Choking during sex has moved from the margins to the mainstream for many young adults, but the risks have not changed. New research shows how common the practice has become, and how confused many people are about what makes it dangerous.
A survey commissioned by the Institute for Addressing Strangulation (IfAS) has found that more than one-third of people aged 18 to 34 have been choked or strangled at least once during consensual sex. IfAS is a UK-based organisation that aims to reduce harms from strangulation in domestic abuse, sexual contexts and forensic settings – environments where injuries are examined for legal, evidential or investigative purposes.
The survey findings suggest that pornography featuring choking is helping to normalise strangulation during sex among young adults. The report was published as the UK government prepares to ban such content in the upcoming crime and policing bill.
While many participants reported positive experiences, others described deeply negative experiences, and just over one-quarter said they had been choked without agreeing to it first. This raises particular concern because choking during sex sometimes intersects with domestic abuse and non-fatal strangulation is a known predictor of serious harm in intimate partner violence.
When a behaviour that is well documented in coercive and violent relationships becomes normalised in consensual settings, the boundaries can blur. Young people may struggle to distinguish experimentation from harm and may feel pressured to accept acts they do not want. The survey’s accounts of distress and lack of consent highlight how these boundaries can erode.
One of the most revealing parts of the survey explored how people think about danger. Almost three-quarters of respondents described choking during sex as either “very dangerous” or “somewhat dangerous”. However, when asked whether it is possible to strangle someone safely during sex, opinions were divided. Twenty-nine percent believed it is possible, 39% believed it is not and 32% were unsure.
Participants also gave a wide range of answers about how a person might try to make this safer. One important theme was that participants were divided about whether it is more important to avoid pressing on the airway or on the blood vessels in the neck.
This confusion matters because the body responds very differently to these types of pressure. Strangulation denies the brain oxygen and this can happen in two ways.
One involves blocking the airway, which makes breathing difficult or impossible. The other involves interrupting the flow of blood to and from the brain, by blocking blood vessels on the side of the neck.
Some people use the word choking for the first and strangulation for the second, but these terms are often used in confusing ways.
A key difference is how quickly these two types of strangulation affect the brain. Blocking breathing can take around one minute to cause unconsciousness. Blocking blood flow can cause unconsciousness in as little as five to ten seconds.
Another difference is that restricted breathing feels uncomfortable and obvious, while restricted blood flow can be hard to recognise until it is too late. It is not intuitive to people that they can be strangled while still being able to breathe.
Strangulation’s rapid effects happen because the brain depends on a constant supply of oxygen. If oxygen is cut off, the brain can suffer damage very quickly. Some areas such as the hippocampus, which plays a central role in memory, are particularly vulnerable.
As oxygen levels fall, the brain tries to protect itself by reducing its own use of oxygen, which causes unconsciousness. If oxygen is not restored quickly, brain cells begin to die.
Strangulation can also harm the body in other ways. Sexual choking can cause a range of physical and psychological injuries and, in extreme cases, can be fatal. During or after choking a person may experience trouble breathing, pain or difficulty swallowing, loss of bladder or bowel control, memory problems or psychological trauma.
In rare cases, choking during sex can trigger a stroke. This can happen if a blood vessel is damaged and bleeds, or if blood pools behind a blockage and forms a clot that later travels to a smaller vessel.
What can be done?
Public health has two broad approaches to risky behaviour. The first is prohibition, which creates legal or practical barriers to prevent dangerous acts.
The UK government’s plan to ban pornography that shows choking is one example. However, sexual practices take place in private settings and cannot be monitored or restricted in the same way as access to pornography, which limits the reach of prohibition.
The second approach is harm reduction. It accepts that people may continue a behaviour even if discouraged and aims to help them reduce the risks. This approach is complicated in the case of sexual choking, because misinformation is widespread and many online communities promote inaccurate ideas about “safe” practice.
Both approaches attract debate. Prohibition is sometimes criticised as intrusive or unrealistic, and harm reduction as condoning dangerous or immoral behaviours. But they do not have to work against each other. They can operate together by reducing the likelihood of a behaviour while equipping people with accurate information about risk.
The IfAS survey shows that many young people misunderstand what makes strangulation dangerous – and this gap in knowledge could have life-threatening consequences. Education that explains how strangulation affects the body could help reduce harm by giving people a clearer sense of the risks involved.
Accurate information would also support wider public health efforts by helping people recognise why certain sexual practices carry significant danger, and why legal and clinical responses are being developed to address them.
