Autoerotic deaths refer to fatalities occurring during individual, solitary sexual activity, in which some device, situation, or act is used to gain or boost the sexual arousal of the subject. Anorectal autoeroticism is an autoerotic paraphilic activity that pertains to the self-insertion of various objects into the anal canal and rectal cavity to gain or heighten the subject's sexual drive. Although most foreign bodies inserted into the rectum do not cause significant injury, the introduction of some objects into the rectum might have unpredictable and even fatal effects. In this paper, we describe an intriguing autoerotic case of a 35-year-old male who sustained an explosive rectal trauma as a result of the unanticipated bursting of an expandable rubber pipe stopper that he inserted into his rectum and hyperinflated via an air blow gun connected through a pressure pipe to a centralized air-distribution system. The man sustained a circular abruption of the rectum with partial avulsion of the abdominal wall, associated with bleeding into the abdominal cavity and chest wall, and died before admission to the hospital. A police investigation revealed that the victim was a regular contributor to several web forums dedicated to unusual sexual activities. This case raises awareness of the broadening spectrum of methods and experiments associated with autoerotic behavior. We also reviewed the literature pertaining to this topic and outlined some of the characteristics of atypical autoerotic deaths. Although certain autoerotic methods are relatively common, other unusual autoerotic techniques may present novel challenges within the medicolegal field.

Department of Forensic Medicine Faculty of Medicine in Hradec Králové Charles University University Hospital Hradec Králové 500 05 Hradec Králové Czechia

Department of Forensic Medicine Jessenius Faculty of Medicine Comenius University 036 59 Martin Slovakia

See more in PubMed

Aggrawal A (2009) References to the paraphilias and sexual crimes in the Bible. J Forensic Legal Med 16:109–114 DOI

Money J (1997) Principles of developmental sexology. Continuum, New York

Seidl S (2004) Accidental autoerotic death. In: Tsokos M (ed) Forensic pathology reviews. Humana Press, Totowa, pp 235–262 DOI

Ober WB (1984) The sticky end of Frantisek Koczwara, composer of “The Battle of Prague”. Am J Forensic Med Pathol 5:145–149 DOI

Sauvageau A, Geberth VJ (2013) Autoerotic deaths: practical forensic and investigative perspectives. CRC Press, Boca Raton DOI

Kernbach-Wighton G, Madea B (2014) Auto-erotic death. In: Madea B (ed) Handbook of forensic medicine. Wiley, pp 525–527

Sauvageau A (2016) Autoerotic deaths. In: Gall JAM, Payne-James JJ (eds) Current practice in forensic medicine. John Wiley & Sons, Chichester, pp 81–96 DOI

American psychiatric association. Diagnostic and statistical manual of mental disorders (2013). 5th edn. American Psychiatric Publishing, Washington

Aggrawal A (2009) Forensic and medico-legal aspects of sexual crimes and unusual sexual practices. CRC Press, Boca Raton

Irizarry E, Gottesman L (1996) Rectal sexual trauma including foreign bodies. Int J STD AIDS 7:166–169 DOI

Vennemann B, Pollak S (2006) Death by hanging while watching violent pornographic videos on the Internet - suicide or accidental autoerotic death? Int J Legal Med 120:110–114 DOI

Hemandas AK, Muller GW, Ahmed I (2005) Rectal impaction with epoxy resin: a case report. J Gastrointest Surg 9:747–749 DOI

Geberth VJ (2003) Sex-related homicide and death investigations: practical and clinical perspectives. CRC Press, Boca Raton DOI

Byard RW, Eitzen DA, James R (2000) Unusual fatal mechanisms in nonasphyxial autoerotic death. Am J Forensic Med Pathol 21:65–68 DOI

Shields LB, Hunsaker DM, Hunsaker JC 3rd, Wetli CV, Hutchins KD, Holmes RM (2005) Atypical autoerotic death: part II. Am J Forensic Med Pathol 26:53–62 DOI

Sivaloganathan S (1985) Catheteroticum. Fatal late complication following autoerotic practice. Am J Forensic Med Pathol 6:340–342 DOI

Krikava K (1978) [An unusual case of injury of the large intestine by compressed air (author’s transl)]. Acta Chir Orthop Traumatol Cechoslov 45:86–88

Weber M, Kolbus F, Dressler J, Lessig R (2011) Survived ileocecal blowout from compressed air. Int J Legal Med 125:283–287 DOI

Pahwa HS, Kumar A, Srivastava R, Rai A (2012) Trans-anal barotrauma by compressed air leading to sigmoid perforation due to a dangerous practical joke. BMJ Case Rep 2012

Das S, Hanuman SB, Toi PC, Subramania DB, Yanamadala SP (2019) Colon perforation by compressed air: a case report and short review of literature. Am J Forensic Med Pathol 40:376–380 DOI

Bains L, Gupta A, Kori R, Kumar V, Kaur D (2019) Transanal high pressure barotrauma causing colorectal injuries: a case series. J Med Case Rep 13:133 DOI

Burt AV (1931) Pneumatic rupture of the intestinal canal. Arch Surg 22:875–902 DOI