Verified by 
Key points
- The lightheaded feeling that comes with hypoxia (inadequate oxygen to the brain) feels good for some people.
- Breath play can produce the rush of hypoxia, especially when paired with orgasm.
- Choking or strangulation is becoming very popular, even though it is physically and emotionally dangerous.
- Any kind of oxygen deprivation can cause damage to delicate brain cells, cognition, mood, and memory.
From children playing “the choking game” as a way to achieve a blissful light-headed feeling to adults who restrict their own or others’ air or blood flow, many humans seem to enjoy the sensation of hypoxia, which is the feeling that people get when they have inadequate oxygen flowing to their brains. Rising public awareness of kinky sex and the accessibility of a wide range of pornography have contributed to popularizing choking during sex, with mixed results. Like many things related to sexuality, people’s experiences of choking during sex vary significantly by gender.
Breath Play
Breath play involves controlling someone’s air intake at their nose and mouth, and is different from choking or strangulation that restricts blood flow in the neck. BDSM practitioners have included breath play in their repertoire of kinky sex for a very long time.
Susan Wright is the executive director of the National Coalition for Sexual Freedom (NCSF), an organization that advocates on behalf of people in kinky and consensually nonmonogamous relationships.
“It's a misconception that the kink communities are endorsing choking/strangulation… kink communities make the distinction between choking/strangulation and breath play, which incorporates things like ordering someone to hold their breath or putting your hand over someone's mouth and nose," Wright explains. "There's also roleplay choking, which is placing a hand on the neck without any compression.”
In addition to the physical buzz associated with hypoxia, many kinksters also enjoy the exchange of power via dominance and submission that can come with breath play. Crucially, kinksters who want to protect their partners’ well-being are careful to negotiate breath (and any kind of) play before they get started.
Explicit and Prior Permission
Another thing that distinguishes breath play from choking is the careful and consensual nature of breath play. Through decades of research and contemplation of consent, the National Coalition for Sexual Freedom has established itself as a thought leader regarding consent and BDSM. The NCSF has developed a model of consent that provides kinky sex enthusiasts with careful guidelines about how to play such potentially dangerous games, moving from the larger cultural emphasis on “no means no” to first include “safe, sane, and consensual” and then “risk-aware kink,” before eventually landing on “explicit prior permission.”
Each iteration of consent guidelines has become clearer and more direct as trial and error exposed the inadequacies of the former versions. Through their Consent Counts project, the NCSF details precisely how to negotiate explicit and prior permission, some best practices for establishing consent in BDSM (and consensually nonmonogamous) relationships, a database of legal documentation relevant to consent, and a reporting mechanism for consent violations.
The NCSF’s five steps to negotiate explicit prior permission for consent to kink are:
- You agree to specific acts and the intensity before you start.
- You agree what roleplay resistance is okay to ignore.
- You must identify a way to stop at any time, like a safe word or safe signal.
- You are of sound mind.
- You can’t risk seriously injuring someone.
Because of the risk of serious injury, choking and strangulation are not allowed under the explicit prior permission protocol. Choking, even with consent, is against federal law in the United States, and many states have made choking illegal. Combining mood alteration with sex is also not advised under the explicit prior permission protocol, which affirms that you must be of “sound mind” to engage in consensual play. While mixing sex with drugs and alcohol is a time-honored human tradition, it is also one of the primary ways that sexual interactions go horribly wrong. Mood alteration can decrease decision-making capacities and impair responses to danger while simultaneously encouraging people to do things that they might not do if they were sober. This can be especially dangerous with riskier sexual activities like breath play.
Men Choking Women
Recent research indicates that an increasing number of people are playing with hypoxia in partnered sex. Debby Herbenick, professor of public health at Indiana University, and her colleagues have been documenting and analyzing this rising trend of choking during sex. Herbenick’s research team found that over half (58 percent) of female college students have been choked during sex, sometimes with consent and sometimes without. Women are four times more likely to be choked by a man than to choke their male partners, and are also more likely to engage in choking to please a partner.
Many of these folks are using their hands to strangle their partners, in part because pornography often demonstrates that technique.
“The wide range of pornography that has contributed to popularizing choking during sex is the root of the problem," Wright notes. "Porn stars aren't really choking each other in those films. That's roleplay choking, which is simply placing the hand on the neck without compression or gouging. The attorneys for production companies won't let their actors really choke each other due to liability risks to the company and the actors. So people are seeing roleplay porn and thinking it's real. That's led to a huge uptick in choking and associated injuries from being choked/strangled.”
When partners fail to negotiate consent, choking becomes even more dangerous. Herbenick’s research team found that at least half of the women in the sample of people who had been choked during sex experienced a partner doing so nonconsensually. Consent is a key distinguishing factor that makes the difference between kinky sex and intimate partner violence. Strangulation is a popular weapon in intimate partner violence and rape. Even when the person doing it does not intend it to be abusive, surprise choking can be terrifying to experience.
Noting the significantly higher number of men choking their female partners, Wright wondered, “If pleasure is the motivation, then why aren't these percentages more equal? This gendered dynamic around choking/strangulation, combined with the high percentage of nonconsensual choking/strangulation found by Herbenick, indicates it this may be gender-based violence.”
Even when people carefully negotiate breath play before doing it, they still run the risk of potential negative impacts on long-term brain health. While the research is not yet conclusive, multiple studies indicate that repeated exposure to hypoxia can produce cumulative damage to memory and cognitive function and is linked to higher rates of anxiety, depression, loneliness, and sadness.
“Professionals need to tell everyone about the risks involved and to stop choking/strangling your loved ones," says Wright. "Therapists need to be educated about the risks so they can tell their clients to stop choking/strangling their partners. Educators need to stop posting online that people can go to the kink communities to get classes on choking/strangulation.”
References
Herbenick, D., Fu, T. C., Patterson, C., Rosenstock Gonzalez, Y. R., Luetke, M., Svetina Valdivia, D., ... & 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.
Herbenick, D., Patterson, C., Beckmeyer, J., Rosenstock Gonzalez, Y.R., Luetke, M., Guerra-Reyes, L., Eastman-Mueller, H., Svetina Valdivia, D., & Rosenberg, M. (2021b). Diverse sexual behaviors in undergraduate students: Findings from a campus probability survey. The journal of sexual medicine, 18(6), 1024-1041.
Herbenick, D., Guerra-Reyes, L., Patterson, C., Rosenstock Gonzalez, Y. R., Wagner, C., & Zounlome, N. (2021). “It was scary, but then it was kind of exciting”: Young women’s experiences with choking during sex. Archives of sexual behavior, 1-21.
Schori, A., Jackowski, C., & Schön, C. A. (2022). How safe is BDSM? A literature review on fatal outcome in BDSM play. International journal of legal medicine, 136(1), 287-295.
