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One female and 21 males had died in the course of autoerotic practices (group I, n\u00a0= 22). Nine males and 14 females had performed sexual practices with mutual consent (group II, n\u00a0= 23), and 13 males and 16 females without mutual consent (group III, n\u00a0= 29). The average age in group I was 45.4 years; in group II, 40.6 years; and in group III, 39.2 years. Most of the deceased were found in their own apartments. Forms of stimulation included vaginal, anal, and oral intercourse; insertion of foreign bodies; use of chemical substances; and tools for respiratory depression\/hypoxia. Three cases of death occurred during sexual activities involving bondage and discipline, sadism, and masochism (BDSM). Death due to strangulation was the main cause in group I, whereas intoxications were predominant in group II. Sharp force (eg, knife) was mainly responsible for death in group III. Anogenital injuries were documented in all groups in approximately equal percentages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Implications<\/jats:title>\n                    <jats:p>The cases presented show a high variety of circumstances in which non-natural death connected to sexual activity may occur.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Strengths &amp; Limitations<\/jats:title>\n                    <jats:p>This study presents a large postmortem collection of non-natural death cases with associated sexual activity. As the main limiting factor, it must be stated that mutual consent for a sexual practice or consumption of substances was presumed based on the information provided and a lack of evidence against this assumption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In cases of death associated with sexual activity, medical staff should perform thorough unbiased examinations and documentations. Strangulation and the consumption of stimulants should be classified as life-threatening, pleasure-enhancing techniques. Patients and young people should be informed about these risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.jsxm.2019.07.008","type":"journal-article","created":{"date-parts":[[2019,8,22]],"date-time":"2019-08-22T08:26:35Z","timestamp":1566462395000},"page":"1547-1556","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":10,"title":["Non-Natural Death Associated with Sexual Activity: Results of a 25-Year Medicolegal Postmortem Study"],"prefix":"10.1093","volume":"16","author":[{"given":"Lena","family":"Bunzel","sequence":"first","affiliation":[{"name":"Institute of Legal Medicine at University Hospital, Goethe University , Frankfurt , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah C.","family":"Koelzer","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine at University Hospital, Goethe University , Frankfurt , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Zedler","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine, Justus Liebig University of Gie\u00dfen , Gie\u00dfen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel A.","family":"Verhoff","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine at University Hospital, Goethe University , Frankfurt , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Parzeller","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine at University Hospital, Goethe University , Frankfurt , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,8,22]]},"reference":[{"key":"2023012309523498500_bib1","doi-asserted-by":"crossref","first-page":"995","DOI":"10.3346\/jkms.2006.21.6.995","article-title":"Causes of sudden death related to sexual activity: results of a medicolegal postmortem study from 2001 to 2005","volume":"21","author":"Lee","year":"2006","journal-title":"J\u00a0Korean Med Sci"},{"issue":"Suppl","key":"2023012309523498500_bib2","first-page":"20","article-title":"Unerwarteter Tod\u2013Herzinfarkt und Sexualit\u00e4t aus der Sicht des Rechtsmediziners","volume":"10","author":"Krauland","year":"1976","journal-title":"Sexualmedizin"},{"key":"2023012309523498500_bib3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0379-0738(95)01873-5","article-title":"Stressful events as a trigger of sudden death: a study of 43 medico-legal autopsy cases","volume":"79","author":"Lecomte","year":"1996","journal-title":"Forensic Sci Int"},{"key":"2023012309523498500_bib4","first-page":"330","article-title":"The so-called coition death","volume":"17","author":"Ueno","year":"1963","journal-title":"Jpn J Legal Med"},{"key":"2023012309523498500_bib5","first-page":"44","article-title":"Sudden cardiovascular death during sexual intercourse\u2014results of a legal medicine autopsy study","volume":"88","author":"Parzeller","year":"1999","journal-title":"Z\u00a0Kardiol"},{"key":"2023012309523498500_bib6","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1053\/euhj.2000.2329","article-title":"Sudden cardiovascular death in correlation with sexual activity\u2013results of a medicolegal postmortem study from 1972\u20131998","volume":"22","author":"Parzeller","year":"2001","journal-title":"Eur Heart J"},{"key":"2023012309523498500_bib7","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1385\/FSMP:2:2:109","article-title":"Sudden cardiovascular death associated with sexual activity: a forensic autopsy study (1972-2004)","volume":"2","author":"Parzeller","year":"2006","journal-title":"Forensic Sci Med Pathol"},{"key":"2023012309523498500_bib8","first-page":"339","article-title":"Tod aus nat\u00fcrlicher Ursache bei sexuellen Aktivit\u00e4ten\u2014Ergebnisse einer Follow-up-Mortalit\u00e4tsstudie von 1972\u20132011. 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