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Bulgaria. The victim is a 37-years-old male. The cadaver was found in the apartment where he lived. It was in a relatively advanced stage of decomposition. The timing of death is approximately 4 days prior the finding of the cadaver. Examination of the death scene revealed that the cadaver was tied by ligatures over the ischial area and the lower extremities for the board of the bed, and the torso was in a lying position on the bed. The head was lying on the covers of the bed. The arms were free and held a rope. The clothing was feminine, tightened strongly around the body with cords. There were different sexual accessories such as ropes, handcuffs, belts, and vibrator over the bed.

Fig.1 The victim is 37-years old male. The cadaver was found in the apartment where he lived.

There was a thin scarf over the mouth and nostrils, and under the scarf there was a folded cloth. There was a semi soft rubber ball strung on a belt in the mouth. The belt that held the ball in the mouth was tightened with a loop over the neck and occipital area, and buttoned with a metal buckle. After the removal of all the clothes it was found that there was a condom put on the testicles, additionally tightened with a rubber band. The rubber ball was taken out of the mouth and it was found that there was stomach content – pieces of meat and vegetables, into the rhinopharynx.

Fig.2 There were different sexual accessories such as ropes, handcuffs, belts, and vibrator over the bed.

The internal examination of the cadaver showed that the esophagus, the larynx, and the trachea were filled with the same stomach content – pieces of meat and vegetables. The lungs’ surface looked mosaic, with areas of emphysema and atelectases due to aspiration of stomach content. There were spot-like hemorrhages under the conjunctiva of the left eye and visceral pleura, the blood was dark red and liquid, and the internal organs were cyanotic. Samples of blood, urine and aqueous humor were taken. The toxicological analysis showed presence of ethylic alcohol in the samples as follows: 0,20‰ in the blood sample, 0,50‰ in the urine sample, and 0,70‰ in the aqueous humor sample. There were no other substances detected toxicologically.

The cause of death established after the analysis of the forensic medical examination compared with the data of crime scene inspection was autoerotic mechanical asphyxiation caused by two mechanisms – immobilization of the body which caused difficulty in breathing movements and obstruction of the airways with vomited stomach content.

Fig.3 There was a semi soft rubber ball strung on a belt in the mouth.

In the presented case the death occurred by accident due to autoerotic mechanical asphyxiation. It was caused by the combination between postural asphyxiation and aspiration of vomited stomach contents. Most probably the partial hypoxia due to postural asphyxiation led to vomiting and aspiration because the rubber ball in the mouth and the scarf over the mouth and nostrils made it impossible the vomits to come out.

The gross morphology showed that the fatal outcome occurred quickly which was related to the acute decrease of oxygen in the blood. The presence of alcohol points that prior to death the victim had drunk some. Concentrations of the alcohol in the sample were very low, so they did not take part in the mechanism of occurrence of death. The investigation of the death scene showed no data that might raise suspicions that it could be a case of suicide or homicide.

Fig.4 There was a condom put on the testicles, additionally tightened with a rubber band.

Autoerotic death refers to the accidental death of individuals of either sex due to failure of devices, or unexpected effects of materials, that were being used to enhance the sexual experience. Although asphyxia from hanging has been described most frequently, a wide variety of other lethal situations have been reported. As there is great variability in the number and types of sexual aids that may be used by individuals, careful death scene examination is essential in helping to exclude suicide and more rarely homicide. The clandestine nature of this paraphilia may, however, make subsequent identification and diagnosis difficult unless the death scene features are typical. This is particularly so in the rare cases involving women.

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