In this section, we consider four additional varieties of noncoercive paraphilias that are generally uncommon or even rare. We begin our discussion by describing auto­erotic asphyxia, a dangerous form of variant sexual behavior. We then offer a few brief comments about three other uncommon noncoercive paraphilias: klismaphilia, copro – philia, and urophilia.

Autoerotic Asphyxia

Autoerotic asphyxia (also called hypoxyphilia or asphyxiophilia) is a rare and life – threatening paraphilia in which an individual, almost always a male, seeks to reduce the supply of oxygen to the brain during a heightened state of sexual arousal (Hucker, 2009; Hucker et al., 2011). The oxygen deprivation is usually accomplished by apply­ing pressure to the neck with a chain, leather belt, ligature, or rope noose (by means of hanging). Occasionally, a plastic bag or chest compression is used as the asphyxiating device. A person might engage in these oxygen-depriving activities while alone or with a partner. Available data indicate that the majority of people who express this para­philia are White males (Sauvageau & Racette, 2006).

We can only theorize from limited data about what motivates such behavior. Peo­ple who practice autoerotic asphyxia rarely disclose this activity to relatives, friends, or therapists, let alone discuss why they engage in such behavior (Garza-Leal & Landron,


An unusual variant of sexual expres­sion in which an individual obtains sexual pleasure from receiving enemas.

1991; Saunders, 1989). For some the goal seems to be to increase sexual arousal and to enhance the intensity of orgasm. In this situation the item used to induce oxygen depri­vation (such as a rope) is typically tightened around the neck to produce heightened arousal during masturbation and is then released at the time of orgasm. Individuals often devise elaborate techniques that enable them to free themselves from the stran­gling device before losing consciousness.

The enhancement of sexual excitement by pressure-induced oxygen deprivation may bear some relationship to reports that orgasm is intensified by inhaling amyl nitrate ("poppers"), a drug used to treat heart pain. This substance is known to temporarily reduce brain oxygenation through peripheral dilation of the arteries that supply blood to the brain.

It has also been suggested that autoerotic asphyxia is a highly unusual variant of sexual masochism in which participants act out ritualized bondage themes (American Psychiatric Association, 2000; Cosgray et al., 1991). People who engage in this practice sometimes keep diaries of elaborate bondage fantasies and, in some cases, describe fan­tasies of being asphyxiated or harmed by others as they engage in this rare paraphilia.

One important fact about this seldom-seen paraphilia is quite clear: This is an extremely dangerous activity that often results in death (Cooper, 1996; Garos, 1994; Hucker, 2009). Accidental deaths sometimes occur because of equipment malfunction or mistakes, such as errors in the placement of the noose or ligature. Data from the United States, England, Australia, and Canada indicate that one to two deaths per 1 million people are caused by autoerotic asphyxiation each year (American Psychiatric Association, 2000; Hucker, 2009; Hucker et al., 2011). The Federal Bureau of Investigation estimates that deaths in the United States resulting from this activity may run as high as 1,000 per year.

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