35 votes

On the increased popularity and serious risks of choking during sex

23 comments

  1. [2]
    patience_limited
    (edited )
    Link
    Rule #1 of kink (and perhaps, sex in general...) - never do anything that has the remotest chance of causing physical or mental harm without a previously agreed-upon means of communicating "stop...

    Rule #1 of kink (and perhaps, sex in general...) - never do anything that has the remotest chance of causing physical or mental harm without a previously agreed-upon means of communicating "stop right now". Safe word or safe gesture/noise. Martial arts tap-out, tape a bell or air horn to a body part that can operate it if you have to... There must be a method of not just withdrawing consent, but indicating a potential emergency.

    Of course there's no consensus for providing sex education about consent, safety, self-confidence, first aid, trust, boundaries, communication... I learned more from the lesbian BDSM community in an hour than anyone is likely to hear in a school sex ed class or a year's worth of online porn.

    26 votes
    1. slade
      Link Parent
      Rule #2: forget everything you see in porn.

      Rule #2: forget everything you see in porn.

      18 votes
  2. [13]
    boxer_dogs_dance
    Link

    Necks are alarmingly fragile. Blocking the jugular vein requires less pressure than opening a can of Coke. Evidence suggests that strangulation is now the second most common cause of stroke in women under 40. According to one piece of sobering research, it’s more dangerous than the torture known as waterboarding, because strangulation affects blood flow as well as airflow. Though some cases can cause loss of consciousness in seconds and death in minutes, in others consequences can be delayed by weeks. It can cause a change in voice, difficulty swallowing, incontinence, seizures, problems with memory, decision-making and concentration, depression, anxiety, miscarriage.

    17 votes
    1. patience_limited
      (edited )
      Link Parent
      I have a minor bone to pick with the cited statistics on choking - the linked stroke study was based on research about partner injury in the context of reported domestic violence. This isn't the...

      I have a minor bone to pick with the cited statistics on choking - the linked stroke study was based on research about partner injury in the context of reported domestic violence. This isn't the same situation as kids generally imitating something they've seen in online porn, except for the ones bent on violence and rape in the first place.

      The data on hypoxic brain damage from consensual choking is alarming enough that I don't dispute the need for better education at all, but moral panic based on exaggerated claims is never helpful. The statement "a person cannot consent to being harmed for the purpose of sexual gratification" in the description of the Domestic Abuse Act is so general that I can see real injustice resulting from innocent and essentially normal consensual sex acts.

      35 votes
    2. [8]
      chocobean
      Link Parent
      We need to urgently spread this message to as many young people as possible. Urgently. more controversial opinion follows. At the risk of being labelled sex negative, I hope society eventually...

      The samples from the women who’d been strangled showed elevated levels of S100B, a marker of brain damage.

      “There’s no safe way to do it, no safe quantity of blood or oxygen you can cut off from her brain for fun,” [...]

      Although, for most, their first experience had involved no prior discussion – including one who was having sex for the first time

      We need to urgently spread this message to as many young people as possible. Urgently.

      more controversial opinion follows.

      At the risk of being labelled sex negative, I hope society eventually move to a model where, until two (or more) people are sitting down sober with all their clothes on discussing having vanilla sex for the first time, it is automatically assumed that no sex at all will be happening and nobody is pressured to "make a move" or to anticipate their partner will be "making a move". First time with a partner sex cannot be spontaneous: one cannot assume safety at the hands of a stranger, and one cannot assume a known partner to understand safety and consent without prior discussion. It will be too late to discuss boundaries and understanding of safety when folks are already in the middle of a brain damage inducing or lethal act that takes less effort than opening a can of coke.

      And that until another such sober clothes wearing, detailed discussion about kink happens, it is automatically assume that no kink at all will be happening and nobody is to suggest or assume or to bring up or initiate a kink during sexual encounters.

      19 votes
      1. Moonchild
        Link Parent
        explicit communication is one tool among many that you can use to establish trust. it's not like it's hard for people to lie or misunderstand, and you absolutely can assume all sorts of things...

        one cannot assume a known partner to understand safety and consent without prior discussion

        explicit communication is one tool among many that you can use to establish trust. it's not like it's hard for people to lie or misunderstand, and you absolutely can assume all sorts of things about people without their explicitly saying them—you have to. it feels very reductionist to say that thou canst only negotiate by such-and-certain means, and everything else is Bad Communication or Too Risky (for whom?)

        29 votes
      2. [6]
        patience_limited
        Link Parent
        I don't think your stance is sex-negative at all. I kind of came of age in the radically sex-positive feminist early 1990's, and what you've described is what was discussed as optimal sex...

        I don't think your stance is sex-negative at all. I kind of came of age in the radically sex-positive feminist early 1990's, and what you've described is what was discussed as optimal sex communication at the time. But I'll emphasize the "feminist" part, because much of the discussion was led by women who didn't expect men to "just know" what was pleasurable for women, who had no means of establishing trust and safety besides face-to-face conversations.

        Tinder, Hinge, etc. and online porn have created unrealistic expectations for safety - it's not an Uber ride or a set of norms and values which should be imitated.

        12 votes
        1. [5]
          balooga
          Link Parent
          From an informed, sex-positive standpoint, I think that participants having dispassionate straight talk about consent and boundaries and safety before beginning is chef’s kiss. Fully on board with...

          From an informed, sex-positive standpoint, I think that participants having dispassionate straight talk about consent and boundaries and safety before beginning is chef’s kiss. Fully on board with that.

          But I don’t think it’s realistic. We’re animals. We have hormones and pheromones and impulses. It may be ideal to suppress all that, but I think it’s naive to expect society to willingly do so en masse.

          Honestly I don’t know what the dating / hookup scene is like these days. I’ve been monogamously married for decades, from long before Tinder and the rest. If these apps are basically Uber for sex (as opposed to romance/dating services) then that’s actually a great context for these consent conversations to be normalized. Because everybody’s already up-front about what they’re there for. But if the range of expectations becomes broader and more ambiguous, then that becomes a much bigger ask.

          11 votes
          1. [4]
            patience_limited
            Link Parent
            It isn't about suppressing hormones and pheromones and impulses, but creating a context for releasing them in a way that's maximally pleasurable and minimally harmful to partners in sex. Most...

            It isn't about suppressing hormones and pheromones and impulses, but creating a context for releasing them in a way that's maximally pleasurable and minimally harmful to partners in sex. Most people want good things for each other, to be well regarded, and to participate in loving relationships, even when they're painfully horny. I don't think it's unreasonable to teach kids about boundaries, consent, etc. before they're storming with hormones, and let them practice talking about their feelings and concerns. But in the spirit of realism, reason and ignorance/religious shaming are at odds. I'll agree that there just aren't enough people confident of what they do/don't want to sit down and frankly, effectively negotiate sex in advance.

            I also haven't looked at hookup apps myself - I don't know if you can filter on preferences, boundaries, or predefine consent before you even start a chat. Considering that they don't even block known predators, I'd think that sex ed these days should probably include training in online safety.

            8 votes
            1. [2]
              krellor
              Link Parent
              I mean, the idea of teaching kids and having it work is "a tale as old as time." You can teach kids and give them space to talk, but they won't really learn, have confidence, or be able to have...

              I mean, the idea of teaching kids and having it work is "a tale as old as time." You can teach kids and give them space to talk, but they won't really learn, have confidence, or be able to have mature conversations until they awkward their way through a half dozen situations or so, at least.

              I think teaching kids is helpful because it gives them a backdrop against which to compare their lived experiences against. But even as an old married monogamous guy, I remember my first forays into dating. No amount of prep or logic can offset the hormones or emotions. All you can do is give them a backdrop for comparison and a moral compass and let them find their path.

              10 votes
              1. patience_limited
                Link Parent
                Agreed - my beginning fumbles were a complete abandonment of the Reason Titanic after running into the icebergs of lust and embarrassment. It's no surprise that kids are waiting longer or avoiding...

                Agreed - my beginning fumbles were a complete abandonment of the Reason Titanic after running into the icebergs of lust and embarrassment. It's no surprise that kids are waiting longer or avoiding sex altogether these days because they are communicating more with each other about how fraught it is.

                3 votes
            2. chocobean
              Link Parent
              Agreed on sex ed. Maybe even just part of non sexual phys ed: airways are fragile; people being tied up improperly can cause nerve damage; putting fire crackers in your butt has severe...

              Agreed on sex ed. Maybe even just part of non sexual phys ed: airways are fragile; people being tied up improperly can cause nerve damage; putting fire crackers in your butt has severe consequences; things slide a lot better with lubrication; how to do dumb "jackass" type stuff safely...etc etc

              4 votes
    3. [3]
      Weldawadyathink
      Link Parent
      I know the water boarding example is there for the shock value, but isn’t that kinda obvious? The whole point of torture is not to kill the person, it’s to make them suffer. Given two forms of...

      I know the water boarding example is there for the shock value, but isn’t that kinda obvious? The whole point of torture is not to kill the person, it’s to make them suffer. Given two forms of torture that cause the same quantity of suffering, but one places the person at a higher risk of death, you would choose the safer one every time. I would guess that many daily activities besides erotic asphyxiation are far more dangerous than waterboarding. As the saying goes, dead men tell no tales.

      6 votes
      1. CannibalisticApple
        Link Parent
        I think it does an effective job at emphasizing that choking is lethal though. Pretty sure the people who need this message most aren't thinking about it in terms of torture and lethality.

        I think it does an effective job at emphasizing that choking is lethal though. Pretty sure the people who need this message most aren't thinking about it in terms of torture and lethality.

        1 vote
      2. slade
        Link Parent
        Yeah, I had the same thought. It was kind of a silly thing to add to the point.

        Yeah, I had the same thought. It was kind of a silly thing to add to the point.

  3. [5]
    Gaywallet
    Link
    This is obviously a piece meant purely to evoke emotion, rather than examine anything factual, as it starts off with an anecdote about someone who has a "tinder situation" open up with "can I come...

    This is obviously a piece meant purely to evoke emotion, rather than examine anything factual, as it starts off with an anecdote about someone who has a "tinder situation" open up with "can I come over and rape you?" Simply put, I find this article extremely dismissive. "There is no safe way to do it" is nonsense, and the author jumps to conclusions not supported by the evidence. One of the first pieces of evidence they link to is a pre-print, meaning it has not gone through any review. I have personally found that people linking to pre-prints to be a huge red flag, as they are usually trying to wrap up their idea in the guise of scientific credibility. They then go on to cite interviews with women who dealt with choking during sex in a non-consensual matter and how that was harmful to them - talking about non-consensual acts and framing it as "the risks of choking during sex" is clearly not any review in good faith.

    13 votes
    1. [4]
      boxer_dogs_dance
      (edited )
      Link Parent
      You inspired me to dive into the PubMed database. The reference I found that mentioned stroke subsequent to choking came from an article discussing choking from domestic abuse and sexual violence....

      You inspired me to dive into the PubMed database. The reference I found that mentioned stroke subsequent to choking came from an article discussing choking from domestic abuse and sexual violence.

      However it looks like researchers are starting to examine what the effects might be from consensual choking.
      This article was interesting I thought:. https://pubmed.ncbi.nlm.nih.gov/37459254

      Brain Behav
      . 2023 Aug;13(8):e3160. doi: 10.1002/brb3.3160. Epub 2023 Jul 17.
      Structural brain morphology in young adult women who have been choked/strangled during sex: A whole-brain surface morphometry study
      Jiancheng Hou 1 2, Megan E Huibregtse 2 3, Isabella L Alexander 2, Lillian M Klemsz 2, Tsung-Chieh Fu 4 5, Molly Rosenberg 6, James Dennis Fortenberry 7, Debby Herbenick 4 5, Keisuke Kawata 2 8

      Abstract
      Introduction: Being choked/strangled during partnered sex is an emerging sexual behavior, particularly prevalent among young adult women. Using a multiparameter morphometric imaging approach, we aimed to characterize neuroanatomical differences between young adult women (18-30 years old) who were exposed to frequent sexual choking and their choking naïve controls.

      Methods: This cross-sectional study consisted of two groups (choking [≥4 times in the past 30 days] vs. choking-naïve group). Participants who reported being choked four or more times during sex in the past 30 days were enrolled in the choking group, whereas those without were assigned to the choking naïve group. High-resolution anatomical magnetic resonance imaging (MRI) data were analyzed using both volumetric features (cortical thickness) and geometric features (fractal dimensionality, gyrification, sulcal depth).

      Results: Forty-one participants (choking n = 20; choking-naïve n = 21) contributed to the final analysis. The choking group showed significantly increased cortical thickness across multiple regions (e.g., fusiform, lateral occipital, lingual gyri) compared to the choking-naïve group. Widespread reductions of the gyrification were observed in the choking group as opposed to the choking-naïve group. However, there was no group difference in sulcal depth. The fractal dimensionality showed bi-directional results, where the choking group exhibited increased dimensionality in areas including the postcentral gyrus, insula, and fusiform, whereas decreased dimensionality was observed in the bilateral superior frontal gyrus and pericalcarine cortex.

      Conclusion: These data in cortical morphology suggest that sexual choking events may be associated with neuroanatomical alteration. A longitudinal study with multimodal assessment is needed to better understand the temporal ordering of sexual choking and neurological outcomes.

      Edit - Here is another study

      Association of blood biomarkers for neural injury with recent, frequent exposure to partnered sexual strangulation in young adult women.
      Huibregtse ME, Alexander IL, Fu TC, Klemsz LM, Rosenberg M, Fortenberry JD, Herbenick D, Kawata K.
      J Sex Med. 2025 May 10;22(5):961-970. doi: 10.1093/jsxmed/qdaf036.
      PMID: 40062485

      Abstract
      Background: "Choking" or partnered strangulation is an emerging and popular sexual behavior that is more often experienced by young women, yet the neurobiological consequences of partnered sexual strangulation remain unclear.

      Aim: The aim of the present study was to assess differences in 5 brain-injury blood biomarkers in young adult women who frequently engaged in sexual strangulation.

      Methods: Young adult women were recruited from a large Midwestern university and assigned to groups based on sexual strangulation experience: (1) at least 4 instances of being strangled by a partner during sexual activities in the past 30 days or (2) no prior experience being strangled by a sexual partner. Choking/strangulation history during partnered sexual activities was assessed using a self-report questionnaire. Blood samples were collected via venipuncture. Data from 32 female participants (median 21.5 years old [IQR 20-24]) were available for analysis: 15 with a history of recent, frequent partnered strangulation exposure and 17 without any history of partnered sexual strangulation.

      Outcomes: Serum levels of 5 blood biomarkers for brain injury were measured using sandwich enzyme-linked immunosorbent assay (S100B) and single-molecule array digital immunoassay (neurofilament light, tau, ubiquitin C-terminal hydrolase L1, and glial fibrillary acidic protein).

      Results: Group differences for the 5 biomarkers were examined using 1-way multivariate analysis of covariance, adjusting for age and alcohol use. We observed a significant multivariate effect of group, Pillai's trace = 0.485, F(5, 24) = 4.235, P = .007, η2 = 0.47. Univariate results indicated that female college students who were recently, frequently strangled during partnered sexual activities exhibited elevated S100B levels compared to their peers who had never engaged in this partnered sexual behavior, F(1,28) = 11.165, P = .002, η2 = 0.29.

      Clinical implications: Engaging in this partnered sexual behavior may elicit neuroinflammation, with unknown long-term consequences for brain health.

      Strengths and limitations: Strengths include the recruitment of a novel population, as this investigation was the first of its kind to examine neurobiological correlates of repetitive exposure to partnered sexual strangulation. Another strength is the panel of 5 blood biomarkers that were assessed, providing information from multiple cell types and pathophysiological processes. Limitations were the relatively small sample size and the cross-sectional design, which prevents causal inference.

      Conclusion: Young adult women with a history of recent, frequent experience being strangled by a sexual partner exhibited higher serum S100B, an astrocyte-enriched protein, compared to their biomarkers, meriting future work to determine a causal mechanism between partnered sexual strangulation and neuroinflammatory processes.

      5 votes
      1. [3]
        Gaywallet
        (edited )
        Link Parent
        Ah yes, the one study that always gets linked as it's arguably the only real study looking into this. It has some serious drawbacks and limitations, but it is the closest thing we have to unbiased...

        Ah yes, the one study that always gets linked as it's arguably the only real study looking into this. It has some serious drawbacks and limitations, but it is the closest thing we have to unbiased research on the subject.

        A few thoughts to chew on with this particular study:

        • The population is college aged women in a particular area. This reduces generalizability. It's also just one study, so take everything with some grain of salt.
        • Strangulation is based on participant recall. Recall is not the best metric, especially when we're dealing with something that theoretically could cause loss of memory. It's also not repeatedly asked to participants, and some participants may be hesitant to share this information, even on a confidential questionnaire.
        • I have never seen a study attempt to quantify coercion in the context of consensual acts. For example - Did they ever experience non-consensual acts with the same partner? Did the partner ever coerce them in other ways? Was it an in the moment situation or pre-planned?
        • With choking in particular, I think it's important to ask questions about the specifics of the act - was it about pressure on the neck? Cutting off blood flow? What was the duration of choking? Was the person choking experienced in choking? Have they ever sought education on how to choke safely?
        • It's really hard to control for other factors which might contribute to metrics such as cortical thickening and gyrification, but the authors do address this and recognize some of the usual suspects and address them in a theoretical fashion to explain some findings
        • Ideally we'd have a pre/post measure, but since we are dealing with something that is ethically questionable it's probably not something we should do... however, if we were to recruit people who already engage in consensual choking and simply scan their brain at regular intervals and question them about their habits, we could have much better data which doesn't pose any clear ethical issues

        As an aside: I think there's some serious points to be made about sexual coercion and dangerous acts with individuals who already do not respect someone's autonomy. Those who coerce are much less likely to care about the health of the person they are exerting that coercion on, and in that context strangulation (I use that word here instead of choking because I think it is more about power and the assaulting person's sexual gratification) is a big problem. But trying to modify the behavior of people who are already treating others as objects is a much more difficult problem than trying to teach people who are being coerced or forced into acts of the dangers of an act they didn't really sign up for. I'm not so certain teaching people of the dangers of an act they didn't fully opt into is going to do much except victim blame or make them feel worse about actions done to them without their full consent.

        6 votes
        1. [2]
          boxer_dogs_dance
          Link Parent
          Thanks for your thoughts. I did edit to include a second study before I read this reply. In addition to coercive/antisocial individuals, I also believe there are risks to teens believing that...

          Thanks for your thoughts. I did edit to include a second study before I read this reply.

          In addition to coercive/antisocial individuals, I also believe there are risks to teens believing that breath play is a standard component of sex.

          2 votes
          1. Gaywallet
            Link Parent
            Thanks for finding and including another study! A lot of the same reflections still apply to this study as well, I just want to provide some food for thought when reading through these studies and...

            I did edit to include a second study before I read this reply.

            Thanks for finding and including another study! A lot of the same reflections still apply to this study as well, I just want to provide some food for thought when reading through these studies and how they should be interpreted or viewed.

            I also believe there are risks to teens believing that breath play is a standard component of sex.

            Very true! I view this as a broader public health issue as a result of the commercialization of porn, but it is important to call out!

            1 vote
  4. [3]
    chocobean
    Link
    Thought on the difficulty of making strangulation pornography illegal: make it so that if any performer claims lifetime disability due to brain damage, the companies are responsible for the rest...

    Thought on the difficulty of making strangulation pornography illegal: make it so that if any performer claims lifetime disability due to brain damage, the companies are responsible for the rest of the performer's lives. Make it financially ruinous and it will stop faster than moral ethics culture kindness consent what have yous.

    8 votes
    1. [2]
      Moonchild
      Link Parent
      the problem is depicting it, not doing it. you can't tell from a video if that hand is really squeezing or not

      the problem is depicting it, not doing it. you can't tell from a video if that hand is really squeezing or not

      16 votes
      1. chocobean
        Link Parent
        True, but it's good if at least the performers' safety is covered, first.

        True, but it's good if at least the performers' safety is covered, first.

        5 votes