Erotic asphyxiation (variously called asphyxiophilia, hypoxyphilia or breath control play) is the intentional restriction of oxygen to the brain for the purposes of sexual arousal. The term autoerotic asphyxiation is used when the act is done by a person to themself. Colloquially, a person engaging in the activity is sometimes called a gasper.[1] Erotic asphyxiation can lead to accidental death due to asphyxia.

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


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, serotonin, and beta-endorphin had been reported in all the conditions associated with hallucinations."[2]

Practitioners describe a number of physiological responses including "pleasurable sensations/euphoria (81.7%), a head rush (43.8%), feeling like they could not breathe (43.0%), difficulty swallowing (38.9%), unable to speak (37.6%), and watery eyes (37.2%). About 15% had noticed neck bruising and 3% had lost consciousness from being choked."[3]


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.[4]


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.[5] Complicated devices (such as hydraulics) are sometimes used to produce the desired effects.[6] 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."[7] Cases have also been reported in Scandinavia[8] and Germany.[9][10] Swedish police reported in 1994 that the number of autoerotic asphyxiation fatalities in the Stockholm area (c. 1.7 million inhabitants) were at least five annually, but the number of unrecorded cases was assumed to be high.[11] Autoerotic asphyxiation may often be mistaken for suicide, which is a major cause of death in teenagers.[12]

Women and transgender/nonbinary/gender nonconforming individuals are more likely to have been choked during sex than men, with the mean age of first exposure being 19.[3]

Accidental death (with autoerotic asphyxiation)

Main article: Autoerotic fatality

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.[13]

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 scene of an accidental death often show evidence of other paraphilic activities,[14] such as fetishistic cross-dressing and masochism.[5] 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.[15]

The great majority of known erotic asphyxial deaths are male; among all known cases in Ontario and Alberta from 1974 to 1987, only 1 out of 117 cases was female.[5] Some individual cases of women with erotic asphyxia have been reported.[16][17][18][19] The main age of accidental death is mid-20s,[5][20] but deaths have been reported in adolescents[21][22][23] and in men in their 70s.[9][20]

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.[24][25][26]

In fiction

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The sensational nature of erotic asphyxiation often makes it the subject of urban legends. It has also been mentioned specifically in a number of works of fiction.

See also


  1. ^ Roberts, Chris (30 January 2012). Lost English: Words And Phrases That Have Vanished From Our Language. Michael O'Mara Books. p. 66. ISBN 978-1843172789.
  2. ^ Dr. E L Lloyd (29 March 1986). "Points: Hallucinations, hypoxia, and neurotransmitters". British Medical Journal. 292 (6524): 903. doi:10.1136/bmj.292.6524.903-d. PMC 1340016.
  3. ^ a b Herbenick, Debby; Fu, Tsung-chieh; Eastman-Mueller, Heather; Thomas, Sally; Valdivia, Dubravka Svetina; Rosenberg, Molly; Guerra-Reyes, Lucia; Wright, Paul; Kawata, Keisuke; Feiner, John (28 July 2022). "Frequency, Method, Intensity, and Health Sequelae of Sexual Choking Among U.S. Undergraduate and Graduate Students". Archives of Sexual Behavior. 51 (6): 3121–3139. doi:10.1007/s10508-022-02347-y. PMC 9333342.
  4. ^ "Erotic Asphyxiation". Lust Magazine. 1997. Archived from the original on 31 August 2006. Retrieved 2 September 2006.
  5. ^ a b c d Blanchard, R.; Hucker, S. J. (1991). "Age, transvestism, bondage, and concurrent paraphilic activities in 117 fatal cases of autoerotic asphyxia". British Journal of Psychiatry. 159 (3): 371–377. doi:10.1192/bjp.159.3.371. PMID 1958948. S2CID 20137589.
  6. ^ O'Halloran, R. L.; Dietz, P. E. (1993). "Autoerotic fatalities with power hydraulics". Journal of Forensic Sciences. 38 (2): 359–364. doi:10.1520/JFS13416J. PMID 8454997.
  7. ^ Uva, J. L. (1995). "Review: Autoerotic asphyxiation in the United States". Journal of Forensic Sciences. 40 (4): 574–581. doi:10.1520/JFS13828J. PMID 7595293.
  8. ^ Innala, S. M.; Ernulf, K. F. (1989). "Asphyxiophilia in Scandinavia". Archives of Sexual Behavior. 18 (3): 181–189. doi:10.1007/BF01543193. PMID 2787626. S2CID 42384991.
  9. ^ a b c Janssen, W.; Koops, E.; Anders, S.; Kuhn, S.; Püschel, K. (2005). "Forensic aspects of 40 accidental autoerotic death in Northern Germany". Forensic Science International. 147S: S61–S64. doi:10.1016/j.forsciint.2004.09.093. PMID 15694733.
  10. ^ Koops, E.; Janssen, W.; Anders, S.; Püschel, K. (2005). "Unusual phenomenology of autoerotic fatalities". Forensic Science International. 147S: S65–S67. doi:10.1016/j.forsciint.2004.09.095. PMID 15694734.
  11. ^ Olof Westerberg: "Sexlekar allt vanligare dödsorsak", Vasabladet 31 August 1994.
  12. ^ Downs, Martin (1 January 2005). "The Highest Price For Pleasure: A Deadly Turn-On". WebMD. Archived from the original on 28 December 2011. Retrieved 4 October 2011.
  13. ^ Autoerotic Asphyxiophilia Archived 15 May 2009 at the Wayback Machine on 'Sexinfo' website, University of Santa Barbara, Ca.
  14. ^ Bogliolo, L. R.; Taff, M. L.; Stephens, P. J.; Money, J. (1991). "A case of autoerotic asphyxia associated with multiplex paraphilia". American Journal of Forensic Medicine and Pathology. 12 (1): 64–73. doi:10.1097/00000433-199103000-00012. PMID 2063821.
  15. ^ Downs, Martin. The Highest Price for Pleasure Archived 28 December 2011 at the Wayback Machine, featured by WebMD
  16. ^ Danto, B. (1980). "A case of female autoerotic death". American Journal of Forensic Medicine and Pathology. 1 (2): 117–121. doi:10.1097/00000433-198006000-00004. PMID 7246503. S2CID 40463465.
  17. ^ Behrendt, N.; Buhl, N.; Seidl, S. (2002). "The lethal paraphilic syndrome: Accidental autoerotic deaths in four women and a review of the literature". International Journal of Legal Medicine. 116 (3): 148–152. doi:10.1007/s00414-001-0271-x. PMID 12111317. S2CID 24969597.
  18. ^ Martz, D. (2003). "Behavioral treatment for a female engaging in autoerotic asphyxiation" (PDF). Clinical Case Studies. 2 (3): 236–242. doi:10.1177/1534650103002003006. S2CID 145098915.
  19. ^ Sass, F. (1975). "Sexual asphyxia in the female". Journal of Forensic Sciences. 2: 181–185. doi:10.1520/JFS10256J.
  20. ^ a b Burgess, A. W.; Hazelwood, R. R. (1983). "Autoerotic deaths and social network response". American Journal of Orthopsychiatry. 53 (1): 166–170. doi:10.1111/j.1939-0025.1983.tb03361.x. PMID 6829721.
  21. ^ Shankel, L. W.; Carr, A. C. (1956). "Transvestism and hanging episodes in a male adolescent". Psychiatric Quarterly. 30 (3): 478–493. doi:10.1007/BF01564363. PMID 13359556.
  22. ^ Sheehan, W.; Garfinkel, B. D. (1987). "Adolescent autoerotic deaths". Journal of the American Academy of Child and Adolescent Psychiatry. 27 (3): 367–370. doi:10.1097/00004583-198805000-00017. PMID 3379021.
  23. ^ Edmondson, J. S. (1972). "A case of sexual asphyxis without fatal termination". British Journal of Psychiatry. 121 (563): 437–438. doi:10.1192/bjp.121.4.437. PMID 5077101. S2CID 35353344.
  24. ^ Cooper, A. J. (1995). ""Auto-erotic asphyxial death: Analysis of nineteen fatalities in Alberta": Comment". Canadian Journal of Psychiatry. 40 (6): 363–364. doi:10.1177/070674379504000626. PMID 7585413. S2CID 41699554.
  25. ^ Cooper, A. J. (1996). "Auto-erotic asphyxiation: Three case reports". Journal of Sex and Marital Therapy. 22 (1): 47–53. doi:10.1080/00926239608405305. PMID 8699497.
  26. ^ Garza-Leal, J. A.; Landrom, F. J. (1991). "Autoerotic death initially misinterpreted as suicide and a review of the literature". Journal of Forensic Sciences. 36 (6): 1753–1759. doi:10.1520/JFS13200J. PMID 1770343.

Further reading