Columns / Discourse / May 6, 2015

A rush of blood to the head

The focus of this week’s risky sex column is autoerotic asphyxiation (AEA), or the practice of controlled hypoxia while masturbating. Those who engage in such behavior assert that the restriction of oxygen supply to the brain (via choking devices such as nooses, plastic bags and wetsuits) produces feelings of giddiness, lightheadedness, and exhilaration that heightens the experience of orgasm. Though neuroscience has more or less debunked this claim, the practice is still widespread enough to attain erotic legitimacy: asphyxiation has been part of the sex worker’s repertoire for centuries, and AEA has been described in the scientific literature as early as the 1600s.

The most respected etiologic theories of this behavior rely on psychoanalytic concepts such as psychosexual development (not to mention the death drive); a particularly prominent conceptualization of AEA (and other paraphilias, a defining feature of which is childhood onset) is that of separation anxiety. Specifically, this theory holds that breastfeeding involves both pleasure (good visceral feelings) and suffocation (hypoxia induced by clinging to the nipple); the two sensations become associated and ultimately reinforced through a process of classical conditioning. Other speculations pertaining to origins include pursuit of an erotic taboo (AEA is practiced in secret, away from the prying eyes of society), and desire for that which is potentially fatal. The latter reason will be given the most weight today, as it upholds the risky sex paradigm discussed in the previous two columns.

Though it’s difficult to get a handle on prevalence rates of AEA, as the behavior is performed out of sight, psychologists and clinicians estimate that between 500-1000 Americans per year execute this behavior unsafely enough to die from it. As the actual number of devotees is indubitably higher, researchers like yours truly are faced with an identification problem: are those who die from AEA truly representative of AEA habituees? This confusion begs an additional question: are those who die the most enthusiastic and frequent practitioners, or just the newest and most naive? Furthermore, how big of a role does the possibility of termination play in this sex act, and what does it mean that most AEA victims (and, perhaps, practitioners) are young, otherwise non-paraphilic heterosexual men without obvious suicidal ideation?

To begin uncovering what we don’t know, let’s take a look at what we do, i.e., the demography of AEA victims and the testimonies of AEA practitioners in treatment. Ironically, those whose AEA preference is uncovered in therapy may be less “sick” than those who perish from the practice, as the former often exhibit pervasive psychopathology, of which AEA is but one of many manifestations. At any rate, the combination of case studies and fatalities can generate a picture of who exactly is choking and stroking, and what exactly they’re getting out of it, aside from the aforementioned rush of blood to the head.

By and large, autoerotic behavior is practiced by adolescent males; one study found the average age of death from AEA to be 26. Aside from the sexually appetitive elements of AEA, researchers have unearthed a thrill-seeking component to the behavior; this would explain the prevalence of non-sexual “choking games” across cultures and the correlation between youth and AEA, a fundamentally dangerous behavior the sort of which holds great appeal to those members of the population whose sense of invincibility is inflated and whose fondness for macho experimentation is unparalleled.

Although many AEA deaths can be mistaken for suicides, the bodies are often found alongside sex paraphernalia like tissues and porn, suggesting that the motive to asphyxiate is merely to ejaculate. If pleasure is at stake here rather than self-destruction, then AEA only becomes a problem when it leads to premature death. And yet, is that death really so accidental? One cannot deny the appeal of helplessness and self-endangerment, nor can one ignore the resemblance the whole operation plays to the gallows, wherein, as French psychiatrist DeBoismont noted in the 1830s, “30 percent of the males who died by hanging had associated erections or ejaculations …” Furthermore, the use of asphyxia-inducing mechanisms other than nooses reveals a strong relationship between pleasure and death: the leather masks tied tightly at the neck are eerily reminiscent of those worn by executioners. The line between sex and pain, it would appear, is so flimsy as to be nonexistent—particularly when so many AEA deaths occur as a result of a poorly planned escape route. If escape was paramount, one would pay more attention… if life was paramount, one wouldn’t make the escape route so challenging.

Thus, what the AEA devotee seeks is a specifically terminal orgasm: an experience so intense he loses consciousness and becomes literally limp. In this regard, holding one’s breath or being choked out during sex pales in comparison to the pleasures of autoerotic asphyxiation: flirting with death is too good to pass up. Indeed, the bodies of AEA victims sometimes betray evidence of masochism; many of those seeking treatment for masochistic behavior report a preference for AEA as well. In addition, clinicians have noted a link between AEA and sexual transvestitism, or the practice of dressing in women’s clothes; the fact that AEA is an almost exclusively male (read: thrill-seeking) phenomenon calls to mind associations between non-normative sexual behavior (asphyxiation!) and non-normative expression of desire (read: female; read: passive). All these taboos are interwoven, after all—to asphyxiate is to be helpless, is to be, in this society, female. Who wouldn’t want to dress in women’s clothes to hammer the point home! Not only that, the masks mentioned above are fixtures of the gay leather scene, which brings up a whole host of issues relating to homosexuality as an inherently thrill-seeking, self-destructive praxis. But that’s a discussion for next week! Until next time… oh, and, don’t try this at home.

Joy Westerman

Tags:  autoerotic asphyxiation breast feeding death male masturbation risk sex

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