Intentional restriction of oxygen to the brain for sexual arousal
"Breath play" redirects here; not to be confused withBreath (play).
A woman choking a man for erotic purposes
Erotic asphyxiation (variously calledasphyxiophilia,hypoxyphilia orbreath control play) is the intentional restriction ofoxygen to the brain for the purposes ofsexual arousal. With a partner (or alone), the act often involvesstrangulation. The termautoerotic asphyxiation is used when the act is done by a person to themself. Colloquially, a person engaging in the activity is sometimes called agasper.[1] Erotic asphyxiation can lead toaccidental death due toasphyxia.
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."[5]
History
The practice of autoerotic asphyxiation has been documented since the early 17th century. It was first used as a treatment forerectile dysfunction. The idea for this most likely came from subjects who were executed byhanging. Observers at public hangings noted that male victims developed anerection, sometimes remaining after death (adeath erection), and occasionallyejaculated when being hanged.[6]
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 aligature, gas or volatile solvents, chest compression, or some combination of these.[7] Complicated devices (such as hydraulics) are sometimes used to produce the desired effects.[8] 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."[9] Cases have also been reported in Scandinavia[10] and Germany.[11][12] 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.[13] Autoerotic asphyxiation may often be mistaken for suicide, which is a major cause of death in teenagers.[14]
In a 2021 survey of US students, women and transgender/nonbinary/gender nonconforming individuals are more likely to have been choked during sex than men.[5]
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.[15]
In some fatality cases, the body of the asphyxiophiliac 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.[11] Bodies found at the scene of an accidental death often show evidence of otherparaphilic activities,[16] such as fetishisticcross-dressing and masochism.[7] 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.[17]
The great majority of known erotic asphyxial deaths are male; among all known cases inOntario andAlberta from 1974 to 1987, only 1 out of 117 cases was female.[7] Some individual cases of women with erotic asphyxia have been reported.[18][19][20][21] The main age of accidental death is mid-20s,[7][22] but deaths have been reported in adolescents[23][24][25] and in men in their 70s.[11][22]
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.[26][27][28] Estimating the number of deaths worldwide and how many are due to amental disorder is very difficult due to lack of data from populous developing countries such as India.[2]
Erotic asphyxiation appears in a number of works of fiction.
In theMarquis de Sade's famous novelJustine, 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 inChuck Palahniuk's novelHaunted, 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 filmWorld'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 through aliterary hoax.
It is a reoccurring theme in the fiction toWilliam S Burroughs especiallyNaked Lunch, where hanging is depicted in resulting in instant ejaculation.
^Roberts, Chris (30 January 2012).Lost English: Words And Phrases That Have Vanished From Our Language. Michael O'Mara Books. p. 66.ISBN978-1-84317-278-9.
^"ICD-11 for Mortality and Morbidity Statistics".icd.who.int. Archived fromthe original on 24 January 2026. Retrieved27 January 2026.…. the nature of the paraphilic behaviour involves significant risk of injury or death (e.g., asphyxophilia or achieving sexual arousal by restriction of breathing).
^abcdBlanchard, 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.PMID1958948.S2CID20137589.
^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.PMID8454997.
^Uva, J. L. (1995). "Review: Autoerotic asphyxiation in the United States".Journal of Forensic Sciences.40 (4):574–581.doi:10.1520/JFS13828J.PMID7595293.
^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.PMID2063821.
^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.PMID12111317.S2CID24969597.
^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.PMID13359556.
^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.PMID3379021.
^Cooper, A. J. (1996). "Auto-erotic asphyxiation: Three case reports".Journal of Sex and Marital Therapy.22 (1):47–53.doi:10.1080/00926239608405305.PMID8699497.
^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.PMID1770343.
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