The Rise of Sexual Choking Among Young Adults

A growing body of research has shown a rise in the practice of choking during sexual encounters, particularly among young adults. Much of this work has been conducted by Dr. Debby Herbenick, who is a Provost Professor at the Indiana University School of Public Health-Bloomington and Director of the Center for Sexual Health Promotion. Her research explores the prevalence of sexual choking, individuals’ experiences with choking, as well as the relationship between sexual choking and adverse health outcomes. 

In this post, we’re going to discuss some of the findings from Dr. Herbenick’s research on this topic, then we’ll hear from her to gain more insight into the topic and get an expert’s opinion. 

What is sexual choking? Who does it?

Sexual choking involves any kind of “erotic asphyxiation.” It’s a form of strangulation during sex where external pressure to the neck reduces blood and/or air flow. [1] In a study conducted in 2020 that sampled undergraduate students, one in three women reported that they had been choked during their most recent partnered sexual encounter. [2] This study found that young women were much more likely to have experienced choking/strangulation than men, which may be surprising to some given that “the history of autoerotic asphyxiation is overwheliming[ly] male.” [2]

Several factors may explain the high prevalence of sexual choking among young adults. The simplest explanation is that young individuals have been exposed to choking through pornography use, where depictions of rough sex are very common. However, they may have also been exposed to it through internet memes. Many popular memes depict sexual choking as a mainstream behavior (e.g. “choke me daddy”), which may lead younger people who spend more time online to engage in sexual choking/strangulation in the bedroom. [3]

Although engaging in sexual choking may be a way for individuals to explore dominant-submissive dynamics or breath play, there are certain health concerns related to sexual choking that have been under-addressed or unacknowledged by individuals participating in this behavior, especially young adults. Because choking is a form of asphyxiation, individuals can potentially lose consciousness (albeit accidentally in most cases), which may cause physical and neurological symptoms with long-term consequences. [1] Also, injury can potentially still occur even if someone remains conscious to the extent that excessive pressure to the neck damages blood vessels. Accordingly, sexual choking is an important sexual health topic that warrants closer attention.

Sexual Choking: An Expert’s Perspective

Below are some questions we asked Dr. Herbenick about what people need to know about sexual choking, and what to do if you have experienced sexual choking in unpleasant ways. If you’re interested in learning more, be sure to check out this review of the literature that outlines what we currently know about this topic. 

Q: How has the prevalence of sexual choking in young adults changed in recent years? 

A: Sexual choking, which usually involves some level of pressure on the neck and is thus is technically a form of “strangulation”, has greatly increased in prevalence over about the past 15 years. Sexual choking used to be extremely rare and now many young adults have engaged in it. In several campus-representative studies of college students, we’ve found that about two-thirds of women, nearly half of transgender and gender nonbinary students, and about one-quarter of men report having ever been choked during sex. In contrast, very few adults over 50 have ever been choked during sex. 

Q: Are there aspects of sexual choking that we should be paying particular attention to or be concerned about? 

A: First, given how prevalent sexual choking has become among young adults as well as some teenagers, we need to be talking about this with young people. My book “Yes Your Kid: What Parents Need to Know About Today’s Teens and Sex” includes detailed information about sexual choking and various forms of rough sex as well as concrete tips that parents can use to talk with their teenagers about choking, consent, and health risks. Parents need to step into these conversations because choking is unlikely to be addressed in high school sex education, even though many teenagers are already engaging in it or may soon. 

Second, we need to be talking more as a society about sexual choking, diverse forms of sex, and consent. Just because a person consents to sex does not mean they want to be choked. Yet, because choking has become so common, many people assume their partner(s) are into it. I encourage people to talk about the kinds of sex they’re into it before they do it as well as how they like or don’t like different kinds of sex. Some people do like to be choked but expect the pressure to be done very lightly and then may feel upset or scared or harmed if their partner chokes harder than expected. This can be prevented if people talk about it first. 

Third and very importantly, we need to be talking about the health risks of sexual choking. Many people are getting misinformation on websites that claim that there are “safe” ways of choking. These sites often claim that as long as people put pressure on the sides of the neck, that choking is “safe.” However, they don’t usually say what they mean by “safe” and there is no zero-risk way of engaging in choking. Though deaths from consensual choking are rare, they do happen. Not everyone knows that. Also, pressing on the sides of the neck where the carotid arteries are can lead to tears in the arteries which can potentially lead to stroke, days or weeks or even months later. This risk may increase with age or for people with cardiovascular health problems. Because choking involves restricting blood flow and/or air flow, it can also have an impact on the brain. Over time, some people may experience cumulative brain injury, which is well documented with other forms of strangulation. My colleague Dr. Kei Kawata has been investigating the potential for this in the context of sexual choking/strangulation.

Q: What would you like readers to take away when it comes to sexual choking? Are there any tips to practice sexual choking in safer ways or any resources for people who may have experienced sexual choking in unwanted ways? 

A:  For people who have been choked in ways that didn’t feel good, you’re not alone. There are lots of stories from people in our research and in online articles that describe those situations. If you don’t want to be choked or if you only want to be choked in certain ways (e.g., very lightly) then communicate that to a partner before you hook up or have sex. If you are not into being choked or choking a partner, let them know – it’s better to have that conversation up front than to be surprised. If you are someone who wants to engage in choking in spite of the known health risks, you may be able to reduce the risk of harm by engaging in it rarely (not often), at very light pressures, and by using just one hand (avoiding using two hands, an arm, leg, or ligature/object). Even then, there are still risks, but these are harm-reduction strategies that some people explore. I have also heard from some people who do not feel comfortable choking their partner due to the health risks (and risk of killing their partner, even if low) and so they simulate choking by lightly pressing on their partner’s collarbone and avoiding the neck entirely. 

Do keep in mind, too, that the world is full of all sorts of sexual things to do. If you’re not into choking, there are other ways to be dominant or submissive or to add sexual variety to your life that are much less risky in both the short-term and long-term. So, keep things positive with your partner and explore other options together that are the right balance of pleasure and safety for you. 

If you have a sex question of your own, record a voicemail at speakpipe.com/sexandpsychology to have it answered on the blog or the podcast. 

Want to learn more about Sex and Psychology? Click here to check out other articles on the blog and here to listen to the podcast. You can also follow us on Instagram (@JustinJLehmiller), Facebook (facebook.com/psychologyofsex), Twitter (@JustinLehmiller), or Reddit (reddit.com/r/psychologyofsex) to receive updates.

References:

1: Herbenick, D., Patterson, C., Wright, P. J., Kawata, K., & Fu, T. (2023). Sexual choking/strangulation during sex: A review of the literature. Current Sexual Health Reports, 15(4), 253–260. https://doi.org/10.1007/s11930-023-00373-y

2: Herbenick, D., Fu, T., Patterson, C., Rosenstock Gonzalez, Y. R., Luetke, M., Svetina Valdivia, D., Eastman-Mueller, H., Guerra-Reyes, L., & Rosenberg, M. (2023). Prevalence and characteristics of choking/strangulation during sex: Findings from a probability survey of undergraduate students. Journal of American College Health, 71(4), 1059–1073. https://doi.org/10.1080/07448481.2021.1920599

3: Herbenick, D., Guerra-Reyes, L., Patterson, C., Wilson, J., Rosenstock Gonzalez, Y. R., Voorheis, E., Whitcomb, M., Kump, R., Theis, E., Rothman, E. F., Nelson, K. M., & Maas, M. K. (2023). #chokemedaddy: A content analysis of memes related to choking/strangulation during sex. Archives of Sexual Behavior, 52(3), 1299–1315. https://doi.org/10.1007/s10508-022-02502-5

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