The syndrome of self-hanging while masturbating to achieve sexual gratification is known as “sexual asphyxia.” Its origins are obscure, but probably date back to the 1600s. The syndrome accounts for at least 250 deaths per year in the United States alone. Reported victims range in age from 11 to well over 60 years, but most are adolescents. Though typically perceived as happy, well-adjusted people, they are found hanging by the neck, often wearing women's clothing, apparently having died while masturbating. Few living practitioners have been interviewed. The case report of one is presented here. A developmental model is proposed to explicate the differences and similarities between adolescent and adult practitioners.