Once thought to be a phenomenon only practiced by men, autoerotic asphyxiation, a form of sexual masochism that is life-threatening, has been documented in women. This case study presents a 22-year-old college female with comorbid depression and avoidant personality disorder complaining of the use of autoerotic asphyxiation during masturbation. This female was a virgin and reported that asphyxiation by use of a ligature had always been used since puberty during masturbation and was necessary for her to obtain orgasm. This behavior was conceptualized within an obsessive-compulsive cycle. Covert systematic desensitization using her written sexual fantasy across 10 psychotherapy sessions was able to neutralize the power of the fantasy to elicit orgasm. Subsequent behavioral deterrents and experimentation with a vibrator enabled this female to reach orgasm without engaging in asphyxiation. Following this success, psychotherapy continued to focus on managing her depression and avoidance tendencies.