Unusual fatal mechanisms in nonasphyxial autoerotic death

The diagnosis of autoerotic death is most often made when there has been accidental asphyxia from ropes or ligatures used by the deceased as a part of his or her autoerotic ritual. Three cases of probable autoerotic death are reported in which the mechanisms of death involved hyperthermia, sepsis, and hemorrhage, respectively. Case 1: A 46-year-old man was found dead in bushland clothed in a dress, female undergarments, and seven pairs of stockings/pantyhose. The underwear had been cut to enable exposure of the genitals. The recorded daily maximum temperature was 39 degrees C, and the deceased had been taking the drug benztropine. Death was attributed to hyperthermia due to a combination of excessive clothing, high ambient temperature, and prescription drug side effect. Case 2: A 40-year-old man was found dead in his boarding house. At autopsy, a pencil was found within his abdominal cavity with perforation of the bladder and peritonitis. Death was attributed to peritonitis/sepsis following intraurethral introduction of a pencil. Case 3: A 56-year-old man was found dead lying on his bed following massive rectal hemorrhage. A blood stained shoe horn was found nearby. Death was attributed to hemorrhage following laceration of the anal canal with a shoe horn. The diagnosis of autoerotic death may be difficult when typical features are absent, however, any unusual injury associated with genitourinary manipulation must raise this possibility.