Asphyxia & Anogenital Injuries

The term “asphyxia” is derived from the Greek language to mean the absence of a pulse. However, the absence of a pulse is a criterion used to pronounce somatic death from all causes and simply confirms that death has occurred. Asphyxia has come to mean the lack of delivery, or utilization of oxygen in cells. However, lack of tissue oxygenation can be applied to multiple mechanisms and causes of death, such as the respiratory depression that occurs with opioid toxicity, whereby decreased breathing impairs oxygen intake into the body. Opioid-related deaths are usually considered as a toxicological death rather than asphyxial. Further, given the spectrum of findings in asphyxial deaths and the inability to determine oxygen levels in the body at the time of death, the utility of this term is limited. To date, there has been no satisfactory term to replace asphyxia and this has also led to various classifications of asphyxial deaths. Consequently, this term will be used here. Anogenital injuries are covered in this chapter as they can accompany asphyxial deaths but can occur in a variety of settings. Further, there is little written in the medical literature concerning anogenital injuries and they are not commonly observed at autopsies resulting in variable experience among forensic pathologists when confronted with this uncommon entity.