Physical Health

Open Access: Yes.

Abstract

Sexual choking has become increasingly normalized among young people, largely driven by media, pornography, and peer norms. Although often framed as consensual, breath-control practices are physiologically unpredictable and can cause rapid loss of consciousness, brain injury, or even death within seconds. Once consciousness is lost, consent cannot be given or verified. Clinical and forensic experience in Finland indicates that choking is frequently reported in younger patients, yet national prevalence data are lacking. We argue that sexual choking is never medically safe, that clinicians should routinely ask about it, assess for injury, and provide clear risk counseling, and that medical ethics require engagement with harmful trends in patient care. Further research is needed to quantify prevalence and harms in Finland.

Relevance

“A recent court decision in Sweden has highlighted the dangerous consequences of breath-control practices in sexual contexts. In June 2025, a 28-year-old man was convicted after his partner suffered severe brain damage from consensual erotic choking. She lost consciousness, went into cardiac arrest, and required months of intensive care. The court found the man guilty of aggravated assault and causing bodily harm. Despite their previous history of engaging in such acts, the ruling emphasized that consent cannot justify actions that cause grave bodily harm or risk death.”

“The central danger of sexual choking and other breath-control practices lies in physiological unpredictability and rapid lethality. Carotid sinus pressure, vagal inhibition, and hypoxia can all cause immediate loss of consciousness and in severe cases irreversible brain injury or death. Importantly, unconsciousness can occur already in less than 10 s. Contrary to popular belief that relying on a “safe word” or a gesture previously agreed upon for use in an overwhelming situation is enough…words or other signals have no meaning whatsoever when one can lose consciousness before being able to speak or otherwise communicate the distress. Over stimulation of the chemoreceptor system, leading to a parasympathetic (vasovagal) cardiac arrest without any warning signs can happen even in healthy young individuals.”

“Emerging neuroimaging research indicates that repeated exposure to sexual choking may lead to structural and functional brain changes.”

“Based on our clinical experience, individuals with trauma histories may become accustomed to an addictive dopamine surge tied to repeated survival; the post-choking relief and aftercare can mimic long-standing cycles of violence. In clinical narratives, the illusion of intimacy, submission, or surrender often masks deeper dynamics of unresolved trauma or compulsion. Dissociation, emotional numbing, and people-pleasing tendencies may further obscure the ability to give or withdraw true consent. For some individuals, breath play may become their main route to arousal, not because it is inherently pleasurable, but because it replicates familiar states of powerlessness or danger.”

“Sexual choking or strangulation is neither normal nor safe; in our clinical experience, it is never medically safe. No medically safe method exists for restricting oxygen during sexual activity.”

Citation

Kero, K., Lauerma, H., & Wahlsten, P. (2026). “And then I got strangled”: Dangerous trends of sexual choking among young people. Acta Obstetricia et Gynecologica Scandinavica. https://doi.org/10.1111/aogs.70193