The recent headlining report of a 70-year-old man who inserted a fork into his urethra in a misplaced effort to obtain sexual gratification—and who, in the process, unleashed a collective wince heard 'round the world once the x-ray image of his sounding went viral online—shines a light on the lengths some people will go to for an intense erotic high. Many of us might prefer death to the mortification of having to explain to doctors how it came to be that a full-sized dining utensil made its way into our penis, but nonetheless, this individual was fortunate that his dangerous liaison with a fork didn’t end tragically. “Successful removal,” the surgeons could jubilantly declare, “[was] achieved via forceps traction and copious lubrication.” Others in pursuit of extreme sensualism, in all its forms, aren’t always so lucky.

The exact numbers are a matter of some debate, but the pathologists Riazul Imami and Miftah Kemal estimated that, based on record-keeping of such deaths stretching back to 1791, each year, anywhere from 250 to over 500 randy people—across cultures and in every station of society—lose their lives as the result of an episode of autoeroticism gone bad. They note this, incidentally, in a case report about an otherwise normal 57-year-old man who suffered a fatal heart attack while using a vacuum cleaner for … well, let’s just say for ends it wasn’t exactly designed. This particular scene must have been a real head-scratcher for the first responders:

The decedent was naked, leaning against a dining table with his feet on the floor. His testicles, thighs, and buttocks were tightly bound with panty hose. Areas in direct contact with the beater bar (his abdomen, parts of his chest and arms) showed some burn marks. His tongue, which was protruded, was dry and cyanotic. A bottle of wine, some food items, jars of lubricant, a glass of urine, and a wooden table leg laden with fecal material were on the dining room table.

The man’s wife—who admitted that she hadn't had sex with him in the past five years, which might have some relevance here—said she’d stumbled upon her husband once before in a similarly compromising position with the vacuum cleaner. What makes the whole thing even sadder is that, for all his efforts, the fact that no semen was found means his mutinous heart (which showed signs of pre-existing disease) stole from him even the anesthetizing bliss of an orgasm at death.

The vast majority of autoerotic fatalities involve more run-of-the-mill asphyxiations by ligature or hanging. Conspiracy theories abound, but one of the most famous likely victims of “hypoxyphilia,” as psychologists refer to arousal by oxygen deprivation, was the 72-year-old former Kung Fu star David Carradine, who in 2009 was found naked and hanging by a rope in the closet of a hotel room in Bangkok.

So what are the characteristics of those who enjoy incorporating nooses, plastic bags, masks, and chemicals into their self-pleasuring repertoires? First, the psychiatrist Stephen Hucker suggests that “asphyxiophilia” is a more accurate word than hypoxyphilia, since it’s primarily the restriction of breathing, not the subjective effects experienced from a lack of oxygen per se, that appeals most to these individuals. Based on an Internet survey with 115 practitioners (91 men and 24 women) of this breathless habit, Hucker found that most were generally intelligent, successful people who weren’t especially concerned or distressed about their sexuality. A number of revealing trends, however, suggested connections with other “deviant” patterns of arousal.

Seventy-five percent reported using bondage during asphyxiation or at other times, 44% used clips or clamps, 37% reported transvestic fetishism, 17% used electrical stimulation, 64% reported various fetishes, and 35% used flagellation. Seventy-one percent viewed themselves to be masochistic and 36% as sadistic (some endorsed both behaviors) … The overlap with tranvestic fetishism, bondage, and fetishism was consistent with the published literature.

In fact, this very overlap proves useful for forensic investigators in distinguishing accidental autoerotic deaths from more straightforward suicides. After all, when all you’ve got is a naked corpse hanging from a rope, the decedent’s motives are far from clear—perhaps it’s just a suicide victim who wanted to die in his birthday suit and, for whatever reason, decided not to leave a note. Any such ambiguity tends to clear up pretty fast, Hucker points out, once you notice the telltale paraphernalia littering the scene, such as: “clips, clamps, or electrodes on sexually sensitive parts, presence of objects such as dildos, vibrators, broom handles, and so on, in the rectum; ligatures (sometimes in an usually complex arrangement) extraneous to any asphyxiating mechanism; gases, vapors, etc.; whips, paddles, and so on; garments made of plastic, rubber, fur, etc.; and pornographic magazines, photographs, videos, and personal diaries.” Indeed, although the exact details have understandably been kept private, the police were rumored to have ruled out suicide partly on the basis of a cord found wrapped around Carradine’s genitals. (His former wives also attested to his penchant for sadomasochistic sex.)

Perhaps the most bizarre autoerotic death in the past decade is a case of Aqua-Eroticum reported by Anny Sauvageau and Stéphanie Racette in a 2006 issue of Journal of Forensic Sciences. (Believe it or not, I’m not making that term up. "Aqua-Eroticum" was coined in 1984 by S. Sivaloganathan, a pathologist who surmised that a transvestic fetishist found drowned in a river died as the result of an underwater masturbation session gone wrong.) In Sauvageau and Racette's case, the body of a 25-year-old Canadian, whose mother had reported him missing a week earlier, was found floating on a lake in summertime. That last tidbit was relevant to the investigation, given the rather peculiar clothing on the dead young man.

On his head, the victim had a hockey helmet equipped with a safety grid. The garments were composed of a two-piece black snowmobile suit and beige ski boots.

Of course, being found dead in sports gear and inappropriate seasonal attire isn’t grounds for a medical examiner to conclude that a person has perished due to a masturbatory mishap. But there was more. Much, much more…

On top of the black suit, a complex bondage system joining together the waist, knees, and ankles of the victim was observed with meshed metallic chains and straps and accessories usually used for horseback riding … A section of electrical wire was also used at the knees. The whole bondage device was secured at the pubic region by a padlock, consequently maintaining the victim’s legs tightly joined together ... Furthermore, a meshed metallic chain was attached to the hockey helmet and straps were also present at each wrist … Under his winter garments, the victim was wrapped in a transparent plastic jumpsuit covering him from head to toe … secured with duct tape … Another piece of plastic was separately covering the penis… A careful exam of the [whole] system proved that it was possible for a person to install it alone.

Sauvageau and Racette’s suspicions that an incident of botched autoerotism was behind the man’s demise were further supported by other curious materials found at the scene, including several lines of black tubing, a wooden board, an open plastic container, and an inflatable raft. Quite the mystery. But with some old-fashioned deductive reasoning, here’s what the investigators managed to piece together:

The man was [initially] completely underwater, his feet connected to a wooden board by ski bindings. The wooden board was linked to a floating pneumatic boat by an electrical cord. The victim had linked a long black tube from his mouth to an open plastic container floating on the lake, thus creating a device for air supply. The open plastic container allowed air to enter the black tube and get to the victim.

Ingenuity galore, but unfortunately…

… this system presented a major flaw: the victim had to inhale and exhale through the same tube, the latter being too long to allow sufficient air exchange. Thus, the exhaled air in the tube was mostly re-inhaled. This causes a progressive diminution of the oxygen intake as well as a progressive uptake of CO 2. Death was attributed to an accidental asphyxia.

The authors anticipated criticisms that they still hadn’t proved that this man ventured out on the lake alone that day “to excite the venereal appetite” (as the earliest medical mention of sexual asphyxiation described it back in 1836), saying only that the case was consistent with such an interpretation. Yet, Sauvageau and Racette ask us to consider:

If it had only been a misfortune while trying a homemade diving apparatus, then how can one explain the complex bondage, the overdressing in summertime, the body plastic covering a nude body and the elastic plastic piece tied around the penis?

The clincher came later, when the authors were informed that the victim had been affiliated with an “autoerotic practitioner’s association” whose members shared their experiences online. “Thus,” they felt they could safely conclude, “it seems that our case is the second autoerotic fatality occurring in open water [the first being Sivaloganathan's 1984 case] and the first one using a homemade diving apparatus with bondage as a danger enhancer in a masochistic context.”

What's the take-home message? I'm not sure. Perhaps, "no orgasm is worth your life." In fact, sadly, based on forensic analyses, our Aqua-Eroticum man—just like the vacuum fetishist—didn’t even get that in return for all his hard work.

I discuss paraphilias like these, and much, much more, in my new book Perv: The Sexual Deviant in All of Us, which will release on October 8, 2013. Follow me @jessebering (#DailyDeviant). For more on all things deviant, and to find out if I'll be visiting a city near you for the Perv book tour, visit www.jessebering.com.