Strangulation During Sex: What Everyone Needs to Know

Strangulation often referred to as “choking” has become a mainstream sexual practice among young adults in the United States (Herbenick et al., 2022c). Many people don’t first hear about it from a partner or a sex education class. Instead, they see it online in porn, TV shows, movies, or even memes (Herbenick, 2024; Herbenick et al., 2022a).

In these spaces, strangulation is often portrayed as edgy, passionate, or a sign of intensity. But in reality, this trend comes with serious health, emotional, and even legal risks. And while professionals like counselors and educators need to understand it, this is a topic that affects everyone such as parents and partners to young adults themselves.

The Real Risks Behind the Trend

Research shows that non-fatal strangulation is associated with headaches, depression, anxiety, and post-traumatic stress disorder (Herbenick et al., 2022c). Yet many people who engage in it don’t realize how dangerous it is.

When something becomes normalized in media or relationships, it can start to feel harmless. But strangulation is never risk-free. Cutting off someone’s air, even for a few seconds, deprives the brain of oxygen, which can cause permanent injury or death (Herbenick et al., 2022c).

And it’s not just a health issue. There are legal implications too. When a partner dies as a result of strangulation, even if both agreed to the act, the surviving partner can face serious criminal charges (Herbenick et al., 2023). These are outcomes no one expects in the moment, but they’re real and life-changing.

How It Happens and Why That Matters

People report using their hands, forearms, or an object such as a belt or scarf to apply pressure to the neck or chest (Herbenick et al., 2022b). Strangulation during sex needs to be clearly distinguished from violence or assault, where the intent is to harm.

It’s also different from autoerotic asphyxiation, a solo practice involving self-applied pressure during masturbation (Herbenick et al., 2023).

In BDSM communities, breath play a related practice, sometimes appears within negotiated, safety-focused frameworks. But for most young adults experimenting with strangulation, that kind of communication and safety planning isn’t in place. Without it, the risks multiply.

Consent Isn’t Always Clear

While many people say strangulation was “consensual,” research paints a more complicated picture. Some report that it happened without any prior discussion or agreement (Herbenick et al., 2022c). Others say it started as consensual but became so intense they feared for their safety.

This highlights an important gap in how young adults understand consent. Consent is not just giving or receiving permission, but having open, informed conversations about boundaries, safety, and comfort levels.

Why People Do It

Motivations vary. Some say strangulation increases sexual pleasure or arousal (Herbenick et al., 2020). Others find it exciting or emotionally intense (Herbenick et al., 2022c).

Interestingly, in one study, male participants said they saw strangulation as a sign of trust and intimacy. Female participants, however, did not share that interpretation (Herbenick et al., 2023). This difference may reflect the power dynamics and gender norms that often shape sexual experiences which is a reminder that people can experience the same act in very different ways.

A Gendered and Unequal Practice

Research shows strangulation is not experienced evenly. Young women report being strangled more often than men. One U.S. study found that 45% of trans and non-binary students had experienced strangulation during sex. Lesbian, gay, and bisexual women were also more likely to both receive and administer strangulation (Herbenick et al., 2023; Herbenick et al., 2022c).

These findings show that sexual strangulation disproportionately affects women and people with marginalized identities and that we need inclusive, realistic education to address that.

What Adults and Professionals Can Do

For counselors, educators, and anyone who supports young people, awareness is key. But it’s not just professionals who can make a difference. Parents, mentors, and peers can all help by creating safe, judgment-free spaces for open discussion.

Many young people don’t know that strangulation can cause brain injury or carry legal consequences. Having honest conversations …without shame or fear…can help them make more informed choices and set boundaries that keep them safe.

Talking About It Matters

Encouraging young people to talk about the kind of sex they want to have, and the kind of sex they don’t, is one of the most protective things adults can do. These communication and self-advocacy skills aren’t just about sex they’re about learning to speak up in every area of life.

Whether it’s talking to a healthcare provider, asserting boundaries, or asking for support, these are skills that build confidence and self-respect.

At the end of the day, this conversation isn’t about judgment. It’s about safety and empowerment. Strangulation may look like just another sexual trend, but it carries real, life-altering risks. The more openly we talk about it, the better equipped young people will be to make choices that protect their health, autonomy, and well-being.

References

Herbenick, D., Fu, T. C., Wright, P., Paul, B., Gradus, R., Bauer, J., & Jones, R. (2020). Diverse sexual behaviors and pornography use: Findings from a nationally representative probability survey of Americans aged 18 to 60 years. Journal of Sexual Medicine. 17(4). https://doi:10.1016/j.jsxm.2020.01.013

Herbenick, D., Guerra-Reyes, L., Patterson, C., Wilson, J., Gonzalez, Y.R.R., Voorheis, E., Whitcomb, M., Kump, R., Theis, E., Rothman, E.F., Nelson, K.M., Maas, M.K. (2022a).  #ChokeMeDaddy: A content analysis of memes related to choking/strangulation during sex. Archives of Sexual Behavior.https://doi.org/10.1007/s10508-022-02502-5

Herbenick, D., Tsung-Chieh F., Eastman-Mueller, H., Thomas, S.,Valdivia, D.S., Rosenberg, M., Guerra-Reyes, L., Wright, P.J., Kawata, K., & Feiner, J.R. (2022b). Frequency, Method, Intensity, and Health Sequelae of Sexual Choking Among U.S. Undergraduate and Graduate Students. Archives of Sexual Behavior. 51 https://doi.org/10.1007/s10508-022-02347-y

Herbenick, D., Tsung-Chieh F., Kawata, K., Eastman-Mueller, H., Guerra-Reyes, L., Rosenberg, M., Valdivia, D.S. (2022c). Non-fatal strangulation/choking during sex and its associations with mental health: Findings from an undergraduate probability survey. Journal of Sex & Marital Therapy. 48(3).https://doi.org/10.1080/0092623x.2021.1985025

Herbenick, D., Tsung-Chieh F., Patterson, C., Gonzalez, Y.R.R., Luetke, M., Valdivia, D.S., 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). https://doi.org/10.1080/07448481.2021.1920599