Reviews:

Autoerotic Deaths: Practical Forensic and Investigative Perspectives



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Alphabetical List of Reviewers

Detective Al Cruise
Homicide Unit, Seattle, Washington Police Department

Detective Mark Czworniak
Area North Homicide Bureau, Chicago Police Department

Edwin T. Dreher
Deputy Chief (ret.), New York Police Department

Cathryn F. Lavery, PhD
Iona College

Katherine Ramsland
Forensic Psychologist

Marvin Skeen
Chief Criminal Investigator, Washington State Office of Attorney General

Dr. Ronald Turco, Forensic Psychiatrist
Past President-American Academy of Psychoanalysis
Past President - American Society of Psychoanalytic Physicians
Assistant Clinical Professor Oregon Health and Sciences University
Current Reserve Police Officer/Investigator - 40 years

Dr. Barbara C. Wolf, Forensic Pathologist
Chief Medical Examiner, District 5 Florida


This book is an extremely comprehensive study of this particularly difficult type of death scene. Dr. Sauvageau and Lt. Cmdr. Geberth, using a case history format methodically break down and organize the different sub categories within the occurrence of autoerotic death. This 180 page book includes many full color photographs of autoerotic death scenes with a full description and analysis of each. Each case study includes a medical analysis of the death as well as a description and study of the physical and or mechanical elements of the case.

As a homicide detective and 27 year law enforcement veteran, I can say that autoerotic death scenes can be confusing and even shocking to even the most seasoned of investigators. These scenes are often misread due to inexperienced responders and the low frequency of these events. This book is an appropriate and necessary addition to the library of the full spectrum of responders from first line patrol to homicide detective as well as others working in the medicolegal discipline.

It includes a very useful index as well as numerous checklists for the forensic expert which provides clear and valuable guidance. The book is printed text book quality on glossy paper.

Detective Al Cruise
Homicide Unit
Seattle, Washington Police Department


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This full color, crime scene photographs, which enhances the overall professional look of this publication.

If you are a Death Scene Investigator, then this book is a must-have for both your personal forensic reference library, as well as your office reference library.

This textbook will be an educational standard on the sexual practices which may precede an autoerotic death, and gives insight to the investigator to draw the correct conclusions necessary to correctly differentiate an autoerotic death from a natural death brought on by sexual activity.

This text outlines techniques that will help investigators answer the critical what, who, why, and when questions of equivocal crime scene investigations, to inure that suicides and natural deaths will not be misinterpreted as Autoerotic Deaths.

The book's strength is its painstaking research, detailed analysis and accumulation of historical data from a variety of sources.

The authors illustrate the most crucial tenet that any good investigator should adhere to: the enthusiastic desire to investigate and examine the facts, and make the proper determination as to the Cause, Manner and Mechanism of Death.

The book's clarity and insight on the nature of Autoerotic Deaths will insure that it will remain the singular, go to source by Law Enforcement professionals for years to come.

Detective Mark Czworniak
Area North Homicide Bureau, Chicago Police Department


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Vernon Geberth has done it again. He and his associate, Doctor Anny Sauvageau, have teamed to create the most authentic, up-to-date investigative review of "Autoerotic Deaths."

It is a sign of Geberth's skills as he combines his knowledge of forensics and clear cut dialogue that makes this a "must have" for all members of the law enforcement community.

The team of Sauvageau and Geberth have created the most complete professional insight into the intimate complexities of autoerotic deaths based on scientific research and extensive case experience. I believe that this text will become the “best practice model” for this phenomenon.

Edwin T. Dreher
Deputy Chief (Ret.), Office of the Chief of Detectives, New York City Police Department


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Flirting with Death - A Review of Autoerotic Deaths: Practical Forensic and Investigative Perspectives

As a criminologist, it is not uncommon to be exposed to a number of uncomfortable, often, violent situations with crime scenarios. In our world, we are used to deciphering between the perpetrator and the victim. The cause and the effect, although at times difficult to comprehend, it is routinely done so with applied theory and supportive evidence. It is often presented in a logical explanation, even if the actions are perceived as irrational. However, there is a manner of death, although not fixated on with attention by practitioners, which have a significant impact on hundreds of criminal investigations each year. It is the controversial case of autoerotic fatalities. The topic, still shrouded in secrecy has been considered a taboo subject for discussion, even within the disciplines of criminal justice and criminology. As practitioners we observe a resulting death, where the perpetrator and the victim are one and the same. The motives behind this act are murky and clouded with adjacent themes of fetishism, transvestitism, and masochism.

Autoerotic deaths are not easy to investigate and research literature has been limited to epidemiological and case studies. Anny Sauvageau and Vernon Geberth's endeavor to merge scientific knowledge and expert skills in criminal investigation surrounding this phenomenon is brilliantly successful. For one who may be a practitioner in the field, but not an expert in this area of science and investigation, Sauvageau and Geberth carefully break down the subject of autoerotic deaths in a systematic, clear approach which is easily understood by all readers. Each chapter is broken down to help re-train the reader to think differently about this manner of death and the approach to investigations as well as provide checklists throughout the text for forensic experts to consider.

The text is divided into chapters that assist the reader not only with the complicated factors associated with autoerotic death investigations, but give insight into the history and conflicting literature and studies associated with the topic. One learns from the Chapter on historic context the evolution of the terminology of autoerotic death and how early forensic and criminal justice literature changed definitions and how recent focus with literature has finally translated into proper investigation techniques. The text is full of cases that cross the spectrum in diversity. Typologies of various methods of death are handled with upmost sensitivity while being forthright in the analysis. Pictures, are taken from several perspectives to allow the reader to examine the crime scene from distinct angles. In addition, there are diagrams and reconstructions which all readers to comprehend all aspects of the investigation. Chapters involving topics such as: death scene characteristics, methods of autoerotic deaths and well as atypical methods are presented with carefully selected case studies, clear diagrams and pictures, along with meticulous attention to crime scene details for forensic experts to process, assess and learn from. The breadth of information given by the authors is methodical, clear and necessary.

Sauvageau and Geberth not only argue for a more practical and modern approach to this topic, but outline a "best practices" model for these investigations: giving readers the most up-to-date background information with regard to statistics, evidence collection and crime scene interpretation as well as how to construct valid and reliable reports. Both Sauvageau and Geberth demonstrate their expertise and mastery of the subject matter throughout each chapter.

Autoerotic Deaths: Practical Forensic and Investigative Perspectives (2013) is a complete investigative resource and education tool for those in law enforcement and in the forensic and medical communities. The text gives readers complete insight to this controversial and tragic act. It is a must for all those practitioners who may be faced with this type of investigation.

Cathryn F. Lavery, Ph D
Iona College


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Dangerous Lust

A new book documents just how far (and bizarre) people will go for pleasure. Published on May 13, 2013 by Katherine Ramsland in Shadow Boxing

A middle-aged man was found dead in his home. He lay face-up on the floor, with a rubber slipper placed between his throat and one leg of a heavy chair. An iron support bar lay across his chest, keeping the furniture frame elevated. Analysis showed that he had died from asphyxia due to external compression. Since the decedent had cancer, it looked like an odd form of suicide. However, it turned out that he'd been seeing a psychiatrist to try to ure his habit of placing heavy objects on himself for masochistic gratification. His death was ruled an accident.

Investigators unfamiliar with autoerotic fatality might automatically view a death like this as a suicide. Hence, there's a need for a thorough and instructive book like Practical Forensic and Autoerotic Deaths: Investigative Perspectives (CRC Press)

A correct death determination matters to surviving friends and relatives. Suicide clauses on insurance contracts block payouts for suicide and some religions view suicide as the greatest sin. In addition, there's survivor's guilt. Although autoerotic accidents can be embarrassing, they generally don't have the shattering emotional impact for relatives as a suicide does. Thus, death investigators must learn how to distinguish one type of death from the other.

Anny Sauvageau, the Chief Medical Examiner in Alberta, Canada and world-renowned expert on asphyxia, teams up with retired NYPD lieutenant commander Vernon Geberth, equally renowned author of books like Practical Homicide Investigation, to describe and illustrate the types of autoerotic deaths that investigators have encountered. They also show how to investigate such scenes.

They hope this book, based on scientific research and extensive case experience, will become the "best practice model" for recognizing when a death is the result of autoerotic activity. Helpfully, they include detailed checklists at several strategic points. It's easy to make hasty judgments. This book assists investigators to think, observe, and recognize distinctions between accident and suicide.

The authors cover a lot of ground. They provide the history of the concept since the earliest reported cases, describe errors of judgment, discuss death scene characteristics, and illustrate the differences between typical and atypical incidents. They also demonstrate how the mechanisms work. Death occurs when some part of the mechanism fails.

Not all autoerotic fatalities involve asphyxiation, they point out, but most do. This is a self-induced reduction in oxygen to produce a state of hypoxia. Reportedly, it results in feelings of elation, exhilaration, and heightened sexual pleasure.

Often, autoerotic deaths have obvious features, such as sexual paraphernalia nearby, neck padding, transsexual clothing, and access to pornography. The victims might have encased themselves in something like plastic or duct tape. Aerosol inhalants such as CO2 or nitrogen might also be present, or an electrical apparatus. However, some victims have no obvious paraphernalia and some incidents do closely resemble suicide.

In addition, there are atypical incidents that can be difficult to fathom. One man, 19, died from a massive compression of the thorax when he dressed in a pressure suit for military pilots, covered his head with three masks and a helmet, bound his arms and legs, and turned on a 12-volt air compressor. It inflated the suit to the point that the pressure stopped his ability to breathe and he lost consciousness.

The victims are predominantly young to middle-aged men, but women, the elderly, and even children have engaged in this practice.

In rare instances, the sexual activity is performed underwater. A 25-year-old man went into the water in a homemade plastic bodysuit. He wore a hockey helmet, and over the bodysuit was a snowmobile suit and ski boots. He was bound with an elaborate set-up of straps and chains, padlocked at his groin. However, he'd used a tube too narrow for both the intake and expulsion of air, so his air supply was fouled with carbon dioxide. An indicator that this incident was not a suicide was his membership in an online autoerotic practitioner's club.

Many autoerotic accidents are associated with paraphilias, some of which are quite unique. When a man went missing in Pennsylvania, police went to his home. They saw stacks of magazines and pornographic videotapes about mud eroticism. They also found several empty 5-gallon cans of plaster. The resident's keys and wallet were present, but he seemed to have vanished.

In the bathroom was a large trash receptacle filled with hardened plaster. The investigators might not have given it a second thought except for the plaster-encrusted hand that broke the surface. A TV set was on and a pornographic video was playing in a continuous loop.

The trashcan was hauled into the morgue for removal of the body. Its posture suggested that the victim had planned an autoerotic session, using plaster in place of mud, but had slipped, gone deep into the plaster and aspirated it into his lungs.

Paraphilias show us just how varied the development of our erotic inclinations can be. Some can become addictive and compel us into dangerous territory. One man was actually stuck in a washing machine, but you'll have to get the book to see how that happened. On rare occasions, autoerotic acts coincide with suicide, but people typically do not seek to die in the ways depicted in this book. These incidents are tragic accidents.

Although there are two other books on this subject, Autoerotic Fatalities was published in 1983 and Autoerotic Asphyxiation narrows the definition and lacks the elaborate color photos, tables, checklists, and illustrations. Thus, Autoerotic Deaths has no real competition for its intended audience.

This important resource is not just for investigators, although it's invaluable for them. These cases will also enlighten psychologists, sexologists, and suicidologists about the risks some people are willing to take when chasing the ultimate pleasure.

There has never been such a thorough examination of autoerotic deaths, nor one as meticulously helpful to investigators as Sauvageau & Geberth's text. Autoerotic Deaths provides a comprehensive reference that will clearly become a classic in the field.

Katherine Ramsland, Ph D.
Forensic Psychologist


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Add another resource to your death investigation library, Sauvageau and Geberth have provided the definitive text on autoerotic death investigation in their book Autoerotic Deaths: Practical Forensic and Investigative Perspectives. This book covers everything known about the forensic and practical aspects of investigating autoerotic deaths. It is a must read for any professional charged with investigating or determining cause and manner of these types of deaths.

Marvin Skeen
Chief Criminal Investigator
Homicide Investigation and Tracking System
Washington State Office of Attorney General


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This remarkable book combines the expertise of the medical profession with that of law enforcement, resulting in a text that is the most up to date and complete analysis of autoerotic deaths. Anny Sauvageau, MD is Chief Medical Examiner in Alberta, Canada and a well known world expert on asphyxia. She has a founder designation in forensic pathology from the Royal College of Physicians and Surgeons of Canada, is the author of more than 75 papers in peer-reviewed forensic journals and a much sought after international speaker. She has also founded the Working Group on Human Asphyxia and is cofounder of the International Network for Forensic Research.

Vernon J. Geberth is a retired lieutenant commander of the New York City Police Department with over 40 years of law enforcement experience. He is a seasoned homicide detective who holds duel master's degrees in forensic psychology and criminal justice. He is a graduate of the FBI national Academy and a Fellow in the American Academy of Forensic Sciences. His textbooks on homicide investigation and sex related homicide investigation are well known internationally and the "bible" of investigative analysis for police departments in many countries. He has set the standard for homicide investigation and crime scene analysis in the United States, teaches throughout the country and is highly respected for his ethical stance and concern for the victims of crime.

Autoerotic Deaths-Practical Forensic and Investigative Perspectives is clearly written, concise and free of confusing jargon. It is the most current complete analysis of autoerotic deaths, supplemented with color photographs, and some drawings that are instructive and compliment the text. These photographs are taken from actual case files and associated with individual case histories. Thus, this text goes beyond mere description and provides actual case analysis allowing the reader to grasp the significance of what might ordinarily appear to be minor detail or might be confusing even to the experienced pathologist or homicide detective. The authors also cite numerous references provided after each chapter and give credit to many who investigate this phenomenon, including those who might disagree with their analysis of some aspect an autoerotic death. Definitions of terms are provided that clarify past confusion in the literature and the authors support their terminology with a cogent analysis of accept facts both from the literature and the actual investigations. The book is divided into seven chapters, the first providing a historical context, including the first reported autoerotic case in the United States in 1947 and the groundbreaking work of Hazelwood and his colleagues who published the first book to present a comprehensive view of the topic in 1983. The initial thinking of autoerotic deaths as hanging or ligature strangulation was expanded to other types of autoerotic deaths such as by chemical substances, electrocution, body wrapping, overdressing, drowning, asphyxia by an abdominal ligature and death from foreign body insertion. The authors discuss and illustrate these cases in detail including the awareness concerning the danger of exposing such phenomenon in the media and the need for forensic experts to be cautious in diffusing this practice to the general population.

The turning point in defining the modern conception of autoerotic deaths came in 1991 along with the understanding that deaths from natural causes during unusual or bizarre autoerotic practice are not autoerotic deaths. Another important landmark in understanding autoerotic deaths occurred in 2006 with the classification of autoerotic death as typical, such as with hangings or plastic bags and atypical as by electrocution, body wrapping, foreign body insertion et cetera. The most comprehensive book on autoerotic deaths to date has been Autoerotic Fatalities published in 1983 by Hazelwood et al. Sauvageau and Geberth have filled this gap with the present volume, a collaboration and fusion of science and practical investigation.

Chapter two deals with definitions and practices in approaching autoerotic deaths taking note that natural death occurring during masturbation should not be called autoerotic death. The authors note: "The manner of death in autoerotic death should always be accidental, and death should be directly linked to the use of an apparatus for sexual stimulation." The best definition for autoerotic death is the following: "Autoerotic deaths are accidental deaths that occur during solitary sexual activity in which some type of apparatus that was used to enhance the sexual stimulation of the deceased caused unintentional death." By definition autoerotic deaths are always accidental deaths with no exception as the intent of the autoerotic practitioner is not to die. With regard to classification and terminology it is important to note that some autoerotic deaths such as electrocution are not related to asphyxia. The incidence of such deaths is variable and estimated to be 700 to 1,400 per year, about 0.5 cases per million per year. The authors note the golden triangle of forensic investigation: a complete analysis of the crime scene, the examination of the body and the history (past medical history, psychiatric, sexual etc). These issues are discussed in detail, including those of sexual partners, the decedent's personal computer etc. Noted are the three sources of sexual pleasure: stimulation of the genital organs, lack of oxygen in the central nervous system, and the creation of an atmosphere of fear and anguish in the context of masochism. Lack of oxygen to the brain can create intense sexual pleasure and evidence of masturbation during the autoerotic event is not mandatory, nor does the presence of semen necessarily indicate prior masturbation considering that postmortem masturbation can occur.

Chapter three deals with death scene characteristics in great detail including fifteen scene characteristics in different combinations, such as cross-dressing, exposure of the genitals, foreign body insertion etc. Direct stimulation of the genitals being only one of the possible sources of sexual pleasure. Evidence of repetitive behavior is important. The text and photographic depictions in this chapter are outstanding. Of the 15 compiled characteristics, the most common feature in autoerotic fatality was exposure of the genitals, followed by pornography, with the most common combination of three features being exposed genitals, nudity and pornography in 19% of the cases. The forensic expert thus "should not expect the presence of a long list of classic scene features in most cases." Autoerotic methods are discussed in detail in three different groups: hangings, plastic bag and chemical substances and atypical methods.

Chapter four describes typical methods of autoerotic deaths, with hanging by far the most common method of autoerotic activity leading to death. The terms of strangulation, hanging, ligature strangulation and manual strangulation are carefully defined with appropriate examples and case reports. For example hanging occurs as a form of strangulation when the gravitational weight of the body causes constriction of a band on the neck, and associated the three possible mechanisms, closure of the blood vessels with lack of oxygen to the brain, compression of the airways, and vagal stimulation by pressure on the baroreceptors in the carotid sinuses and the carotid body. Examination of the body as for example the presence of petechiae, cyanosis, neck furrow, protrusion of the tongue, fractures of neck structures, types of bruises etc. are discussed along with a careful examination of the scene itself. This is helpful in differentiating a potential homicide from an autoerotic death. The agonic sequence of loss of consciousness, convulsions, decerebrate rigidity, deep rhythmic abdominal movements, decorticate rigidity, loss of muscle tone and loss of muscle movement is noted with time sequence and other issues such as ischemic habituation on the agonal responses of autoerotic practitioners.

Chapter five deals with typical methods of autoerotic deaths and includes a very important series of definitions of terms like suffocation, smothering, chocking, confined space entrapment and vitiated atmosphere. Specific autopsy finding and pathophysiological responses are discussed in detail along with accompanying photographs. The section on inhalants such as hydrocarbons and propane is quite thorough and enlightening.

Chapter six deal with atypical methods of autoerotic death such as overdressing, electrocution, body wrapping etc. is described as they account for about 5% to 10% of the cases. The methods of death associated with these cases is discussed, providing a clear understanding of the physiologic processes involved, for example the presence of air embolism in heart cavities in the case of foreign body insertion. Definitions for a proposed unified classification in the context of asphyxia in the forensic setting are described. Case histories in these instances are noteworthy and accompanied by photographs. Many are most unusual. Once again the authors emphasize that deaths from natural causes occurring during solitary sexual activity should not be classified as autoerotic deaths.

"The typical victim of an autoerotic accident is a white adult male." Chapter seven covers the four types of atypical victims: the female victim, the non-white victim, the teenage victim and the elderly victim. The first documented case of a female autoerotic death was a case reported by Henry in 1971 in the Medico-Legal Bulletin. Specific features of male and female cases of autoerotic deaths are noted in detail, along with case reports. While the usual victim of an autoerotic death is a male in his 30's teenager and elderly victims are discussed along with the "chocking game" or strangulation game which is a nonsexual activity and requires differentiation from autoerotic activity. With regard to these issues it is important to determine cause for a family that might blame themselves of a suicide of a teenager when in reality the death is a result of autoerotic activity. The scenes of female and teenage victims are not as rich with forensic clues and easier to misinterpret, and there may have been signs of eroticized repetitive hangings.
The autoerotic death of an 87 year old male is discussed in detail, along with photographs of the victim.

This outstanding book is destined to become a classic in the study and investigation of autoerotic death. This is due to the thoroughness of the authors in searching the literature and their long experience with death investigation, as well as the meticulous collaboration of the medical/forensic pathology profession and the law enforcement/homicide investigation profession. Both authors are internally recognized in their respective fields of study and the result is a unique combination of knowledge and experience from both professions. This book is a model for professional death investigations involving autoerotic deaths and the first of its kind in over thirty years. The work presented is based on solid scientific research and case experience from the field demonstrated by case examples. The additional resource information noted throughout the book is a major source of further study and discussion thus complementing this complete analysis of autoerotic deaths with both theory and application. I highly recommend this comprehensive text as a resource for the study of autoerotic deaths for anyone involved in death investigation.

Dr. Ronald Turco, Forensic Psychiatrist
Past President-American Academy of Psychoanalysis
Past President - American Society of Psychoanalytic Physicians
Assistant Clinical Professor Oregon Health and Sciences University
Current Reserve Police Officer/Investigator - 40 years


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The newest book in the renowned Practical Aspects of Criminal and Forensic Investigations series, Autoerotic Deaths: Practical Forensic and Investigative Perspectives, is co-authored by forensic pathologist Anny Sauvageau, M.D., founder of the Working Group on Human Asphyxia, and series editor Vernon J. Geberth, retired Commander of the Bronx Homicide Task Force with the New York Police Department. The text draws from the unique combination of the medical knowledge of an academic forensic scientist and the vast practical experience of a "murder cop" and consultant in medicolegal death investigations. The result provides the forensic community the definitive treatise on the subject of autoerotic asphyxia.

This is an extremely well written and elegantly illustrated book that applies the principles of Commander Geberth's Practical Homicide Investigation to the subject of sexual asphyxias. Beginning with a review of the historical and literary recognition of the subject, Autoerotic Deaths explores the investigative, forensic pathologic and pathophysiologic aspects of the typical and more uncommon methods employed by autoerotic practitioners. Drawing material from numerous case studies, the authors provide a thorough understanding of the importance of the multidisciplinary medicolegal investigation of such deaths. They also bring important new medical knowledge to the field through the study of the agonal sequence of filmed hangings made available to the authors. The result is that Autoerotic Deaths: Practical Forensic and Investigative Perspectives is a comprehensive text that will be a valuable resource for law enforcement, forensic pathologists and behavioral scientists.

Barbara C. Wolf, M.D.
District Medical Examiner
District 5, FL


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