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Fatal outcomes while participating in BDSM activities occur. The aim of this literature review is to give a better insight into potential dangerous BDSM play by summarizing published data on BDSM fatalities. A literature search was conducted. It was searched for non-natural death related to BDSM activity. Seventeen cases were found. The age of the deceased ranged between 23 and 49\u00a0years (mean age 34.9\u00a0years). Strangulation in the course of erotic asphyxiation was the most common cause of death (88.2%). In 13 cases, a toxicology report for the deceased was mentioned, of which in eight cases (61.5%) toxicology analysis was positive. In four of these cases, the BDSM partner was also tested positive with the same substance. Drugs or alcohol was involved in 64.3% of fatal BDSM play. In nine cases, the level of experience in BDMS activity of the deceased and the partner was described, and in all of them, the deceased and the partner were not new to BDSM play. Fatal outcomes of BDSM plays are rarer than autoerotic fatalities and natural deaths related to sexual activities. Safeguards and education on medical aspects exist in the BDSM communities. If they are followed by the practitioners, the risks of BDMS play can be reduced. Cases of non-natural death connected to BDSM are rare incidents and can be prevented.<\/jats:p>","DOI":"10.1007\/s00414-021-02674-0","type":"journal-article","created":{"date-parts":[[2021,8,12]],"date-time":"2021-08-12T02:02:36Z","timestamp":1628733756000},"page":"287-295","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["How safe is BDSM? 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