Homicidal Neck Compression of Females: Autopsy and Sexual Assault Findings

Abstract

Homicides due to neck compression have been noted to commonly occur with sexual assault motives. We reviewed all female homicides in which the cause of death involved neck compression, smothering, and/or asphyxia. Medical examiner records included autopsy, toxicology, and investigators’ reports. There were 78 homicides: age from 8–81 years (mean 35 years). The causes of death involved: 68 neck compressions, eight smotherings, and two homicidal asphyxias. Of the deaths caused by neck compression: 93% had injury of the soft tissues of the neck, 80% had external neck injury, 79% had petechiae of the eyes/face, and 28% had a fractured hyoid and/ or thyroid cartilage. Three decedents (4%) had no external injury or petechiae but did have soft tissue injury on internal examination. There was evidence of recent sexual activity/assault in 34/78 (44%) decedents. Although the majority of deaths due to compression of the neck had evidence of external injury and petechiae, deaths due to compression of the neck can be missed without an internal examination (20% had no external neck injury, and 4% had no external neck injury or petechiae). The absence of external injury or hyoid/thyroid cartilage fracture does not exclude fatal neck compression. The association of recent sexual activity/assault in 44% of the decedents supports the common forensic maxim to consider sexual assault (and collect sexual assault evidence) in instances of suspected neck compression/smothering deaths. Similarly, one should suspect neck compression in deaths with evidence of a sexual assault.