotic practices

Electronic Autoerotic asphyxia falls on the masochistic spectrum and, where it persists for more than six months and causes clinically significant distress or impairment in functioning, it can be considered a sexual masochism disorder with asphyxophilia (DSM-5). It can be implemented through various strategies such as hanging, confinement with objects applied over the head, chest compression, use of gas or volatile solvents to reach the level of oxygen depletion up to near loss of consciousness necessary to promote arousal sexual. Autoerotic asphyxia has been associated with high lethality in US cases, however in Italy the phenomenon is little studied, especially from a forensic pathological point of view. Restrictions applied to contain the Covid-19 pandemic, including social distancing and lockdown phases, have been linked to changes in sexual habits and behavior. The authors report two cases of male individuals who died from confinement asphyxia, obtained through the use of plastic bags well adhered to the head, apparently during autoerotic practices. The death occurred due to suffocation due to the concentration of a gas inserted and concentrated in the plastic bag, the purpose of which was to deplete the inhaled air and thus the circulation of oxygen. This artifice was ideally functional to the erective stimulus and sexual pleasure, obtainable through sensory clouding. The first hypothesis formulated by the judicial police officers present on the spot was that of suicide. Only the subsequent medico-legal investigation in association with ancillary investigations made it possible to reconstruct the dynamics of the events, providing a scientific explanation for cases of particular interpretative complexity.