In autoerotic asphyxiation, the line between pleasure and death is almost nonexistent.
Using nooses or plastic bags, hundreds -- if not thousands -- of Americans die each year gasping in search of sexual fulfillment, according to Dr. Park Dietz, a forensic psychiatrist who has studied the deaths.
"This is not to be tried at home," he said. "There is a risk of death or permanent brain damage. Which is why most people in the S&M community suggest one only do this with a partner."
The idea that loss of oxygen can enhance an orgasm is false, said a New York S&M instructor.
Instead, the pleasure is derived from the excitement about the act itself, he said.
"I did AE. I noosed myself as a teenager, and I am extremely lucky to be alive," he said.
"Someone who has had a great deal of experience with surviving self-hanging [can still] suddenly make a fatal error -- usually putting the ligature in the wrong place," the S&M teacher said.
"Or as simple as doing it while having alcohol on board, or doing it when one is at risk of a heart attack."