What to Know About the Dangerous Trend of Sexual Choking

Sexual choking, which is a form of strangulation, has become alarmingly normalized among teens and young people, with many engaging in the activity unaware of the risk of neurological and physical harm. Recent research has found that nearly 40% of young adult women have been choked during sex and that 1 in 3 were choked the last time they had sex.

But young people are not the only ones uninformed about aspects of this behavior. The adults in their lives may not know about the prevalence of this dangerous trend, preempting the ability of parents and professionals to have informed conversations to keep teens and young adults safe.

“They are not even having the conversations with their teenagers or their young adult kids, not because they don’t think it’s important but because they don’t even know that some of these things are now normative among young people,” said Dr. Debby Herbenick, a sexual health researcher and Director of the Center for Sexual Health Promotion at Indiana University. Herbenick’s keynote presentation, “Strangulation: What Parents and Professionals Need to Know,” was featured in Culture Reframed’s virtual conference, “Breaking Down Silos: Addressing the Harms of Pornified Media on Youth.”

Herbenick’s team has conducted U.S. nationally representative surveys, college campus-representative surveys, and in-depth interviews that have addressed rough sex practices, with a focus on sexual choking. Herbenick said that over the past 15 years, sexual behavior trends have changed in important ways that impact young people’s safety and well-being. Sexual behaviors that college students used to think of as more aggressive and violent are now commonly considered “rough sex.” These changes have occurred so quickly that many parents, educators, and healthcare providers don’t realize their perceptions may be outdated.

“Ideas of what ‘rough sex’ even means have changed, and I think this is really important because sometimes when grownups in their 40s and older hear that rough sex has become more commonplace, they have one thing in mind that is different than the realities of so-called rough sex for teenagers and people in their 20s and so on,” Herbenick said.

Health Risks of Sexual Choking

Sexual choking, which is usually described as consensual, is using hands, limbs, or a ligature (such as a tie, cord, or belt) to press or squeeze the neck. Various intensities are reported, from light pressing/holding to very intense/aggressive. Technically, external pressure to the neck that may close off air passages and blood vessels is strangulation, while internal blockage of the airway is choking; however, people who engage in sexual choking tend to associate the term strangulation with aggression, crime or hard/harmful pressure rather than with sexual pleasure or intimacy, and choking is the term used.

Herbenick said about 40% of those who reported being choked during sexual activities said that they couldn’t breathe or speak, which has serious implications for consent and the withdrawal of consent. The study also found that about one in five reported at least one alteration in consciousness, such as blurred vision, temporary vision loss, or feeling dizzy or light-headed. Three percent said they lost consciousness. She said this is important because intimate partner violence literature indicates that women who have been strangled and experienced at least one alteration in consciousness are significantly more likely to have long-term problems with mental health or cognitive function.

Other effects reported in the hours or days after being choked included 5% who experienced memory loss related to the event and 4% who experienced neck swelling, which could be potentially life-threatening and generally warrants emergency care.

Trends Regarding Sexual Choking

Sexual choking behavior used to be rare but has substantially increased in recent years, with 64% of women, 29% of men, and 56% of trans and nonbinary students saying they had been choked out of the approximately 5,000 randomly sampled college students in Herbenick’s study. In addition to becoming more prevalent, choking has also become more frequent, with about one in five reporting that they’ve been choked more than 25 times. Herbenick said she was floored by the change, as such shifts are usually smaller.

Students report they first learned about choking from friends, partners, pornography, social media, and other forms of media, including TV shows, movies, and magazines/websites such as Cosmo, Men’s Health, and Women’s Health. In an analysis of 27 online media articles, none indicated choking is a form of strangulation, and most described it in positive terms (hot, sexy, pleasurable, adventurous). Although about 70% acknowledged choking could result in death, only 30% addressed brain injury and other non-fatal injuries or outcomes, such as stroke, that can be delayed by days or months as a result. Despite the risk of brain and cognitive damage, most suggested there was a “safe” or “proper” way to choke someone, even though there is no risk-free way.

What Parents and Professionals Can Do

With the proliferation and normalization of sexual choking by pornography and media, many people who engage in these practices are not aware that they might have been exposed to misinformation and have unintentionally risked harm to themselves or a partner. It’s important to note that sexual choking may intend to restrict blood flow or airflow, but one-third of those who engage in the behavior are unsure what they’re doing or experiencing. Herbenick encourages parents and professionals to share the health risks of choking, but cautions they should avoid using a fear-based approach.

“Young people often tell us that they don’t want to hear a ‘don’t do it’ approach, but they want to learn how to choke safely,” Herbenick said. “Given the depictions in pornography and misinformation in social media and from friends and peers, they may believe that choking can be done safely.”

Parents and adults need to challenge that message and can help by sharing the following information:

• Share that there is actually no risk-free way to engage in choking and being choked/strangled can be harmful to health, including brain health.
• Share that there are other much safer ways to be intimate and affectionate with a partner.
• Talk about what young people can say to someone if they don’t want someone to choke them or if they don’t want to choke other people.

Professionals providing clinical care, mental health services or therapy, as well as public health agencies, can also play a role.

Recommendations for Clinical Care:

• Consider anticipatory guidance
• Approach from a brain health perspective
• Describe symptoms that might warrant immediate medical attention
• Consider screening for brain injury more generally

Recommendations for Mental Health Counselors and Therapists:

• In addition to assessing assault, intake forms might ask: “Has anyone ever done something to you during sex (e.g., choked, slapped, smothered, etc.) that you either did not consent to or that you consented to but was rougher than you expected?”

In addition, Herbenick said if the Centers for Disease Control were to issue public health guidance regarding sexual choking, it would increase awareness and intervention.

Watch Dr. Herbenick’s full presentation here:

For more information on this topic, read our report, “Sexual Strangulation: Unpacking the Realities of this Harmful and Dangerous Practice”