International Journal of Current Research and Review
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IJCRR - Vol 04 ISSUE 16, August, 2012

Pages: 103-107

Date of Publication: 28-Aug-2012

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Author: Sandesh H. Chaudhari , Mandar Sane, Anand Mugadlimath, D. B. Deshmukh, K. J. Pimpale, Dr. Waghmare

Category: Healthcare

Abstract:Volatile substance abuse and autoerotic behaviour are distinct phenomenon. Still considerable overlap is observed in some cases. Autoerotic deaths in transvestite are reported in young males, who tend to experiment alone and are heterosexual. We present a rare case of an autoerotic death involving a fatal combination of plastic bag asphyxia, and, intoxication with inhaled toluene whitener and alcohol. Of note in this case is the fact that the victim was a male with transvestite attire. Toluene and alcohol are known to have additive effects. Furthermore, toluene inhalation may induce cardiac arrhythmias, particularly aggravated by high sympathetic activity during autoerotic ritual. We discuss the death scene investigation, past use of lethal and nonlethal paraphilia, and, findings at autopsy in arriving at conclusion of accidental mode of death.

Keywords: glue sniffing, autoerotic activity, asphyxiophilia.

Full Text:

Autoeroticism represents deviant sexual behaviour (paraphilia) that seeks sexual gratification by means of manipulations with the own body. Different practices of autoeroticism are known like asphyxiophilia, anesthesiophilia, and electrophilia.1 Most common methods of asphyxiophilia are, plastic bag asphyxia, strangulation, etc, while various methods used for anesthesiophilia may be inhalation of nitrous oxide, gasoline, propane, aerosols like toluene,etc.2 The usual method of abuse is for a quantity of the solvent or other chemical to be placed in a plastic bag. The warmth of the hand holding the bag, as well as the warm breath, encourages vaporization of the solvent, which enters the tidal air stream and is absorbed through the pulmonary membranes into the blood.3 Accidental deaths are occasionally reported due to such practises. Transvestism is described as the wearing of clothes of the opposite sex for sexual purposes. It is seen in both sexes. There are two types of transvestite, a heterosexual group and a group with strong homosexual tendencies. The homosexual male transvestite tends to wear clothes which caricature and mock women. The heterosexual male transvestite wears conventional female clothing and unresolved problems in his marriage or other heterosexual relationships are often evident.4

Case history
In the present case, the victim, a student of IInd MBBS in a Private Medical College was found in his room which was locked from inside with no response to repeated loud door knocks. When his friend forcibly broke open the door, they found him dead with female dress and polythene bag over his face. At the scene of incidence they were surprised to see multiple bottles of Camlin whitener eraser along with empty bottles of alcohol and smoked bits of cigarette [Fig 1]. Police were immediately intimated and body shifted for medicolegal autopsy. At autopsy, on external examination, it was a body of an adult male moderately built and well nourished. He was in transvestite attire in the form of pink sari, blouse, petticoat and ladies underwear [Fig 2]. Polythene bag covering the face was smeared from inside with whitish colloid substance having turpentine like smell. Whitish slightly blood tinged froth was collected around his mouth. Rigor present partly in the upper limbs and well marked in lower limbs. Post mortem lividity was fixed over back of the trunk. Subconjunctival haemorrhages were noted with petechial haemorrhages around the eyes. Nail beds were bluish discoloured. Dried seminal fluid was present around glans penis and inner aspect of thigh. Turpentine like smell was emanating from the body. On internal examination, Petechial haemorrhages were present over pleura and epicardium. Generalized visceral congestion was noted. Stomach contained semi digested unrecognized food particles (250 ml.), congested and haemorrhagic mucosa with peculiar spirit like smell.

Chemical analysis
All the articles were collected immediately packed in nylon bag and preserved for chemical analysis. 1. Organic solvent Toluene was detected in Camlin Dilutor (fluid) bottle and polythene (covering the face). 2. 154mg% of ethyl alcohol was detected in stomach and intestines contents, 117mg% ethyl alcohol in liver, spleen and kidney, 85mg% of ethyl alcohol was detected in blood, brain and lungs. Retrospective detailed interview of deceased friends revealed that deceased was addicted to toluene inhalation, with whitener as a means of it. He used to practise it alone since last 6 to 8 months. . However, he was not known to be a homosexual or suffering from depressive disorder. Overtly, there was no history suggestive of his transvestite perversion.

Autoerotic deaths can be classified into- Typical and Atypical depending on the presence or absence of accompanying non-lethal paraphilia. Lethal paraphilia may be in the form of compression around the neck, restrictive bondage, plastic bag asphyxia, chest compression, inhalation of volatile substances, insertion of objects in genitals, stimulation of genitals by low voltage electricity. While non lethal paraphilia are fetishism, transvestism, usage of mirror, pornography, etc. An autoerotic death may be diagnosed if it is solitary, accidental, and caused by any lethal paraphilia.4 Volatile substance abuse and autoerotic behaviour are distinct phenomenon. Still considerable overlap is observed in 8% of cases reported by Anderson HR.5 Autoerotic deaths in transvestite are reported in young males.6, 7 Adolescents tend to experiment alone and are heterosexual. On the other hand, adults often practice sexual asphyxia in pairs and are primarily homosexual in orientation. Clearly, the "sole-practitioner" in the adolescent population is at high risk for accidental death due to the lack of supervision by a sex partner.8 In the present case, the victim was known to have practised toluene inhalation for euphoric effects on many occasions, either alone or with his friends. On the fateful day, he used a plastic bag and toluene inhalation for inducing autoerotic asphyxia, both being lethal paraphilia. He was wearing transvestite female attire reflecting non-lethal paraphilia. He was not known to have homosexual behaviour.

Paraphilia are associated with alcoholism, which was more than average for general population.9 Alcohol has varied physiological effects in presence of toluene. Toluene is an aromatic petrol hydrocarbon used widely in industry as a solvent and thinner for whitener. Euphoric effect of alcohol and toluene show additive effect and lasts longer.10 Impaired judgement and increased sexual desire are effects of alcohol at higher BAC levels. This may further lead the victim to overindulge in inhalation of volatile solvent for autoerotic purpose which may reach fatal levels. Volatile substances sensitise the heart to the effects of sympathetic stimulation which may occur during sudden exercise and other activities.5 It is relevant, like in present case, that amongst the deaths from autoerotic activity along with abuse of volatile substances, cardiac arrhythmia is the most likely cause of death. Like other volatile substances, Toluene is quickly eliminated from the body, so tests for qualitative and quantitative analysis are only useful if they are done very soon after exposure. The unknown factor is usually of ‘tolerance’ and there is no method of assessing this at autopsy. Determining the manner of death has always been a challenge for Forensic experts and investigating agency. Different views may be present about deaths with substance abuse. Death may not be considered accidental since addict may foresee the risk and deliberately takes the drug knowing that he risked the death. It may be considered as accidental as being inadvertent death due to self administration of drug for purpose of euphoria.11 Manner of death can be inferred by various circumstances like location, attire, sexual paraphernalia, evidence of previous experience, and lack of suicide note.8 In the present case, suicidal manner was unlikely because victim was not known to suffer from any premorbid psyche and no suicide note was found near the body. Victim was practising toluene inhalation for more than 6 months, female attire, co-intoxication by alcohol and absence of rescue help due to secluded place corroborated to manner of death as accident. Though sporadically reported in newspapers, magnitude of deaths due to autoerotic deaths, particularly in sexually perverts like in transvestism is highly unaddressed. There are several limitations in the data concerning autoerotic asphyxiation. Difficulty in ascertaining the number of practitioners of asphyxiophilia due to the social stigma, lack of statistics available in the Indian literature, relatives often hide the evidence of asphyxiophilic deaths due to the negative societal perception and finally, there is no specific category in the ICD codes for deaths by sexual asphyxiation, hence, these deaths may be misclassified as accidents, suicides, or homicides. As a result, there is probably an underestimation of the rate of death by sexual asphyxiation in Indian setup. We highlight importance of positive interpretation of autoerotic death with regards to death scene circumstantial evidence, past history of lethal and non-lethal paraphilia and autopsy findings in determining manner of death.


1. Janssen W, Koops E, Anders S, Kuhn S, Puschel K. Forensic aspects of 40 accidental autoerotic deaths in Northern Germany. Forensic Science International, 2005: 147S; S61–S64.

2. Seidl S. Accidental autoerotic death. In: Tsokos M, editor. Forensic Pathology reviews, Vol 1. New Jersey: Humana Press; 2004. p238

3. Saukko P and Knight B. Knight’s Forensic Pathology. London: Arnold press; 2004. P 595

4. Bhardwaj DN, Rautji R, Sharma RK, Dogra TD. Suicide by a Transvestite or Sexual Asphyxia? A case report. Med. Sci. Law. 2004: 44(2); 174.

5. Anderson HR, Macnair RS, Ramsey JD. Deaths -from abuse of volatile substances: a national epidemiological study. British Medical Journal,1985: 290; 304-307

6. Breitmeier D, Mansouri F, Albrecht K, Bohm U, Troger HD, Kleemann WJ. Accidental autoerotic deaths between 1978 and 1997, Institute of Legal Medicine, Medical School Hannover. Forensic Science International, 2003:137; 41–44

7. Johnstone JM and Hunt AC. Plastic-bag asphyxia in adults. British Medical Journal, 1960; 1714

8. Uva JL. Review: Autoerotic Asphyxiation in the United States. Journal of Forensic Sciences, 1995: 40(4); 574-581.

9. Allnutt SH, Bradford JMW, Greenberg DM, Curry S. Co-Morbidity of alcoholism and the paraphilias. Journal of Forensic Sciences, 1996: 41(2); 234-239.

10. Http:// htm. Accessed on 09/06/2012 11. Vij K. Textbook of Forensic Medicine and Toxicology. New Delhi: Elsevier; 2008. P 632.

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A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
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A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
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A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

A Study by Sana Parveen and Shraddha Jain entitled "Pathophysiologic Enigma of COVID-19 Pandemic with Clinical Correlates" published in Vol 12 issue 13

A Study by Rashmi Jain et al. entitled "Current Consensus Review Article on Drugs and Biologics against nCOVID-19 – A Systematic Review" published in Vol 12 issue 09

Emerging Researcher Award

A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

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