Erotic asphyxiation

Erotic asphyxiation or breath control play is the intentional restriction of oxygen to the brain for the purposes of sexual arousal.

This sexual practice is variously called asphyxiophilia, autoerotic asphyxia, hypoxyphilia. The term autoerotic asphyxiation is used when the act is done by a person to themselves. Colloquially, a person engaging in the activity is sometimes called a gasper.

The erotic interest in asphyxiation is classified as a paraphilia in the Diagnostic and Statistical Manual of the American Psychiatric Association.

Physiology
Author John Curra wrote, "The carotid arteries (on either side of the neck) carry oxygen-rich blood from the heart to the brain. When these 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."

Author George Shuman describes the effect as such, "When the brain is deprived of 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 addictive."

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 by 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 hypoxia he found that "abnormalities in the cerebral neurochemistry involving one or more of the interconnected neurotransmitters, dopamine, 5-hydroxytryptamine, and β-endorphin had been reported in all the conditions associated with hallucinations."

History
Historically, the practice of autoerotic asphyxiation has been documented since the early 17th century. It was first used as a treatment for erectile dysfunction. The idea for this most likely came from subjects who were executed by hanging. Observers at public hangings noted that male victims developed an erection, sometimes remaining after death (a death erection), and occasionally ejaculated when being hanged. However, post-mortem ejaculation occurs in hanging victims after death because 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 as a hanging, suffocation with a plastic bag over the head, self-strangulation such as with a ligature, gas or volatile solvents, chest compression, or some combination of these. Sometimes, complicated devices are used to produce the desired effects. The practice can be dangerous even if performed with care and has resulted in a significant number of accidental deaths. Uva (1995) writes “Estimates of the mortality rate of autoerotic asphyxia range from 250 to 1000 deaths per year in the United States.” Cases have also been reported in Scandinavia and Germany. Autoerotic asphyxiation may often be mistaken for suicide, which is a major cause of death in teenagers.

Accidental death
Deaths often occur when the loss of consciousness caused by partial asphyxia leads to loss of control over the means of strangulation, resulting in continued asphyxia and death. While often asphyxiophilia is incorporated into sex with a partner, others enjoy this behaviour by themselves, making it potentially more difficult to get out of dangerous situations.

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. Bodies found at the scene of an accidental death often show evidence of other paraphilic activities, such as fetishistic cross-dressing and masochism. In cases involving teenagers at home, families may disturb the scene by "sanitizing" it, removing evidence of paraphilic activity. This can have the consequence of making the death appear to be a deliberate suicide, rather than an accident.

The great majority of known erotic asphyxial deaths are male; among all known cases in Ontario and Alberta from 1974 to 1987, only one out of 117 cases was female. Some individual cases of women with erotic asphyxia have been reported. The main age of accidental death is mid-20s, but deaths have been reported in adolescents  and in men in their 70s.

Autoerotic asphyxiation has at times been incorrectly diagnosed as murder and especially so when a partner is present.

Lawyers and insurance companies have brought cases to the attention of clinicians because some life insurance claims are payable in the event of accidental death, but not suicide.

Famous cases

 * Peter Anthony Motteux, English author, playwright, translator, publisher and editor of The Gentleman's Journal, "the first English magazine", from 1692 to 1694, died from apparent autoerotic asphyxiation in 1718, which is probably the first recorded case.
 * Frantisek Kotzwara, composer, died from erotic asphyxiation in 1791.
 * Sada Abe killed her lover, Kichizo Ishida through strangulation while he was sleeping, after having experimented with erotic asphyxiation, in 1936, proceeding to cut off his penis and testicles and carry them around with her in her handbag for a number of days. The case caused a sensation in 1930s Japan and has remained one of the most famous Japanese murder cases of all time.
 * Albert Dekker, stage and screen actor, was found dead in his bathroom in 1968 with his body graffitied and a noose around his neck.
 * Vaughn Bodé, artist, died from this cause in 1975.
 * Diane Herceg sued Hustler magazine in 1983, accusing it of causing the death of her 14-year-old son, Troy D., who had experimented with autoerotic asphyxia after reading about it in that publication.
 * Stephen Milligan, a British politician and Conservative MP for Eastleigh, died from autoerotic asphyxiation combined with self-bondage in 1994.
 * Kevin Gilbert, a musician and songwriter, died of apparent autoerotic asphyxiation in 1996.
 * Michael Hutchence, Australian singer-songwriter and member of rock band INXS. His death was in 1997 ruled as suicide by the coroner but was believed by his family and partner to be the result of autoerotic asphyxia.
 * David Carradine died on June 4, 2009 from accidental asphyxiation, according to the medical examiner who performed a private autopsy on the actor. His body was found hanging by a rope in a closet in his room in Thailand,  and there was evidence of a recent orgasm; two autopsies were conducted and concluded that his death was not suicide, and the Thai forensic pathologist who examined the body stated that his death may have been due to autoerotic asphyxiation.  Two of Carradine's ex-wives, Gail Jensen  and Marina Anderson,  stated publicly that his sexual interests included the practice of self-bondage.

In fiction
The sensational nature of autoerotic asphyxiation often makes it the subject of urban legends. It has also been mentioned specifically in a number of works of fiction.
 * In the Marquis de Sade's famous novel Justine, or The Misfortunes of the Virtue, Justine is subjected to this by one of her captors. She survives the encounter.
 * In the Guts short story in Chuck Palahniuk's novel Haunted, one the characters discusses parents who discover the accidental deaths of their sons to autoerotic asphyxiation. They are said to cover up the deaths before police or coroners arrive to save the family from shame.
 * In the novel (and later movie adaptation) Rising Sun, death as a result of this type of sexual arousal is explained when it is offered as a possible cause for a murder victim's death.
 * In the film World's Greatest Dad, the protagonist's teenage son accidentally kills himself with asphyxiation whilst sexually aroused. The protagonist then stages his son's death as a suicide, which gives him the opportunity to rise to infamy via a literary hoax.
 * In the film Ken Park a character named Tate practices autoerotic asphyxia.
 * Autoerotic asphyxiation occurs in the cold open of Six Feet Under episode Back to the Garden.
 * Kenny from South Park dies from suffocating while wearing a Batman costume and practicing autoerotic asphyxia in the episode "Sexual Healing".
 * In the season four episode of Californication, titled "Monkey Business", the character Zig Semetauer is found dead in his bathroom by Hank, Charlie and Stu after suffocating due to autoerotic asphyxia, to which Hank quips "I'm not averse to the occasional choke-n'-stroke, but this is a prime example of why one must always use a buddy system."
 * A character in the film Knocked Up offers to be a "spotter" for a friend if he intends on performing autoerotic asphyxiation.