Scientists have found that non-natural deaths associated with sexual activity occur in a variety of scenarios, experts report.

Their recent Journal of Sexual Medicine study provided an overview of such deaths in Germany.

“These cases are not limited to autoerotic fatalities or sexual homicides and seem to be much more complex than natural deaths connected to sexual activity,” they wrote.

The researchers examined autopsy reports, along with available police and court records, for 74 non-natural sex-related deaths occurring between 1993 and 2017. These deaths represented 0.45% of all autopsies performed at the Institute of Legal Medicine in Frankfurt during that time period.