A retrospective review of the circumstances and characteristics of 72 adult autoerotic neck compression deaths in Australia, between 2000 and 2022.

Autoerotic asphyxial deaths are a rare but recurring phenomenon, the most common modality of which involves neck compression. Autoerotic neck compression can involve any compression to the neck during individual sexual activity performed to heighten arousal. This retrospective study examines 72 such deaths occurring in Australia between 2000 and 2022. The study aims to provide detailed medico-legal interpretation of such deaths and recommendations for investigation within Australian contexts, and globally. Demographic analysis reveals a predominance of Caucasian males under 50 years of age, with diverse employment and health status. Pathological examination uncovers a spectrum of injuries, from superficial abrasions to rare skeletal and cartilaginous injuries, providing insights into the mechanics and characteristics of these fatalities. Contextual examination highlights sexual paraphernalia, evidence of genital stimulation, and isolation are consistent features in most autoerotic deaths within the sample. There was a wide variety of tool usage (ropes, belts, etc.), and geo-temporal features associated with autoerotic neck compression. The study provides comprehensive examination of the circumstances and characteristics of autoerotic neck compression which may assist in differentiation between suicidal and homicidal neck compression deaths such as hanging or ligature strangulation respectively. This study is an Australian first and is the first study of autoerotic asphyxial deaths to focus solely on deaths with a neck compression component. The study incorporates new variables and suggests ways these should be considered in future death investigations. The authors argue for delineation and subcategorization of autoerotic neck compression from other autoerotic asphyxial death due to their distinct injury characteristics and mechanism of injury.