Sexual asphyxia: a lesser epidemic.

Asphyxiophilia is a paraphilia of the sacrificial/expiatory type in which sexual arousal and the attainment of gratification depend on hypoxia induced through either strangulation, smothering, chest compression and/or the inhalation of volatile substances. A peculiar, auto-erotic variant of this perversion is described, one in which the participant accidently died. Numerous female prostitutes have been canvassed in order to ascertain the prevalence in Durban, Republic of South Africa. The figures are an order of magnitude higher than was hitherto imagined. Insurance companies have been loathe to compensate the beneficiaries of such victims fully. How they and the courts view pivotal concepts such as 'mental infirmity', 'accident', 'natural consequences', and the legitimacy of psychiatry presenting itself as a unified body of knowledge sets precedents, and sets in motion processes whereby these decisions permeate into the general population and become--in time--accepted as norms. Thus, the medicolegal ramifications of sexual asphyxia affect not only the police and the courts, but also our society in general.