Shock over reports of actor David Carradine’s sudden death in Thailand was compounded when officials there said he was found hanging with a rope tied around his neck and genitals. Those circumstances have led to speculation that the "Kill Bill" star's death was a case of accidental auto-erotic asphyxiation — death while masturbating and restricting the flow of oxygen to the brain as a means to intensify orgasm.
While the practice may sound bizarre, it is not rare, said Dr. John Hunsaker, associate chief medical examiner for Kentucky, who has studied auto-erotic asphyxiation. He said coroners in just about every county in the U.S. see at least a case a year, although there aren't up-to-date numbers.
The practice is popular among bondage and sado-masochism communities, said Kathryn Ando. The board member of San Francisco’s Center for Sex and Culture did her doctoral thesis on the topic of so-called “breath play”. In her study, she surveyed 350 people who used some form of air restriction. Despite the possible dangers, she said, practitioners can be highly motivated in pursuit of a more intense sexual experience. “It can be trust building and still induce fear in partners,” she said. She meant “fear” in a good way.
While most of her 350 subjects practiced breath play with a partner, the physiological mechanism is no different when one masturbates alone. The idea is to use a noose of some kind, a plastic bag, or a gas like propane, to restrict oxygen from reaching the brain. The induced hypoxic state creates a sense of euphoria that can also intensify orgasm. Some also bind their penises with cord, as Carradine reportedly did, to restrict blood flow and prolong an erection.
The death of the 72-year-old actor, who rose to fame with the 1970s TV series "Kung Fu," immediately triggered comparisons to the 1997 death of Michael Hutchence, lead singer of the Australian band INXS. Hutchence was found hanging in a Sydney hotel and while his death was ruled a suicide, his girlfriend and mother of his child, Paula Yates, insisted it was auto-erotic asphyxiation. In 1994, British officials ruled the death of Parliament member and former BBC reporter Stephen Milligan to be consistent with an auto-erotic misadventure.
According to Hunsaker, auto-erotic asphyxia deaths typically occur because somebody made a miscalculation. Often, he said, the apparatus is some form of a noose “with various components. Once the individual appreciates that it is getting to be dangerous, they can kick it, or pull on it to release the noose. But sometimes the apparatus is incorrectly designed, the release mechanism did not work, or the individual lost consciousness before he or she could do anything.”
In a study of 16 Kentucky deaths between 1993 and 2001, Hunsaker and colleagues found that of 13 victims who still had a ligature around their necks at the time of autopsy, 11 of them had configured a slipknot meant to be tugged to release the pressure. One end of the rope was then tied around the wrist in two of these people in an attempt to create a fail-safe mechanism.
At least three subjects had used the technique over a long period of time until something went wrong.
Families grapple with stigma
For families of people who die from auto-erotic asphyxiation, or AEA, the shock of grief is compounded by disbelief.
“The thing that’s probably the hardest is that you learn about a side of a person who didn’t know about,” said Keith Clarke, 40, of Raleigh, N.C.
His brother, Kevin, a salesman, died in 2007 at age 34. Like Carradine, Kevin Clarke was discovered naked in a hotel room. He had used a belt tied to a closet rail to choke himself while viewing pornography. Police told the Clarke family to say the death was a suicide, in order to avoid stigma. At the funeral home, the staff said they’d seen several similar cases already that year, Keith Clarke said.
Don't miss these Health stories
More women opting for preventive mastectomy - but should they be?
Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.
- Larry Page's damaged vocal cords: Treatment comes with trade-offs
- Report questioning salt guidelines riles heart experts
- CDC: 2012 was deadliest year for West Nile in US
- What stresses moms most? Themselves, survey says
- More women opting for preventive mastectomy - but should they be?
He and his wife, Lisa, 41, decided to speak out about the issue, even creating a Web site for friends and family members of other victims: www.hark4KC.com.
“People who practice AEA have so much shame around them and we wanted to help do away with that shame,” she said.
Roots in 'choking game'
Some auto-erotic deaths have roots in the “choking game,” a blackout game often played by adolescents who strangle themselves looking for a “woozy, floaty feeling,” said Kate Leonardi. She’s a St. Augustine, Fla., woman who created the DB Foundation in 2006 to raise awareness about the issue after the death of her 11-year-old son, Dylan.
As they mature, teens and adults may add a sexual component to the ritual, often in hopes of enhancing the climax, Leonardi said.
But deaths related to autoeroticism can be especially difficult for families left behind.
“It’s got a shame stigma to it, that there was some sort of perverse, underground activity going on,” she said.
“I think it makes it increasingly more difficult.”
Families often feel a combination of anger and shame at older victims. Unlike children, teens and adults know they’re taking a risk for the sake of a sexual thrill.
Cases have been reported around the world, including Turkey, Bulgaria and Canada, among other places. Most victims are men.
In Canada, one report notes, “a 34-year-old man died due to asphyxia, secondary to body wrapping in the largest and most complex plastic bag ever involved in a published case of auto-erotic death.”
The taboo, yet tragic-comic, aspect of auto-erotic choking means that many people who do it never speak of it and so have no safe outlet other than their own makeshift means. This is why, according to Ando, clients often request breath play from dominatrices.
But breath play is more common than most of us think. Many couples, for example, may try to create the same effect, Ando said “but are not calling it breath play. One of the points in my study was that in talking to people who teach human sexuality in colleges, their students say ’Oh my God, that is sick! I would never do that. I just like to choke my girlfriend.’”
But even when breath play involves a partner, she said, it can still be dangerous, even exacerbating unknown medical problems. “That’s when you get people saying, ‘Oh, I didn’t realize my partner had a heart condition.’”
© 2013 msnbc.com. Reprints