Water meeters: An overview of aquaphilia

Following a previous blog I wrote on psychrocism and sexual arousal from ice, it got me wondering what other sexual behaviours might involve water. In a comprehensive list of paraphilias in the books Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices (by Dr.Anil Aggrawal) and the Encyclopedia of Unusual Sex Practices (by Dr. Brenda Love), a number of water-related paraphilias and sexual behaviours were listed. The list included:

• Aquaphilia: Sexual arousal from water and/or watery environments including bathtubs or swimming pools (and sometimes called hydrophilia)
• Albutophilia – Sexual arousal from water
• Ablutophilia – Sexual arousal from baths or showers
• Antiohilia – Sexual arousal from floods
• Coitobalnism —Sex in a bath tub
• Coitus a unda – Sex under water
• Bidetonism – The use of water spray from a bidet as a genital sexual stimulant for women while masturbating.

In her sex encyclopedia, Brenda Love has a section devoted to having sex in and/or under water (i.e., coitus à unda) and can include masturbation, oral sex and/or penetrative sex in any number of water-based situations (e.g., bath, shower, swimming pool, lake, ocean, etc.). She also says that such activities can include fellatio where the partner holds hot water in his or her mouth. She also highlights a number of other activities that come under the generic banner of ‘water sex’. These include:

• Sexually based ‘entertainment’ hosted in pubs, bars and/or restaurants (e.g., wet T-Shirt or jock-strap competitions, naked women swimming inside large aquariums)
• The use of water as a lubricant to facilitate insertion of bodily parts (e.g., fingers, toes) or sex toys into various bodily orifices
• The use of baby baths along with the addition of child’s bath toys for those who derive sexual pleasure from being an adult baby (i.e., infantilism).

She also claims that Tiberius Caesar had a passion for aquatic sex. She claims Caesar trained young boys (that he called ‘minnows’) to swim after him and come up from below to nibble and suck on his genitals. Other cultures aren’t so liberal. For instance, Dr. Aggrawal notes that in Hinduism – and according to the ‘Laws of Manu’ (i.e., the words of Brahma, the Hindu god of creation – “A man who has committed a bestial crime, or an unnatural crime with a female, or has had intercourse in water, or with a menstruating woman shall perform a Samtapana Krikkhra” (i.e., a 24-hour fast where no food can be consumed whatsoever).

Other psychologists and scientists (e.g., Dr. Viren Swami and Dr. Adrian Furnham in their book The Psychology of Physical Attraction; Dr. Katherine Ramsland and Dr. Patrick McGrain in their book Inside the Minds of Sexual Predators) define aquaphilia (like Dr. Aggrawal and Dr. Love) as a form of sexual fetishism that involves sex in (or under) water but extends the definition to include images of people swimming or posing underwater. According to Wikipedia, the term “aquaphile” was “first used by Phil Bolton, when he created the ‘Aquaphiles Journal’ – an online magazine for followers of the underwater erotica scene published in the 1990s”.

Another more unusual water-related paraphilia is hypoxyphilia. Autoerotic asphyxiates use a variety of methods to restrict their oxygen supply including partial hanging, the use of plastic bags or masks over the face, chest compression, and submerging under water (known in the clinical and forensic literature as “aqua eroticum”). Reports of water-related hypoxyphilic deaths are exceedingly rare but have been documented.

The term “aqua-eroticism” was first used in a 1984 paper – in the journal Medicine, Science and the Law – by Dr. S. Sivaloganathan. However, the use of the term here solely related to hypoxyphilia (i.e.. autoerotic asphxiation). While there have been hundreds of papers and articles about hypoxyphilia, to my knowledge only two papers have been published involving submersion under water. These very rare occurrences have come to light when things have gone drastically wrong (i.e., death for the person engaging in the activity). As with hypoxyphilic activity more generally, underwater submersion while holding one’s breath produces the same effects of oxygen deprivation via other methods (e.g., hanging, self-strangulation).

In the case documented by Dr. Sivaloganathan, a man was found drowned with a stone tied to his ankle (to weigh him down in the water). He was also assumed to have transvestite tendencies as he found dressed in women’s clothes. It was assumed to be an example of autoerotic asphyxia given that it seemed to be a very peculiar way to be swimming or committing suicide. The act of swimming in the opposite sex’s clothes with a weight tied to the leg also had many key features of deliberately induced danger as a method of increasing the arousal level. There is always the possibility that other similar types of incident may have occurred but have been labelled as suicide rather than death by misadventure.

The second case in the academic literature was reported by Dr. A. Sauvageau and Dr. S. Racette in the Journal of Forensic Sciences. Here, the evidence for autoerotic asphyxiation was more clear cut. During the summer, a man aged 25 years was found dead in a lake, submerged underneath his boat. Despite being the height of summer, he was wearing a hockey helmet, a snowmobile suit, and ski boots. However, underneath these clothes he was found to be wearing a self-constructed plastic bodysuit over his naked body from head to toe with a separate plastic tube wrapped around his genitals. Furthermore, there were clear bondage elements. Around his wrists, ankles, knees and waist he was tightly bound in a mixture of mesh and chains (all of which were padlocked to his groin). The only air supply was a black tube joined to his mouth and sealed to the suit by silicone. The man’s air supply system comprised an open plastic container floating on the lake to his mouth.

Although such elaborate bondage suggests a second party may have been involved, the crime scene investigators established that the man could have put on the harness. The victim’s clothing and water submersion appeared to facilitate a masochistic scenario. The investigation also established that the dead man had been an active member of an online hypoxyphiliac website. The authors noted:

“The victim was found completely submerged, with an air tube running from his mouth to a floating plastic container. However, he’d apparently miscalculated, using a tube too narrow for both the intake and expulsion of air. Rather than giving him the right degree of hypoxia for a heightened erotic experience, his air supply was significantly fouled with carbon dioxide, killing him”.

The coroner ruled the death as accidental (i.e., autoerotic asphyxia from re-breathing, caused by the faulty self-constructed air-supply device). Clearly this latter case has overlaps with sadomasochism and bondage. In fact, there are dedicated websites for ‘water bondage’ (where women are gagged and bound and submerged into “helpless submission”). For instance, at waterbondage.com:

“Water bondage is where rope bondage, fetish and BDSM meet breath control, immersion, water sex, predicament bondage, and more. Women are bound, dunked, sprayed and drenched, then dildo fucked and tortured with vibrators until they cum. With the most elegant rope bondage around, Water bondage has extreme bondage, breath play, punishment, domination, BDSM, fetish, submission, pain, and real female orgasms”

The only other sexually related water fetish or paraphilia that I have come across is liquidophilia. Various online articles (such as the not-so-imaginatively-titled Dirty Mag website) mention this behaviour and all define it as a paraphilia in which individuals derive sexual pleasure and arousal from immersing their genitals in some kind of liquid. Although most liquidophiles use water (e.g., taking a bath would be highly erotic for such people), any liquid can apparently be used. It has also been claimed that some liquidophiles have a preference for liquids that resemble bodily secretions (e.g., milk).

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.

Dirty Mag (2011). Fetish fix: Liquidophilia. September 12. Located at: http://dirtymag.com/fetish-fix-liquidophilia/

Love, B. (2001). Encyclopedia of Unusual Sex Practices. London: Greenwich Editions.

Sauvageau A. & Racette S. (2006). Aqua-eroticum: An unusual autoerotic fatality in a lake involving a home-made diving apparatus. Journal of Forensic Sciences, 51, 137-9.

Sivaloganathan S. (1984). Aqua-eroticum – A case of auto-erotic drowning. Medicine, Science and the Law, 24, 300-302.

Swami, V. & Furnham, A. (2008). The Psychology of Physical Attraction. London: Routledge.

Ramsland, K.M. & McGrain, P.N. (2010). Inside the Minds of Sexual Predators. Santa Barbara, CA: ABC-CLIO.

Wikipedia (2012). Aquaphilia (fetish). Located at: http://en.wikipedia.org/wiki/Aquaphilia_(fetish)

You’re killing me: A brief psychological and ethical consideration of autassassinophilia

Autassassinophilia is a paraphilia in which an individual derives sexual pleasure and arousal by the thought and/or risk of being killed. The paraphilia may on occasion overlap with other paraphilias such as autoerotic asphyxiation (i.e., sexual suffocation) where there is a risk to their life. In some instances, the autassassinophile may also derive sexual pleasure and arousal from planning their own death. Given these facts, it is clear that autassassinophilia is exceedingly rare and very dangerous. The condition was first written about in a clinical (and academic) context by Professor John Money in his 1986 book Lovemaps. He wrote that:

“Autassassinophilia [is] a paraphilia of the sacrificial/exploratory type in which sexuerotic arousal and facilitation or attainment of orgasm are responsive to, and dependent upon stage-managing the possibility if one’s own masochistic death by murder. The reciprocal paraphilic condition is lust murder or erotophonophilia…Erotophonophilia [is] a paraphilia of the sacrificial/exploratory type in which sexuerotic arousal and facilitation or attainment of orgasm are responsive to, and dependent upon stage-managing and carrying out the murder of an unsuspecting sexual partner. The erotophonophiliac’s orgasm coincides with the expiration of the partner. The reciprocal paraphilic condition is autassassinophilia”

Brenda Love cites one of Money’s own cases in her Encyclopedia of Unusual Sex Practices:

“The masochistic drama of erotic death and atonement may be enacted not as an autoerotic monologue, but as a dialogue with a co-opted partner in collusion. The partner is not necessarily a paraphilic sadist, but rather a daredevil hustler or mercenary given to trying almost anything for kicks, or for profit. This was not the type of hustler whom a young man with a paraphilia of homosexual masochism would pick up, one or more at a time, on the waterfront. With his beguiling brand of macho, he would cue the hustlers into their roles in his masochistic drama. First he would supply them with squeeze bottles of mustard or ketchup and a spray can of shaving cream to squirt on him as he lay naked, masturbating. Then he would direct them to bind him up with rope, urinate on him, degrade and abuse him verbally, hit hum, and kick him harder with heavy boots, harder and harder, until he would ejaculate, not knowing whether a blow on the head would wound him or kill him”.

A paper on the phenomenology of autassassinophilia by Dr. Lisa Downing in a 2004 issue of Sexuality and Culture questioned the definitions provided by Money and argued that the reciprocal conditions outlined by Money were fundamentally flawed. Downing made the interesting observation that:

“The autassassinophiliac, for Money, is more interested in his orgasm than in his death, resulting in a compulsion to ‘stage manage the possibility’ rather than the actuality of his end at the hands of another person. The erotophonophiliac, on the other hand, is driven by the actualization of the other’s death and – crucially – this other must be unaware of the killer’s intentions. These difinitions, then, effectively preclude reciprocity”.

Some of you reading this might think that autoassassinophile is more of a theoretical (rather than an actual) paraphilia, but there are a number of documented cases of two lovers in a consensual ‘murder pact’. The most high profile heterosexual case is that of Sharon Lopatka and Robert Glass. Lopatka (from Maryland, US) was strangled and killed consensually by Glass who she met online at an “extreme fantasy” website. Over a number of months in 1996, they exchanged 1000s of emails (found by the police after she was found dead) fantasizing about – and planning – her own murder. Glass eventually pleaded guilty to manslaughter claiming he had never actually intended to kill her.

The most high profile homosexual case was that of the German men Armin Meiwes and Jürgen Brandes – a case that I examined in relation to a previous blogs on vorarephilia (i.e., a sexual paraphilia in which people are sexually aroused by the idea of being eaten, eating another person, or observing this process for sexual gratification) and autosarcophagy (i.e., self-cannibalism). Meiwes, a computer technician, gained worldwide media attention as the ‘Rotenburg Cannibal’ for killing and eating a fellow German male victim (also a computer technician). The one aspect that shocked most people was not the fact that Meiwes ate a lot of Brande’s body but that Brande appeared to consent to being eaten. Email exchanges between Meiwes and Brandes were later shared in the court case:

Brandes: “Thanks for your mail. You really turn me on…Winter with the temperature at around 5 to 15 degrees below freezing is good weather for slaughter. Great to be naked and tied in weather like that and to be driven to the slaughter. Where you then stun me and I collapse. You then hang me up, jerking, and cut my carotid artery. Warm blood flows. Everything goes routinely. I don’t have any chance to escape my slaughter at the last moment. It’s a real turn-on, the feeling of being at your mercy being in your possession. Having to give up my flesh”

Meiwes: “It’ll be awesome, anyway. Your tasty body on show like that. Spicing it…Tying you up will be no problem, I’ve got rope and some cuffs for your hands and feet. I’ll really enjoy the bit with the needles. I’ll see if I can get hold of some really long ones. I can’t wait for you to be here”

In court, Brande’s consent to being killed was accepted by the jury and Meiwes was given an eight and a half year prison sentence for manslaughter. These (and other) cases raise some interesting and controversial ethical questions. These were discussed at length in Dr. Downing’s excellent and thought provoking phenomenological paper on autassassinophilia. She clearly makes the point that being killed for sexual pleasure “problematizes commonplace assumptions about the legitimacy to consent”. When it comes to sexual behaviour, I would describe my views as liberal and are in line with the liberal sex tenets outlined by Robert Solomon that (i) the essential aim of sex is enjoyment, (ii) sex is an essentially private activity, and (ii) any sexual activity is as valid as any other. However, like Downing, I think the idea of consensual lust murder appears to exceed “acceptable” limits of sexual behaviour. However, that doesn’t mean I believe totally in the commandment “thou shalt not kill”. I am pro-euthanasia and have much sympathy with those who have carried out so-called ‘mercy killings’ when a person is in intolerable pain and is unable to end their own life (and a loved one is asked by the suffering person to kill them as humanely as possible).

Downing makes reference to the work of Alan Soble who has written widely of the philosophy of sex. Soble’s 1996 book Sexual Investigations makes the following observation:

“If persons of sound mind and adequate foreknowledge consent to engage in sex together, and do only the acts that both agree to, and do not wrongfully affect third parties, how could their acts be morally wrong? [However], one person’s harming another – and perhaps a person’s allowing himself to be harmed – is wrong even when both parties enter into the act voluntarily”.

Downing considers the last sentence here as “moral absolutism” overriding the liberal standpoint. In fact she says that: “this interventionist and infantilizing approach assumes a class of person (professionals, and theorists) who just know better than the people who consent to certain types of activity”. Given that some sections (like myself) are socially tolerant of euthanasia, it’s more a case of having “a problem with the idea of validating the right to consent to a sexually pleasurable death”. I have to be honest and say that although I am a sexual liberal, I find it hard to accept consensual sex killing and think it is morally wrong.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Beier, K. (2008). Comment on Pfafflin’s (2008) “Good enough to eat”. Archives of Sexual Behavior, 38, 164-165

Downing, L. (2004). On the limits of sexual ethics: The phenomenology of autassassinophilia. Sexuality and Culture, 8, 3–17.

Love, B. (1992). Encyclopedia of Unusual Sex Practices. Fort Lee, NJ: Barricade Books

Money, J. (1986). Lovemaps: Clinical concepts of sexual/erotic health and pathology, paraphilia, and gender transposition in childhood, adolescence, and maturity. New York: Irvington.

Pfafflin, F. (2008). Good enough to eat. Archives of Sexual Behavior, 37, 286-293.

Pfafflin, F. (2009). Reply to Beier (2009). Archives of Sexual Behavior, 38, 166-167.

Soble, A. (1996). Sexual Investigations. New York: New York University Press.

Solomon, R. (1997). Sexual paradigms. In A. Soble (Ed.), The Philosophy of Sex: Contemporary Readings (Third Edition, pp.21-29). Oxford: Rowman and Little.

Autoerotic sex drives! What is the relationship between sex and cars?

“I have a friend that get’s sexually excited by cars and rims, I’ve seen her melt down at the sight of a nice car and big rims. Funny – her mom is like that too, and I always thought she was just a gold digger!”

This opening quote hopefully highlights that for some there is a relationship between sex and cars. This relationship has been written about in both academic and non-academic books for many years (and no, this blog will not be looking at the car as a phallic symbol). However, in the world of paraphilias there are much fewer writings. There are a number of different paraphilias that have some association with cars. These include:

• Mechanophilia: Sexual arousal from cars or other machines (and sometimes referred to as ‘mechasexuality’).
• Symphorophilia: Sexual arousal from witnessing or staging disasters such as car accidents. (The main characters in the 1973 novel Crash by British author J.G. Ballard, and the subsequent 1996 film adaptation of the same name, are therefore symphorophiles).
• Amomaxia: Sexual arousal from having sex in parked cars.

(There’s also case study evidence in a 2003 American Journal of Psychiatry review paper by Dr Jennifer Pate and Dr Glenn Gabbard on infantilism [where people get sexual arousal from being ‘adult babies’] that some ‘adult babies’ enjoy playing with toy cars – but even I think that’s stretching it a bit!). Cars have also been central to other paraphilic behaviours – such as hypoxyphilia – but I’ll return to that later.

In 1992, Dr Padmal De Silva and Dr Amanda Pernet (at the time both at the Institute of Psychiatry, London) published a case study in the journal Sex and Marital Therapy. The case involved an unusual sexual deviation in a young 20-year old British man (‘George’) who had little social interaction and was incredibly shy. They reported that his main sexual interest and excitement was from cars – particularly Austin Metro cars. George’s family belonged to a strict religious sect who strongly disapproved of any sexual involvement by their son with women. Things changed for George when his parents bough an Austin Metro car (the front of which reminded George of a smiling child-like face). George began masturbating inside the car, and then outside masturbating outside the car while crouching down next to the car’s exhaust pipe. Although he occasionally engaged in masturbating over scantily dressed pictures of women, he was far more sexually aroused by the Metro photographs in his bedroom.

So that he couldn’t be caught masturbating, he would go to great lengths to find deserted places to engage in his sexual activity with the car. He also became sexually excited by cars that resembled the look of the Metro (including the Fiat Uno, Ford Fiesta, and various makes of Vauxhall cars including the Astra and the Nova). George used to become very sexually excited when the car’s exhaust pipe was running and pumping out car fumes. This aspect of “elimination” – according to De Silva and Pernet – was an important central element in George’s other sexual preferences – particularly his fascination of urination. As a very young child he had an unusual interest in dogs urinating. After the age of 10 years, he was more interested in children and adult women urinating. The authors also speculated there may have been an increase in George’s arousal due to a “reduction of oxygen intake and related asphyxiation”. This was possibly seen as a mild form of hypoxyphilia.

George was eventually treated by a classical conditioning technique known as orgasmic reconditioning. This technique provided the opportunity for George to change the focus of his sexual arousal from cars to women. However, despite the therapy, he still retained a strong sexual interest in Metro cars. This type of therapy has been used in the treatment of other sexually fetishistic behaviours, but as reported in a number of published papers, overcoming the main fetish is very difficult for affected individuals.

More recently, there was worldwide media interest following a television programme in which Edward Smith, a 57-year old man from Washington State in the US, admitted to having had sex with over 1,000 cars. He also claimed he no longer had sexual interest in humans. His last normal relationship had been an unconsummated affair with a woman when he was 45-years old but he had not had sex since he was a young man. At the time of the programme, Smith was living with ‘Vanilla’ (a white Volkswagon Beetle) but was also having sexual relationships with ‘Cinnamon’ (an Opal GT) and ‘Ginger’ (a Ford Ranger Splash). His previous relationship to ‘Vanilla’ was another VW Beetle called ‘Victoria’. Smith went on to comment:

“I appreciate beauty and I go a little bit beyond appreciating the beauty of a car only to the point of what I feel is an expression of love. I’m a romantic. I write poetry about cars, I sing to them and talk to them just like a girlfriend. I know what’s in my heart and I have no desire to change. I’m not sick and I don’t want to hurt anyone, cars are just my preference. It’s something that grew as a part of me when I was a kid and I could not shake it. I just loved cute cars right from the beginning, but over the years it got stronger once I got into my teenage years and was my first having sexual urges. “When I turned 13 and the famous Corvette Stingray came about, that car was pure sex and just an incredible machine. I wanted it. I didn’t fully understand it myself except that I know I’m not hurting anyone and I do not intend to. There are moments way out in the middle of nowhere when I see a little car parked and I swear it needs loving. There have been certain cars that attracted me and I would wait until nighttime, creep up to them and just hug and kiss them. As far as women go, they never really interested me much. And I’m not gay”

At the age of 15 years, Smith first had sex with a car but had also had sex with other forms of transportation. In fact Smith claimed that his best sexual experience was having sex with a helicopter from the US television series Airwolf. Smith went on to claim he is part of a global community of more than 500 mechasexual “car lovers” that communicate via online forums. Dr. Ian Kerner, a New York City sex therapist commented that in general “there is an exhibitionistic element for the person being stimulated by machine, as well as general submission/domination themes”.

In a 2010 issue of the Internet Journal of Human Sexuality, Amy Marsh described what she claims is the first ever research study conducted on a group of 40 “objectophiles” (i.e., “people who experience emotional, romantic, affectionate and/or sexual relationships with objects”), of which 21 shared their experiences. One of those who shared their experiences of ‘mechasexuality’.

He had been aware of his mechasexuality for one to five years.

“I’ve been in love with my mom’s car and my own car since I got it bought. My car’s appearance is what attracts me the most. [I enjoy intimacy with the cars] between twice a week and once every three weeks [and] involves cuddling and such affectionate activity, and sometimes masturbation…However, I’d like to mention that although there can be a little amount of mental role play, I am fully aware that objects are inanimate and that this mostly is a one-sided relation. Although I may consider a human relationship eventually, it has not happened yet.”

Finally, it’s worth mentioning the case of the 40-year old US male airline pilot (and also married and father of two children). His case was recounted in the Journal of Forensic Sciences by Dr J.C. Rupp (County Examiner’s Office, Texas, USA). The man left his home at 6am in the morning and told his wife that he was going shooting in the country. He was found naked except for a large-link 10-foot chain harness secured around his body. (The harness was tied around the man’s neck in a moderately tight loop and bolted. The chain then went down his chest and was tied into another loop around his waist. This was tied to the bumper of the car) at 7.30am in the morning in a remote area crushed against the left fender of his car (equivalent of a VW Beetle). The engine was still running, ignition was on and the driver’s door was still open. The steering wheel was tied so that it would go round in anti-clockwise circles. His clothes were in the boot of the car. Reconstruction of the events leading to his death showed that he was either being dragged round by the car or following the car producing feelings of asphyxia. When he had finished his sexual turn-on he had tried to approach the car door but had forgotten to undo the chain from the bumper. The chain had got tangled up in the car’s axle and the man was found strangled to death by the chain. This is clearly a case of a car being used to facilitate another paraphilia (i.e., hypoxyphilia). Clearly, this is a very extreme case, but like the other cases outlined in this article, they do at least show that for some people, cars are an integral part to their sexuality and sex life.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Daily Telegraph (2008). Man admits having sex with 1,000 cars. May 21. Located at: http://www.telegraph.co.uk/news/newstopics/howaboutthat/2000899/Man-admits-having-sex-with-1000-cars.html

De Silva, P. & Pernet, A. (1992). Pollution in ‘Metroland’: An unusual paraphilia in a shy young man. Sexual and Marital Therapy, 7, 301-306.

Marsh, A. (2010). Love among the objectum sexuals. Electronic Journal of Human Sexuality, 13, March 1. Located at: http://www.ejhs.org/volume13/ObjSexuals.htm

Pate, J. & Gabbard, J.O. (2003). Adult baby syndrome. American Journal of Psychiatry, 160, 1932-1936.

Rupp, J.C. (1973). The love bug. Journal of Forensic Sciences, 18, 259-262.

Eaten to death: A beginner’s guide to vorarephilia

Vorarephilia – usually shortened to vore – is a sexual paraphilia in which people are sexually aroused by the idea of being eaten, eating another person, or observing this process for sexual gratification. Since the behaviour is unlikely to actually be carried out by the vorarephiliac, the behaviour is more likely to be fantasy-based via different media (e.g., fictional stories, fantasy art, fantasy videos, and bespoke video games). The behaviour doesn’t necessarily involve digestion and/or pain. Probably because it is both rare and fantasy-based, it doesn’t appear in any psychiatric manuals such as the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

Vorarephilia can sometimes co-exist with other fetishistic behaviour such as masochism (sexual arousal from receiving pain), hypoxyphilia (sexual arousal from suffocation and oxygen restriction), and ‘snuff’ fetishes (sexual arousal from seeing someone die). In some cases vorarephilia has been argued to be a variant of macrophilia (i.e., sexual fascination and/or fantasy relating to giants). Most of the fantasies of vorarephiliacs involve the person being the ones being eaten (i.e., the ‘prey’, although a few like to be the ‘pred’ taken from the word ‘predator’). Some vorarephiliacs are known to derive pleasure – sometimes sexual – from watching some animals (e.g., snakes) eating other animals whole.

There have been many different types of vorarephilia documented including ‘hard vore’ and ‘soft vore’. Being primarily fantasy-based, almost any orifice or body part can be capable of vore (e.g., ‘vaginal vore’, ‘anal vore’ and ‘cock vore’). Very briefly:

• Hard vore (sometimes simply called ‘gore’) is where the person is often subjected to horrific injuries and involves lots of blood because of the ripping, cutting, biting, tearing and/or chewing of flesh. It is not typically thought of as either sensually or sexually motivated.
• Soft vore is where the person (that may not necessarily be a willing victim) is consumed alive and whole and is typically unharmed before reaching the stomach but then may be asphyxiated and/or digested. Compared to ‘hard vore’, soft vore is usually seen as more sensual and sexually oriented because of its relatively non-violent nature.
• Female genital vore (vaginal vore) is where the person is consumed by the vagina and taken into the womb (and often referred to as ‘unbirthing’ or a ‘reverse birth’).
• Male genital vore (cock vore) is where the person is consumed by the urethral opening of the penis and taken into the scrotum, prostate, or bladder.
• Anal vore is where the person is consumed by the anus and taken into the rectum, colon, or stomach.
• Breast vore is where the person is consumed by the nipples and taken into the breast.

Here’s a confessional piece I found on a psychology forum discussion group:

“I’m almost 17 now. But since I was really young, I’ve been a phagophile (with a specific interest in being swallowed whole). I’ve had a few girlfriends now, but my present one is by far the most engaging and interesting person I have ever met. She’s the only one I’ve engaged in any real sexual contact with. After meeting her, my interests expanded somewhat; she’s the only person I’ve ever been interested in eating. Fortunately this was impossible, for obvious reasons: I was still thinking in terms of “soft vore”, in which no damage is done to either party. This is where things get difficult. We’ve been together a while now and within the past few weeks, I’ve begun to shift towards “hard vore”. This includes cannibalism: I’ve been attracted especially to biting at her neck, hands, and nose. I feel that I’ve done a good job at communicating this to her, so I haven’t crossed any lines because I’ve controlled myself.”

The motivational driving force underlying vorarephilia is some ways appears to resemble that of sadomasochism from a dominance and submission perspective. Devouring someone could be viewed as the ultimate act of dominance by a predator, and the ultimate act of submission by the prey. Paradoxically, most vorarephiliacs have no real interest in cannibalism, although a few do. Possible vorarephiliacs include the Japanese man (Issei Sagawa) who in 1981 killed and then ate a Dutch woman (Renée Hartevelt), and the serial killer Jeffrey Dahmer who killed 17 men and boys and engaged in both cannibalistic and necrophilic acts with his many victims between 1978 and 1991.

However, the most infamous vorarephiliac is arguably the German Armin Meiwes. His case was referred to at length in a 2008 essay in the Archives of Sexual Behavior, by Dr Friedemann Pfafflin (a forensic psychotherapist at Ulm University, Germany). Meiwes, a computer technician, gained worldwide media attention as the ‘Rotenburg Cannibal’ for killing and eating a fellow German male victim (also a computer technician). Meiwes had allegedly been fantasizing about cannibalism since his childhood and frequented cannibal fetish websites and posted around 60 advertisements asking if anyone would like to be eaten by him. Meiwes claimed around 200 men responded to his request but only one finally met face-to-face.

In March 2002, Bernd Jürgen Brandes responded to Meiwes’ advertisement on the Internet. At their one and only meeting at Meiwes’ house, their first cannabilistic act was for Meiwes to bite off Brandes’ penis and then jointly cook and eat it. Brandes then drank lots of alcohol, cough syrup, and took sleeping pills, and was stabbed to death by Meiwes in his bath (and videotaped). The body was then stored and over time, Meiwes ate large amounts of it (about 20 kg). The one aspect that shocked most people was not the fact that Meiwes ate a lot of Brande’s body but that Brandes appeared to consent to being eaten. Email exchanges between Meiwes and Brandes were later shared in the court case:

Brandes: “Thanks for your mail. You really turn me on…Winter with the temperature at around 5 to 15 degrees below freezing is good weather for slaughter. Great to be naked and tied in weather like that and to be driven to the slaughter. Where you then stun me and I collapse. You then hang me up, jerking, and cut my carotid artery. Warm blood flows. Everything goes routinely. I don’t have any chance to escape my slaughter at the last moment. It’s a real turn-on, the feeling of being at your mercy being in your possession. Having to give up my flesh”

Meiwes: “It’ll be awesome, anyway. Your tasty body on show like that. Spicing it…Tying you up will be no problem, I’ve got rope and some cuffs for your hands and feet. I’ll really enjoy the bit with the needles. I’ll see if I can get hold of some really long ones. I can’t wait for you to be here”

It wasn’t until about 18 months after Brande had been killed that the German police started to investigate Meiwes. An Austrian student had seen Meiwes boasting that he had successfully killed and eaten another man. The police then arrested Meiwes and found human body parts in the freezer and the videotape of the killing. In court, Brandes’ consent to being killed was accepted by the jury and Meiwes was given an eight and a half year prison sentence for manslaughter. Neither Meiwes or Brandes were deemed mentally ill by the court appointed psychiatrists. Dr Klaus Beier (Institute of Sexology and Sexual Medicine, Free and Humboldt-University of Berlin, Germany) was the expert witness who twice provided forensic expertise on Miewes. He said that:

“Armin suffered neither from a psychosis nor any other mental illness or any personality disorder. Quite the contrary, he had a normal IQ and his social competence was high. To everybody who had private or professional contact with him, Armin seemed to be an open-minded and friendly contemporary man who, in the forming of contacts, appeared pleasant-natured, flexible, and socially competent, even agile. Even extremely experienced police officers, who could not believe what he had done, had to put on record that, if they had not known about the offence, Armin M. never offered anything conspicuous during the entire period of investigation.”

A later paper by Dr Beier in response to Dr Pfafflin noted that:

“Before the age of 11 years [Armin] was preoccupied by the idea of incorporating another male by eating his flesh. This paraphilia caused him to seek unsolicited partners who pretended to mirror his desire insofar that they should have the wish of being incorporated. It took him years to find such a counterpart using the frighteningly developed subculture on the internet for that purpose, where people with this special inclination can encourage each other.”

Dr Pfafflin outlined some other cases of German cannibalism including cases he was personally involved in. he said that:

“From my intensive knowledge of both these case histories just referred to, I have no doubt that every form of cannibalism, excepting at most those which happen in times of extreme hunger and whose only purpose is to secure survival, has a pathological, perverse background.”

Little is known about how prevalent this type of behaviour is although Meiwes claimed that based on his internet activity on cannibal fetish websites that there were at least 800 Germans that shared his passion for wanting to eat another person. The number of people that have a desire to be eaten and actually go through with it is likely to be incredibly small – but the internet helped Meiwes locate a willing victim.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Adams, C. (2004). Eat or be eaten: Is cannibalism a pathology as listed in the DSM-IV? The Straight Dope, July 2. Located at: http://www.straightdope.com/columns/read/2515/eat-or-be-eaten

Beier, K. (2008). Comment on Pfafflin’s (2008) “Good enough to eat”. Archives of Sexual Behavior, 38, 164-165

Brundage, S. (2002).  Fetish confessions. The Wave Magazine 2(15). Located at: http://web.archive.org/web/20070927061721/http://www.thewavemag.com/pagegen.php?articleid=22026&pagename=article

Pfafflin, F. (2008). Good enough to eat. Archives of Sexual Behavior, 37, 286-293.

Pfafflin, F. (2009). Reply to Beier (2009). Archives of Sexual Behavior, 38, 166-167.

Hit me baby, one more time: A brief overview of sexual masochism

In a previous blog, I briefly examined the psychological literature on sexual sadism. Today’s blog looks at its counterpart – sexual masochism – often viewed as two sides of the same coin. Sexual masochists comprise those individuals who derive sexual gratification from receiving physical and/or psychological pain. The sexologist Richard von Krafft-Ebing coined the term ‘masochism’ in his 1886 sexology book Psychopathia Sexualis deriving the name from the 19th-century novelist Leopold von Sacher-Masoch, whose book Venus in Furs (well known to us that are big Velvet Underground fans) depicts a man’s humiliation and suffering by a female dominatrix. There are other names for the same phenomenon – such as ‘algolagnia’ – that refer to those people who have a craving for pain. Algolagnia was coined by the German physician in the late 1880s but never caught on in the same way as the term ‘masochism’.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) acknowledges the overlap between masochism and sadism but they are classed as two distinct entities. The DSM-IV defines masochism as when the individual experiences “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer” over a six-month period. To distinguish it as a disorder rather than a non-problematic sexual preference, the masochistic sexual urges, fantasies and/or behaviours have to cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning”. Interestingly, other paraphilic behaviours such as hypoxyphilia (examined in a previous blog) come under the rubric of sexual masochism.

Early empirical studies such as those published in the Kinsey Reports in the late 1940s and early 1950s reported that a quarter of both males and females had experienced sexual arousal from being bitten by their partner during sex although later studies have reported much lower figures of around 3% to 5%. In a late 1980s, a study published in the Journal of Sex and Marital Therapy, by Dr Ethel Person (Columbia University, New York, USA) and colleagues surveyed college students about their sexual behaviours and fantasies. Results showed that around 4% had been tied up or sexually degraded during sex, and that 1% had spanked, whipped, or hit a consenting partner during sex (although ‘consenting partner’ does not necessarily mean they enjoyed being smacked, whipped or beaten). Dr Charles Moser (Institute for Advanced Study of Human Sexuality, California, USA) claims about 10% of the adult population engages in sadomasochistic activity.

Masochistic fantasies are not uncommon. For instance, in a 1980s study published in the Archives of Sexual Behavior, Dr Claude Crépault and Marcel Couture (University of Quebec, Canada) reported that 46% of men had sexual fantasies of being kidnapped and raped by a woman, 12% had fantasies relating to being humiliated, and 36% fantasized about being bound and sexually stimulated by a woman.

Although there is a lot of evidence showing that sexually masochistic desires, fantasies and behaviours are relatively common among men, there has been some dispute about women’s interest in sexual masochism. Research certainly indicates that consensual sexually masochistic behaviour by females can occur and some authors argue that there is a biologically based tendency towards submissiveness in females. However, some claim that it is very rare in women. Back in 1977, Dr Andreas Spengler (University of Hamburg, Germany) has claimed that almost all women who participate in sadomasochist activities are prostitutes that have no personal preference for such activity. However, a number of more recent studies among sadomasochists (1985-2002) have all indicated that a small but significant minority of women engage in both sexually masochistic and sadistic activities (13% to 30%) – very few of which were prostitutes. However, when compared to male sadomasochists, female counterparts were less likely to need sadomasochist activity to fulfil their sexual satisfaction.

Research has also indicated that men are more likely than women to experience masochistic desires during adolescence although a significant minority of male masochists do not express an interest in such behaviour until they have reached adulthood. Studies of sadomasochists show little difference in sexual orientation. For instance, Spengler’s study of 245 male sadomasochists reported that 30% were heterosexual, 31% were bisexual and 38% homosexual. Other studies have found much higher levels of heterosexuality although amongst female sadomasochists there tends to be higher levels of bisexuality than in the study by Spengler.

In a 1985 study carried out by academics at California State University and led by Dr Norman Breslow, 182 sadomasochists (of which 52 were women) were surveyed. One-third of the men (33%) were dominant, 41% were submissive, and 26% were both. Similar results were found among the females. Spanking and ‘master-slave relationships’ were the most preferred sexual activities for both male and female sadomasochists although there were some minor differences. More females preferred bondage and restraint whereas more men preferred pain and whipping. Klismaphilia may also have been a co-morbid paraphilia as 33% men and 22% of females made sexual use of enemas.

A more recent Finnish study led by Dr Laurence Alison reported in the Archives of Sexual Behavior reported that flagellation and bondage were among the most popular activities among sadomasochists. However, there was a wide range of lesser activities that carried greater risk of physical harm including piercings, hypoxyphilia, fisting, knifeplay, and electric shocks. There were also major differences depending upon sexual orientation (for instance, gay men were more likely to engage in activities such as “cock binding”). Most interestingly, the research team identified four sadomasochistic sub-groups based on the type of pain given and received. These were:

• Typical pain administration: This involved practices such as spanking, caning, whipping, skin branding, electric shocks, etc.
• Humiliation: This involved verbal humiliation, gagging, face slapping, flagellation, etc. Heterosexuals were more likely than gay men to engage in these types of activity.
• Physical restriction: This included bondage, use of handcuffs, use of chains, wrestling, use of ice, wearing straight jackets, hypoxyphilia, and mummifying.
• Hyper-masculine pain administration: This involved rimming, dildo use, cock binding, being urinated upon, being given an enema, fisting, being defecated upon, and catheter insertion. Gay men were more likely than heterosexuals to engage in these types of activity.

There are many theories on why people engage in such behaviours from traditional learning theories (based on both operant and classical conditioning) through to psychoanalytic interpretations. Most of these theories place the origins of the behaviour within a developmental framework and argue that the root of the paraphilic behaviour begins in childhood. Somewhere in childhood and adolescence, the individual starts to associate pleasure with pain, and then become sexualized in adulthood.

In a 1995 paper published by the sexologist Kurt Freund and colleagues, they noted there was a distinct difference between commonplace consensual and play-oriented sadomasochistic activities and more dangerous and potentially fatal practices of a small minority of hardcore sadomasochists. As with many paraphilias, sexual masochism would only classified as a mental disorder if it causes significant psychological and physical impairment (that in very extreme circumstances may be life threatening). This has been echoed by Dr Richard Krueger (New York State Psychiatric Clinic, USA) who noted in a 2010 review on the diagnostic criteria for sexual masochism that the main criticisms and concerns surrounding this behaviour (and paraphilias more generally) is that they “should not be included in the DSM because they are not mental disorders, they are unscientific, they are unnecessary, and to do so pathologizes groups who engage in alternative sexual practices” (p.348).

However, in 2006, Dr Charles Moser and Peggy Kleinplatz (Carleton University, Canada) argued in the Journal of Psychology and Human Sexuality that there is no evidence that sadomasochists more often need emergency services “than practitioners of other sexual behaviours” (p. 106), although this has been disputed by others in the field. The review by Dr Krueger concludes that:

“While masochistic and/or sadomasochistic behavior occur with some frequency in the population and is associated with generally good psychological or social functioning, there are a very small number of cases where masochistic fantasy and behavior result in severe harm or even death. These cases clearly indicate a sexual interest pattern that has become pathological. Since so little is know about this behavior, further research is indicated, and inclusion in the DSM would facilitate this” (p.353).

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Alison, L., Santtila, P., Sandnabba, N. K., & Nordling, N. (2001). Sadomasochistically oriented behavior: Diversity in practice and meaning. Archives of Sexual Behavior, 30, 1–12.

Baumeister, R. F. (1988). Masochism as escape from self. Journal of Sex Research, 25, 28–59.

Breslow, N., Evans, L., & Langley, J. (1985). On the prevalence of roles of females in the sadomasochistic subculture: Report of an empirical study. Archives of Sexual Behavior, 14, 303–317.

Crépault, C., & Couture, M. (1980). Men’s erotic fantasies. Archives of Sexual Behavior, 9, 565–576.

Donnelly, D., & Fraser, J. (1998). Gender differences in sado-masochistic arousal among college students. Sex Roles, 39, 391-407.

Freund, K., Seto, M. C., & Kuban, M. (1995). Masochism: A multiple case study. Sexuologie, 4, 313-324.

Hucker, S. J. (2008). Sexual masochism: Psychopathology and theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (pp. 250-263). New York: Guildford Press.

Kinsey, A. C., Pomeroy, W. B., Martin, C. E., & Gebhard, P. H. (1953). Sexual behavior in the human female. Philadelphia: Saunders.

Krueger, R.B. (2010). The DSM diagnostic criteria for sexual masochism. Archives of Sexual Behavior, 39, 346–356.

Moser, C., & Kleinplatz, P. J. (2006). DSM-IV-TR and the paraphilias: An argument for removal. Journal of Psychology and Human Sexuality, 17, 91-109.

Ormerod, D. (1994). Sado-masochism. Journal of Forensic Psychiatry, 5, 123–136.

Paclebar, A. M., Furtado, C., & McDonald-Witt, M. (2006). Sadomasochism: Practices, behaviors, and culture in American society. In E. W. Hickey (Ed.), Sex crimes and paraphilia (pp. 215–227). Upper Saddle River, NJ: Pearson Education.

Person, E.S., Terestman, N., Myers, Goldberg, E.L. & Salvadori,  C. (1989). Gender differences in sexual behaviors and fantasies in a college population. Journal of Sex and Marital Therapy, 15, 187-198.

Sandnabba, N. K., Santtila, P., Alison, L., & Nordling, N. (2002). Demographics, sexual behaviour, family background and abuse experiences of practitioners of sadomasochistic sex: A review of recent research. Sexual and Relationship Therapy, 17, 39–55.

Sandnabba, N. K., Santtila, P., & Nordling, N. (1999). Sexual behavior and social adaptation among sadomasochistically oriented males. Journal of Sex Research, 36, 273–282.

Spengler, A. (1977). Manifest sadomasochism of males: Results of an empirical study. Archives of Sexual Behavior, 6, 441–456.

Dressed to thrill? A brief overview of transvestic fetishism

There is arguably more debate about whether transvestism can be classed as a disorder and/or sexually deviant than any other paraphilia. Transvestism has traditionally been defined as the cross-dressing in clothes worn by the opposite sex for sexual pleasure. However, there are a number of groups of people who may dress themselves in the clothes of the opposite sex but may experience absolutely no sexual arousal whatsoever. Therefore, those who study paraphilic behaviour are more likely to use the term ‘transvestic fetishism’ to describe the small group of people (typically male but there are some documented female cases in the literature) who derive their sexual pleasure from cross-dressing. Therefore, transvestite groups (where the word simply refers to cross-dressing) may comprise:

• Transvestic fetishists who cross-dress for sexual pleasure and that in some cases may involve sexual arousal from a very specific piece of clothing
• Female impersonators who cross-dress to entertain
• Effeminate homosexuals (who may occasionally cross-dress for fun)
• Transexuals who cross-dress because they fell they have been biologically assigned to the wrong sex and typically suffer from a gender identity disorder. It has also been speculated that some transsexuals may be psychologically similar to paraphilias such as apotemnophilia (i.e., the desire to be an amputee)

These different groups show that unlike all other paraphilias (e.g., necrophilia, zoophilia, hypoxyphilia), the motivations for cross-dressing may not necessarily be sexually motivated, and therefore are unlikely to be viewed as either deviant or disordered.

In the World Health Organization’s International Classification of Diseases (ICD-10), transvestic fetishism is defined as “the wearing of clothes of the opposite sex principally to obtain sexual excitement and to create the appearance of a person of the opposite sex”. Similarly, the latest version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines it as “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing”. Interestingly, Dr Kirk Newring (Nebraska Department of Correctional Services, USA) and his colleagues think is possible that future books on sexual deviance will not include transvestic fetishism as a sexual deviance, but rather as a sexual variance.

There have been a couple of relatively large-scale studies of transvestism including that of Dr Richard Docter and Dr Virginia Prince (California State University, USA) who surveyed 1,032 transvestites, and Dr Niklas Långström (Centre for Violence Prevention, Karolinska Institutet, Stockholm, Sweden) and Dr Kenneth Zucker (Centre for Addiction and Mental Health, Toronto, Ontario, Canada) who examined tranvestism in a Swedish community survey of 2,540 adults. This, and other research, has suggested there appear to be at least two distinct sub-groups of transvestic fetishists (‘periodic transvestites’ and ‘marginal transvestites’).

• Periodic transvestites: These transvestites are said to have psychological satisfaction with both their male gender and sexual identity, and with the activity of cross-dressing activity. Furthermore, they have no desire to pursue any other form of feminization.
• Marginal transvestites: These transvestites experience psychological dissatisfaction with their male gender and sexual identity. The sexual arousal experienced from cross-dressing is typically lower than that of periodic transvestites. They may also engage in other feminization activities including hormone treatment, bodily hair removal, and (in extreme cases) surgical reconstruction. Some marginal transvestites may therefore include transsexuals who cross-dress not only for sexual pleasure but also for gender synchrony.

As with many other paraphilic behaviours, there is a relative lack of data and much of it comes from clinical case studies. Based on the published papers, the data suggest that the majority of transvestic fetishists report cross-dressing in secret before the onset of adolescence. As children, cross-dressing may provide excitement and pleasure but the activity is unlikely to be particularly sexualized (e.g., clothes that belong to females in the house may trigger and/or facilitate highly pleasurable sensory experiences [such as perfumed fragrances] accompanied by feelings of familiarity and comfort. During adolescence, case study evidence suggests that the act of cross-dressing becomes increasingly paired with sexual urges and arousal (e.g., erections, ejaculation) and in some cases it may lead to thoughts of being female in public or in private.

However, some sexologists have speculated that the transvestic behaviour develops via classical conditioning after an accidental exposure to female clothing or a female undressing. Similarly, it has also been suggested transvestic behaviour may be negatively reinforced when it is used as a means coping during times of emotional distress (for instance, a number of studies have reported high rates of parental separation during transvestic men’s childhood). The etiology of transvestism appears to be similar to other paraphilic behaviours (i.e. early conditioning experiences) although there are case studies of parental punishment by humiliation of wearing girls’ clothes leading to transvestism. According to Dr Kenneth Zucker and colleagues such separation may explain the need for transitional objects that many children eventually develop.

Smaller scale studies carried out in the 1970s to the 1990s reported that transvestites were more likely to be heterosexual and married. In 2005, Långström and Zucker’s study of 2,450 Swedes appeared to confirm these earlier findings. The archetypal transvestite was reported as being in his mid-30s, in a steady relationship and having at least one child. Perhaps surprisingly, there were no major socio-demographic differences between transvestic males and non-transvestic males. In Långström and Zucker’s study, nearly 3% of males (n=36) and 0.4% of females (n=5) reported sexual arousal from cross-dressing at least once. The transvestic behaviour occurred more in heterosexual males (85.7%, n=35). This finding was similar to findings of Docter and Prince’s large-scale study of 1,032 transvestites where up to 89% transvestic males identified themselves as heterosexual. Findings from small-scale studies indicate that most men do not tell their wives prior to marriage and when the wives do find out, they tend to tolerate it rather than support it.

Långström and Zucker also examined the co-occurrence of other paraphilic behaviours. The transvestic men were more likely than non-transvestic men to report sexual sadism and/or masochism, exhibitionism, and voyeurism. In a 1981 study of 222 transvestic males, Buhrich and Beaumont reported high rates of bondage fantasies while dressed in women’s clothing. However, over time and into middle age, sexual desires may diminish but the cross-dressing may remain (and therefore would no longer be classed as transvestic fetishism). Most transvestites do not seek professional help (as they do not experience any distress associated with their behaviour) and even with therapy it is unlikely the behaviour will be altered if the person wants to carry on cross-dressing.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Buhrich, N. (1978). Motivation for cross-dressing in heterosexual transvestism. Acta Psychiatrica Scandinavica, 57, 145–152.

Buhrich, N., & Beaumont, T. (1981). Comparison of transvestism in Australia and America. Archives of Sexual Behavior, 26, 589–605.

Docter, R. F., & Prince, V. (1997). Transvestism: A survey of 1032 cross-dressers. Archives of Sexual Behavior, 26, 589-605.

Långström, N., & Zucker, K. J. (2005). Transvestic fetishism in the general population: Prevalence and correlates. Journal of Sex and Marital Therapy, 31, 87-95.

Moser, V. & Kleinplatz, P.J. (2002). Transvestic fetishism: Psychopathology or iatrogenic effect? New Jersey Psychologist, 52(2), 16-17.

Newring, K.A.B. Wheeler, J. & Draper  (2008). Transvestic fetishism. Assessment and theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (Second Edition) (pp.285-305). New York: Guildford Press.

Stoller, R. J. (1971). The term, “transvestism.” Archives of General Psychiatry, 24, 230–237.

Sullivan, C.B.L., Bradley, S.J., & Zucker, K.J. (1995). Gender identity disorder (transsexualism) and transvestic fetishism. In V. B. Van Hasselt & M. Hersen (Eds.), Handbook of adolescent psychopathology: A guide to diagnosis and treatment (pp. 525–558). New York: Lexington Books.

Wheeler, J. Newring, K.A.B. &  Draper, C.  (2008). Transvestic fetishism. Psychopathology and Theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (Second Edition) (pp.272-284). New York: Guildford Press.

Zucker, K.J., & Blanchard, R. (1997). Transvestic fetishism: Psychopathology and theory. In D. R. Laws & W. T. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (First Edition) (pp. 253-279). New York: Guilford Press.

The stranglers’ greatest hit: A brief overview of autoerotic asphyxiation

Hypoxyphilia (more commonly known as ‘autoerotic asphyxiation’ and less commonly known as ‘asphyxophilia’) is a rare and potentially life threatening paraphilia where a person seeks to reduce supply of oxygen to the brain during a heightened state of sexual arousal. Restricting the oxygen flow causes a build of carbon dioxide. This increase in carbon dioxide brings about feelings of giddiness and pleasure which when accompanied by masturbation can heighten the sexual sensations. Typically, this is achieved by chain, leather belt, rope noose or plastic bag either alone or with a partner and often results in death. Deaths occur due to the loss of consciousness caused by partial asphyxia. High profile deaths (by hanging) have included the Australian INXS singer Michael Hutchence, the US actor David Carradine, and the English MP and television reporter Stephen Milligan.

Although asphyxia from hanging has been described most frequently, a review of autoerotic asphyxiate deaths by Dr Roger Byard (Adelaide Women and Children’s Hospital, Australia) concluded that a wide variety of other lethal situations have been reported. Other hypoxyphilia variants that have been reported include: the use of plastic bags, chemical substance, food, electrocution, water submersion, and power hydraulics, etc.

There is some disagreement as to how common such deaths are. The American Psychiatric Association estimates that one in a million deaths are caused this way. The American FBI estimates there to be a mortality rate of 1000 deaths per year in the States. In a review of the literature, Dr Jane Uva (Wright State University, USA) estimated the mortality rate as being anywhere between 250 and 1000 deaths per year in the United States. Most hypoxyphiliacs are male with one Canadian study published in the British Journal of Psychiatry reporting only one of 117 accidental hypoxyphilic deaths as involving a female. In general, hypoxyphiliacs are white middle-aged males, although there are cases in literature of women or men up to 87 years of age.

There is limited data available but the goal seems to be to increase orgasm intensity. This bears some relationship with those who use amyl nitrate (which reduces brain oxygenation). It has been said that this type of behaviour may be a dangerous variant or manifestation of sexual masochism with its ritualised bondage themes. The person often keeps diaries and may watch themselves in mirrors or video record themselves. A German study of 40 accidental autoerotic deaths published in the journal Forensic Science International, reported that the bodies of hypoxyphiliacs are typically discovered naked and/or with genitalia in hand. Pornographic and/or other paraphilic material and/or sex toys are often present. Furthermore, the individuals will have ejaculated shortly before their death. The literature also shows that hypoxyphilia has also been associated with other paraphilias including masochism, transvestitism, bondage, and fetishism.

In one of the few studies of hypoxyphiliacs that are still alive, Dr Stephen Hucker (University of Toronto, Canada) surveyed over 100 participants via the Internet. He reported that 71% engaged in various masochistic activities, and 31% also took sadistic roles. Furthermore, 66% reported using bondage, 44% used clamps on themselves, 14% used electrical stimulation, and 37% self-flagellated. With regards to the act itself, the highest level of arousal was reported to be to obstruction of breathing. However, loss of control and loss of consciousness were also important in increasing sexual arousal. The lowest sexual arousal ratings were for pain and humiliation.

Finally, a recent review – again written by Hucker – in relation to the new DSM-V paraphilia classification, he surveyed over 100 practitioners who have expertise in treating paraphilic activity. Hucker recommended that the term ‘hypoxyphilia’ should be abandoned in favour of the term ‘asphyiophilia’ as there is little empirical evidence to indicate that the effects of oxygen deprivation per se are the primary motive for the paraphiliiac’s behavior. He argued that the behaviour is sexual arousal to restriction of breathing.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

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, 148-152

Blanchard, R. & Hucker, S.J. (1991). Age, transvestism, bondage, and concurrent paraphilic activities in 117 fatal cases of autoerotic asphyxia. British Journal of Psychiatry, 159, 371-377.

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, 64-73

Burgess, A.W. & Hazelwood, R.R. (1983). Autoerotic deaths and social network response. American Journal of Orthopsychiatry, 53, 166-170

Byard, R. (1994). Autoerotic death — characteristic features and diagnostic difficulties. Journal of Clinical Forensic Medicine, 1, 71-78.

Cooper, A. J. (1996). Auto-erotic asphyxiation: Three case reports. Journal of Sex and Marital Therapy, 22, 47–53.

Hucker, S.J. (2008). Sexual masochism: Psychopathology and theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment. pp.25-263. New York: Guildford Press.

Hucker, S.J. (2011). Hypoxyphilia. Archives of Sexual Behavior, 40, 1323-1326.

Janssen, W., Koops, E., Anders, S., Kuhn, S. & Püschel, K. (2005). Forensic aspects of 40 accidental autoerotic death in Northern Germany. Forensic Science International, 147S, S61–S64.

Martz, D. (2003). “Behavioral treatment for a female engaging in autoerotic asphyxiation”. Clinical Case Studies, 2, 236–242.

Tough, S., Butt, J. & Sanders, G. (1994). Autoerotic sexual asphyxial deaths: Analysis of nineteen fatalities. Canadian Journal of Psychiatry, 39, 157-160.

Uva, J.L. (1995). Review: Autoerotic asphyxiation in the United States. Journal of Forensic Sciences, 40, 574–581.