Sudden Death Following Ingestion of an Unlabeled Sexual-Enhancement Capsule: A Forensic Autopsy Case Report
DOI:
https://doi.org/10.66328/ijprmh.2025.010206Keywords:
Dangerous Sexual Practices, Sexual Enhancement, Sudden Unexplained Death, Novel Psychoactive Substances, AutopsyAbstract
A 28-year-old male was found dead and brought to the emergency department of Guru Nanak Dev Hospital, Amritsar, after being discovered unconscious in a hotel room where he had checked in with a female sex worker. The accompanying witness reported that the decedent ingested an unlabeled capsule claimed to be a sexual-performance enhancer and collapsed prior to any intercourse. Autopsy conducted at Government Medical College Amritsar demonstrated bluish discoloration of the lips, nail beds, and earlobe regions, marked visceral congestion, and deep gastric mucosal congestion with undigested food. Histopathology showed no intrinsic pathology. Toxicological screening was negative for routine poisons. Cause of death was certified as undetermined, with a possibility of unknown poisoning. This case highlights the increasing abuse of unregulated sexual-enhancement agents in Punjab, a region marked by high prevalence of synthetic-drug use. It brings to fore the need for expanding toxicology panels, increased public–patient education, and preventive strategies directed at extreme sexual-pleasure behavior.
References
1. Lee JH, Han JH, Kim S, Kim NS, Yoon CY, Kim J, Baek SY. Screening sexual performance enhancing compounds and their analogues in counterfeit and illicit erectile dysfunction drugs by high-performance liquid chromatography and liquid chromatography-tandem mass spectrometry. Journal of Forensic and Legal Medicine. 2021 Aug 1;82:102224.
2. Pellegrinia M, Concetta Rotolo M, Paolo Busardò F, Pacifici R, Pichini S. Non-allowed pharmacologically active substances in physical and sexual performance enhancing products. Current neuropharmacology. 2017 Jul 1;15(5):724-30.
3. Dandoy C, Gereige RS. Performance-enhancing drugs. Pediatrics in review. 2012 Jun 1;33(6):265-72.
4. Sikka SC. Environment, drugs, and chemical exposures in the realm of human sexuality. InBioenvironmental Issues Affecting Men's Reproductive and Sexual Health 2018 Jan 1 (pp. 459-474). Academic Press.
5. Hausmann R, Hammer S, Betz P. Performance enhancing drugs (doping agents) and sudden death–a case report and review of the literature. International journal of legal medicine. 1998 Jul;111(5):261-4.
6. Ghuman RS, Singh J, Kaur G. Dynamics of drug addiction and abuse in India. Routledge India; 2023 Oct 16.
7. Chiang J, Yafi FA, Dorsey Jr PJ, Hellstrom WJ. The dangers of sexual enhancement supplements and counterfeit drugs to “treat” erectile dysfunction. Translational andrology and urology. 2017 Feb;6(1):12.
8. Yéléhé‐Okouma M, Pape E, Humbertjean L, Evrard M, El Osta R, Petitpain N, Gillet P, El Balkhi S, Scala‐Bertola J. Drug adulteration of sexual enhancement supplements: a worldwide insidious public health threat. Fundamental & Clinical Pharmacology. 2021 Oct;35(5):792-807.
9. Okulevičiūtė A, Chmieliauskas S, Laima S, Vasiljevaitė D, Stasiūnienė J. Deaths during sexual activity. Acta Medica Lituanica. 2024 Feb 27;31(1):54.
10. Untoro E, Widodo PT, Payne-James J. Deaths from Sexual Activity. InForensic and Legal Medicine 2023 Dec 20 (pp. 521-530). CRC Press.
11. Posadzki P, Watson L, Ernst E. Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic reviews. European journal of clinical pharmacology. 2013 Mar;69(3):295-307.
12. Venhuis BJ, De Kaste D. Towards a decade of detecting new analogues of sildenafil, tadalafil and vardenafil in food supplements: a history, analytical aspects and health risks. Journal of pharmaceutical and biomedical analysis. 2012 Oct 1;69:196-208.
13. Wood DM, Dargan PI. Novel psychoactive substances: how to understand the acute toxicity associated with the use of these substances. Therapeutic drug monitoring. 2012 Aug 1;34(4):363-7.
14. Campbell N, Clark JP, Stecher VJ, Thomas JW, Callanan AC, Donnelly BF, Goldstein I, Kaminetsky JC. Adulteration of purported herbal and natural sexual performance enhancement dietary supplements with synthetic phosphodiesterase type 5 inhibitors. The journal of sexual medicine. 2013 Jul;10(7):1842-9.
15. Hilal MA, Radwan RA, M Mohamed K, Aref H. Chemistry, Pharmacology and Toxicology of New Designer Drugs-A Comprehensive Review. Sohag Medical Journal. 2017 Jan 1;21(1):205-14.
16. Lai KC, Liu YC, Tseng MC, Lin JH. Isolation and identification of a sildenafil analogue illegally added in dietary supplements. Journal of Food and Drug Analysis. 2006;14(1):15.
17. Tyagi S, Singh J, Manzoor A, et al. (December 18, 2025) Global Patterns of Fatalities With Toxicological Detection of Novel Psychoactive Substances: A Systematic Review and Meta-analysis. Cureus (December 18, 2025) 17(12): e99586. doi:10.7759/cureus.99586
18. Saukko P, Knight B. Knight’s Forensic Pathology. 4th ed. CRC Press; 2015.
19. Harmon KG, Asif IM, Maleszewski JJ, Owens DS, Prutkin JM, Salerno JC, Zigman ML, Ellenbogen R, Rao A, Ackerman MJ, Drezner JA. Incidence, etiology, and comparative frequency of sudden cardiac death in NCAA athletes: a decade in review. Circulation. 2015 May 14;132(1):10.
20. Ash-Bernal R, Wise R, Wright SM. Acquired methemoglobinemia: a retrospective series of 138 cases at 2 teaching hospitals. Medicine. 2004 Sep 1;83(5):265-73.
21. Al Ibrahim AH, Ghallab KQ, Alhumaid FI, Almahfoudh HH, Almadan AJ, Al Eid MA, AlMishqab MH, Alsaffar MF, Aljamea JH, Ghallab K, Alhumaid Jr F. A systematic review of sildenafil mortality through the years. Cureus. 2022 Dec 4;14(12).
22. Cannaert A, Stove C. Activity-based detection of new psychoactive substances in biological matrices. Drug Test Anal. 2021;13(1):84–92.
