Sexual choking injuries: What people should know about the increasingly popular kink

When did sexual choking become almost as mainstream as the missionary position?

Nobody knows for sure, says Debby Herbenick, a leading sexuality researcher at Indiana University and author of Yes, Your Kid: What Parents Need to Know About Today’s Teens and Sex. But judging by the way it’s turning up in music, TV, and social media, being strangled for sexual gratification is now far from taboo. (Although losing your breath due to external airway blockage is technically strangulation, experts commonly use the term “choking” to describe the practice in sexual contexts.)

That tracks with a growing body of research — much of it led by Herbenick — suggesting that a truly astonishing number of young people are choking each other during sex. In surveys she and her team have conducted over the past four years, about half of American college students acknowledge being choked during sex, despite the fact that the practice poses significant health risks.

Like so much of what contemporary humans do in bed, sexual choking initially wormed its way into modern sexual repertoires via pornography. Now, it’s everywhere, says Herbenick — but often as a symbol of sexual edginess and without the context acknowledging the true risks of the practice.

Young people deserve to have exciting sex lives; “We just want you to live so you can enjoy that exciting sex life,” she says.

I talked to Herbenick about why so many people are engaging in sexual choking, what makes it so risky, and how to talk about it. Our conversation has been edited for length and clarity.

How common is sexual choking?

For a long time, the media narrative on sexual choking has been that it’s rare — but it’s not.

In college student surveys we’ve done over the past four years, we consistently find that around 65 percent of young adult women and around 45 percent of transgender and gender non-binary have been choked during sexual activity of some kind. In sex between women and men, it’s almost always the women being choked and the men doing the choking.

Around 25 to 30 percent of male college students also say they’ve been choked during sex. When men get choked during sex, it’s usually within the context of sex with another man, although though some men do explore being occasionally choked with female partners, too.

There definitely seem to be some norms where masculinity goes with choking and femininity goes with being choked. There are also some norms around sexual orientation — one queer guy I interviewed said, “My heterosexual fraternity-types of friends, they don’t get why I want to be choked, whereas, my queer friends get it.”

These numbers track with the US population at large. It’s not just college students, but other young adults as well. Interestingly, almost nobody over 50 reports having ever engaged in choking.

Where are people getting the idea to choke or be choked during sex?

A lot of young men will talk about pornography as the place where they learned about it, but they also talk about friends and partners, and sometimes about media directed at young men, like Family Guy.

For young women and gender-diverse folks, fanfiction comes up a lot. If you go back 10 to 15 years, there’s a lot of very graphic One Direction fanfiction where people were imagining Harry Styles and his bandmates choking each other and being super kinky together.

Sexual choking is also all over social media, especially on TikTok and in memes. We published a paper called #ChokeMeDaddy where we analyzed more than 300 memes that we found within a minute of searching. And it’s referenced in so many mainstream media shows: The Idol, Euphoria, Love Island, Love Is Blind, Lovesick. The No. 1 song in the country for six non-consecutive weeks was Jack Harlow’s “Lovin’ on Me,” which talks about choking as vanilla.

If you are a teenager or a young adult growing up in these media spaces, you’re going to get the idea that sexual choking is very common, super-normative, possibly even romantic, or expected of you and your partners.

There is no risk-free way to engage in choking or strangulation.

When you have external pressure to the neck that reduces blood flow and or airflow, it is technically strangulation, and there’s actually a massive, longstanding literature on the health risks of being strangled. In rare cases, people die; there are other cases in which people have a stroke days or weeks or even months later and may not connect it to being strangled.

Sometimes, after I give talks on this topic around the country, health care workers stay afterward and tell me about young people they cared for who had strokes and who turned out to have been choked during sex.

People can have cardiac arrest in rare cases and can also develop thyroid problems or airway collapse, but the much more common scenario is probably a very invisible cumulative brain injury.

There’s really good research on strangulation in the context of partner violence that shows people who have been strangled and who have experienced alterations in consciousness — maybe they passed out, felt like they might pass out, or felt disoriented, had tunnel vision, or saw stars. These people are significantly more likely to have poor mental health and to struggle with neurocognitive issues over the long term.

Between 19 and 30 percent of our students have experienced these alterations while being choked, and a subset specifically want that. Quite a lot of people who engage in sexual choking get close to losing consciousness, around 3 to 5 percent. It seems small, but it’s actually pretty substantial. So we really are concerned there is a sizable portion of the population of young adults who may not realize choking is likely to cause lasting damage to their brain.

None of us [researchers] are aware of a reporting mechanism for this. That is something that I would love for the federal government to think about is a systematic way to collect injury and fatality data on sexual choking or strangulation.

The best health-related medical advice is, don’t do it. Don’t choke other people, and tell your partners you don’t want to be choked. Find other ways to have sex. It can help people to remember that the sexual menu is vast, and if they like being submissive or they like being dominant or if they like to role play, there are ways to do those things that don’t risk injury and death.

What advice would you give to people who might feel pressured to engage in sexual choking?

You can say early on, in either a relationship or an encounter, “By the way, please don’t choke me because I’m not into it.” Or, “Don’t ask me to choke you because it’s too risky for me and I’m not going to do it.”

If somebody tells you there’s a safe way to do it, you can respond, “Actually, there’s really not — so I’m not going to do it. That’s my line. Thanks for respecting it.”

People aren’t getting accurate messages about the risks of sexual choking from online sources. When most of my students hear about the health risks of choking, they generally say no one ever told them that before. And most of them say they’re going to find safer ways to have the kind of sex they want. And then I have a smaller subset of students who say, “I’m okay with these risks — can you tell me some ways to make it less risky?”

What’s your advice for those people? Consent seems particularly tricky in these scenarios.

Choking is different from other kinds of sex in that it involves experiences in which people lose the ability to communicate, which also means the person being choked may lose the ability to withdraw consent. This can get you into really tricky situations — you can be liable for assault if you are having sex with somebody who has lost consciousness, even briefly.

For people who choose to engage in it regardless of the risks, really clear consent is key, preferably before you ever engage in choking, outside of a sexual situation. We have heard of too many situations where somebody just chokes their partner without asking, or they get consent by putting their hand on their partner’s throat and then gauging their reaction — reading the vibe or the energy, when the partner might not feel like they can freely consent in a meaningful way. So there’s a worry there about pressure or coercion.

People who are really more into kink will tell you: Have this conversation when you’re hanging out, having tea, and planning your sexual event. Don’t spring it on somebody during sex.

Are there other ways to take a “harm reduction” approach to sexual choking?

Stay away from using other items, like belts and cords, or using arms and legs for choking — they’re associated with higher risks than hands. Avoid pressing on the windpipe, but also, avoid pressing on the sides of the neck. Although there’s misinformation out there saying the sides of the neck are safer, they’re not — you’re still risking brain injury and stroke and other harms.

Go very, very light. We’ve had some folks in interviews who say that they didn’t feel comfortable choking a partner or being choked, so they switched from the neck to the collarbone.

About 40 percent of our students tell us they’ve had experiences where they couldn’t breathe while being choked. If you’re going to engage in choking one way or another, you could tell your partner, “I do like to be choked, but not hard — only at the absolute lightest pressures.” You could also say, “Don’t ‘choke me out.’”

In our student surveys, about 4 percent of the people who have been choked report noticing neck swelling, which increases the risk for an airway collapse or another complication. If you have neck swelling, you should be observed in an emergency room setting for up to 36 hours in case you suddenly start to struggle with breathing. So for people who engage in sexual choking, it’s worth knowing that if they or their partner has some neck swelling, they should reach out to a nurse or doctor or go to an emergency room and be evaluated.

How should parents be talking to their kids about this?

Parents sometimes fear bringing this up because they don’t want to plant ideas in their kids’ heads. But if they’ve seen pornography, if they listen to Jack Harlow, if they watch The Idol, they’ve probably heard about choking.

Even if it scares us or worries us, we want to come to these conversations without shaming and judging kids. We can ask them what they’ve seen, what they’ve heard — something like, “I’ve heard that there’s this trend about sexual choking. Have you or your friends talked about this or heard about it? What do people say about it? What’s your sense of it?”

And then, “I want to share some facts with you about it because I have some worries that maybe people your age aren’t getting factual information about it.”

These are hard conversations. Role-playing it with a best friend or a co-parent or spouse can help parents prepare for them.

Is there anything educators can do to talk about it?

Ten to 20 years ago, many school systems were faced with the choking game challenge, where kids were seeing how long they could hold their breath or choking each other to pass out. Some kids died, and the CDC issued a warning to parents and to pediatricians. It resurfaced a few years ago as a TikTok challenge and again, kids died.

The point is, schools can approach this from a brain health perspective — not as a sexualized thing, but more like, “People should always be able to breathe; the brain needs blood flow to provide it with glucose and oxygen, which are food for the brain. It’s not safe to stop blood flow or oxygen flow to the brain.”

At some schools, they can talk about sexual choking in the context of consent; in the rare schools where they can teach pornography literacy, they can talk about this in the context of the bad information a lot of young people get from it.

During the first wave of the choking game trend, the CDC issued a warning to parents and to pediatricians. I wish they’d issue official guidance around sexual choking. This is a major public health issue.