An act seemingly once confined to bondage and “kink” communities has become mainstream. Despite the many risks to health (including death), sexual choking is now popular, even commonplace, particularly among young people.

Sexual choking is a more informal label for strangulation. It involves the grabbing, holding or compression of another’s neck either by hands, or limb, or by use of a prop or weapon, and typically involves restriction of blood or air flow. When it is used as part of a sexual encounter, it is frequently referred to as “erotic asphyxiation” or “breath play”.

In a 2016 survey of Americans aged 18-60 years, 21.4% of women who had sex with men had been choked. And one in five men admitted to choking a partner (male or female) during sex.

An Australian study from this year found that more than half of 18- to 35-year-olds reported they had been strangled during sex at least once. A similar proportion admitting to strangling a partner at least once. Though strangling is common among both men and women, evidence shows that women are more likely to be strangled and men more likely to do the strangling.

Separate research suggests strangulation has become so normalised that many do not consider it to be a form of rough or violent sex at all. A 2019 survey found only around a third of participants considered choking to be rough sexual behaviour. Most considered hair pulling, being pinned down, biting, being tied up and slapping as rough sexual behaviour.

While there have not been many studies on the prevalence of choking until recently, researchers and campaigners have reported that young people are talking about the practise more in recent years.

According to a 2022 study that surveyed American university students, those who report enjoying being strangled cited a high from the experience – a feeling of euphoria – that heightens sexual pleasure.

People give various reasons for engaging in sexual strangling, including wanting to be kinky or adventurous, believing it would please their partner, and feelings of power and dominance. But campaigners point out that the often gendered nature of strangulation can feed into wider patterns of coercion and control of women by men.

Although sexual choking appears to be increasingly common, it is not necessarily wanted by those engaging in or receiving it. A significant proportion of women, in particular, do not consent to being choked, even if the rest of the encounter is consensual.

A survey for the BBC in 2019 found that in a study of 2,000 young women aged 18–39, 38% had experienced unwanted slapping, choking, gagging or spitting during otherwise consensual sex. And a similar proportion of men admit to choking or strangling a partner during sex without their consent.

Normalising strangulation

The act of strangulation has become increasingly normalised and sexualised. The Fifty Shades of Grey trilogy, a worldwide bestseller, was widely criticised by feminist campaigners, academics and domestic abuse charities for eroticising strangulation and making it socially acceptable. The recent Netflix-produced films Lady Chatterley’s Lover and Obsession also contain strangulation during sex scenes, which are presented as part of a love story.

A 2020 investigation by the Times found hundreds of images of sexualised choking and strangulation on Pinterest, Instagram and Tumblr. The images included pictures of young women being pinned down and strangled by men, women with gags over their mouths and children being gripped by the throat.

Social media hashtags promoting these images include #Daddy, #ChokingKink, #BreathPlay and #Strangle. Disturbingly, the investigation found hypersexualised tags and descriptions accompanying many of these images, including one which said “bruise my oesophagus”.

Pornography has also played a role in eroticising strangulation, as part of a wider normalisation of violent sex. And research has found links between people seeing choking depicted in pornography and engaging in it themselves.

In TV, books, social media or pornography, it is almost always men strangling women. Similarly, the evidence on real life sexual choking shows this is a practice more often done by men to women.

The creep of strangulation into legitimate and normalised behaviour makes it more difficult for women to escape (and avoid) violent relationships. This normalisation leads many women to feel like they cannot speak up about nonconsensual choking.

In her recent book exploring rough sex, journalist Rachel Thompson highlights that women feel refusing to participate or responding to non-consensual choking could reflect negatively on them as sexual partners.

Risky behaviour

Regardless of consent, strangulation is associated with a range of health risks. These include loss of consciousness, loss of voice, difficulty in swallowing or breathing, bruising, redness, haemorrhages, headaches, depression, PTSD, suicidal thoughts and death (including delayed death occurring days or weeks after the strangulation).

Strangulation has traditionally been viewed as a violent act and has long been recognised as assault in criminal law. A growing number of homicides of women by men involve claims that the death was an accident resulting from “rough sex” gone wrong.

Strangulation or asphyxiation is a leading cause in many of these cases, and in some, reference has been made to the Fifty Shades of Grey trilogy as the inspiration for engaging in what is alleged to have been consensual sexual choking.

England and Wales have recently introduced a new offence of non-fatal strangulation as part of domestic abuse legislation, which police appear to be actively using. But the law alone isn’t enough to change the normalisation of this dangerous act.

Some advocates for safe BDSM practice have suggested that breath play can be done safely if there is clear consent, proper boundaries and certain rules are followed. But clinicians, academics and parliamentarians have argued there is no safe way to choke someone.