The Dangers of Erotic Choking
Medical Consequences of the Sexual Strangulation Trend
Far be it from me to kink-shame. I’ve been known to play with fire, rope and electricity among a variety of other stimulating devices. But I don’t want to have sex with men who attempt to strangle me. Erotic strangulation, colloquially known as “choking” is a trendy practice that’s especially prevalent among young, heterosexual couples. So far this year, I’ve had two different men, both of whom I know well and have played with before, try to choke me in the middle of sex. Neither bothered to ask whether I like this type of play or obtain my consent. The practice has, evidently, become so ubiquitous that guys don’t think to ask or negotiate it with their partner. As someone who enjoys sex and has professional interest in optimizing health, I think choking deserves my attention.
In a groundbreaking survey study by Indiana University researcher, Debby Herbenick, PhD, 43% of nearly 5000 college aged women reported having ever been choked during a sexual encounter. Nearly a quarter of those reported having their first choking experience between 12 and 17 years of age. In heterosexual encounters, it’s usually men choking women. As was the case in both of my experiences, it’s common for choking to happen without consent or even mention that it is desired. Which can lead to fear of or actual sexual assault.
The mechanics of choking, which involve the hands of the “choker” wrapped around the neck of a “chokee” is actually strangulation. From a medical standpoint, choking refers to occlusion of the airway; usually by a physical obstruction such as food or a foreign body. Children and adults choke on objects such as popcorn kernels or Legos when they “go down the wrong pipe” in the back of the throat.
By contrast, erotic “choking” is strangulation. Wrapping a hand, arm or other device around the neck occludes the blood vessels (arteries and veins) in addition to compressing the airway. The result is a decrease in blood flow to and from the brain which deprives it of oxygen. Low oxygen levels (hypoxia) in the brain can result in feelings of euphoria, lightheadedness and in some cases, loss of consciousness. While some people find the symptoms of hypoxia pleasurable, oxygen deprivation in the brain results in damage to neurons within a very short period of time. Similar to hypoxic ischemic injury caused by stroke or head trauma, brain damage caused by prolonged or repetitive erotic strangulation can result in cumulative damage; the extent of which is only beginning to be studied by researchers. Ultimately, there is no such thing as “safe” choking.
The scientists at Indiana University who are working on the hypoxic and anoxic brain injuries caused by choking are some of the same scientists who raised the alarm about chronic traumatic encephalopathy (CTE) among full-contact athletes. The mechanism of oxygen deprivation is different but the outcome of brain damage appears to be the same. Early studies of women who experienced 4 or more choking encounters within 30 days were found to have measurable changes on brain MRI compared to their choking naive peers. Other studies of people subjected to erotic strangulation found worse mental health outcomes, including increased anxiety and depression. Current data suggests that people who are repetitively strangled during sex are at increased risk of attention problems, emotional lability and cognitive decline.
At the 2024 conference of the International Society for the Study of Women’s Sexual Health (ISSWSH), I had the pleasure of meeting Dr. Herbenick and talking with her about her book “Yes, Your Kid”. It’s an unflinching examination of topics affecting children and adolescents such as rough sex, digital pornography and legal fallout from underage, explicit photo swapping. As a pediatrician, I encourage parents to begin teaching proper anatomic terminology and bodily autonomy during potty-training. I have frank conversations with my adolescent patients about consent, STI screening and pregnancy prevention. But many pediatricians don’t have the luxury of time that my Direct Primary Care practice provides. So who is teaching young people about healthy sex and communication? Usually, the void in education is filled by porn.
The abysmal sexual health education landscape in the United States, along with unfettered access to the internet, has led to pornography being the default source that most young people turn to when they become curious about sex. According to a survey study by Common Sense Media, the average age of first encounter with online pornography is 12. Based on conversations I have with my middle and high-school aged patients, what they learn about sex in school is best described as “nothing”. As the political rage machine implements book bans and tries to crack down on access to explicit content, the reality is that kids are learning to code in grade school. If they have access to the internet, they will find content of a sexual nature.
Which brings me back to the topic of choking. Porn has normalized the idea of rough sex, including choking and anal penetration, to the point that many young women see it as an expectation of their male partners. Whether they like it or not, many straight women will defer to their male partners on rough sex practices in an effort to cater to his sexual gratification. Which in many cases, is an attempt at emotional bonding by facilitating his orgasm. When they look back on the encounter, are they left feeling regretful, assaulted or somehow just treated like a device that he used to jerk off into? Is the young man then subjected to accusations of assault that could have been avoided with a clear and honest conversation about consent?
Young people have less sexual experience and agency than older adult counterparts and are more easily coerced or pressured into doing things they might not actually enjoy. Young men are too often learning how to treat their partners through the objectively terrible educational resource of online porn. Which is why it’s so important for mothers, fathers, sisters, brothers, aunties, mentors and friends to talk with young people about the dangers of erotic strangulation. Because porn certainly won’t point it out.
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