Popularized by pornography and social media, sexual strangulation or “choking,” has become increasingly common among young adults. Having ever been choked during sex was nearly twice as prevalent among adults under 40 than among older adults and the mean age of first being choked/choking is 19. (Orenstein, 2024; Conte et al., 2025; Wright et al., 2022). 

Although sexual strangulation is perceived as something done by men to women, a study of undergraduates at a large public university found that about 65% of female, 29% of male, and 55% of transgender/gender nonbinary students (TGNB) who are sexually active have been choked during sex. Female and TGNB students were more likely to have experienced this behavior multiple times. The same study estimated that 28% of female, 59% of male, and 55% of transgender/gender nonbinary students who are sexually active have choked a partner during sex. Male and TGNB students were more likely to have choked a partner multiple times. (Herbenick et al., 2021b).

The signs and symptoms of sexual choking can include feeling cloudy or groggy, headaches, red eyes, and dizziness. More severe symptoms can include neck swelling, trouble swallowing, trouble breathing, loss of consciousness (e.g., fainting, seizure) and loss of bladder or bowel control (Hebernick et al., 2024; Hone, 2024). Some symptoms can develop up to 36 hours after the encounter (Conte et al., 2025).

The neck area is a vulnerable part of the human anatomy and sexual choking can also risk immediate damage to the larynx, trachea, hyoid and other sensitive areas. People tend to underestimate the amount of pressure that can cause injury. In fact, blocking blood flow to the brain takes less pressure than is used to open a soda can (Herbenick et al., 2021a).

In the short term, someone can become unconscious (within 10 seconds), have a seizure or a fit (within 17 seconds), or even die (within 150 seconds) (Hone, 2024). Repeated, seemingly inconsequential incidents of choking can cause brain damage similar to that seen in football players after subconcussive hits (Orenstein, 2024; Hou et al., 2023).

Ultimately, there is no risk-free way to engage in sexual choking, regardless of intensity or duration.

It is also important to be aware that you or your partner(s) may be at an increased risk of harm due to conditions such as high blood pressure, asthma, or heart conditions (Corinna & Woodley, 2025). 

Sexual exploration can be healthy and fun when safety and informed consent is prioritized. Engaging in discussions with your partner(s) is essential to understanding risks and making informed decisions about what feels comfortable and what is safe. When it comes to sexual strangulation, researchers found that half of college students who had been choked reported that they had never (21%) or only sometimes (32%) been asked for consent or if it was okay to be choked, prior to being choked.” (Herbenick et al., 2021a) 

There is no safe way to engage in sexual choking. Below are some questions that can help to clarify the risks and make informed sexual decisions.

1. Do I know if my partner is at an increased risk for adverse harm (e.g., has asthma, heart condition, high blood pressure, etc.)?
2. Have I had a conversation with my partner about the risks, my boundaries, harm-reduction practices, and exploring alternatives?
3. If I enjoy the sensation of sexual choking, have I explored similar but less risky sexual alternatives (i.e., safe restraints, power dynamics, etc.)?

This page is based on materials developed in Spring/Summer 2025 by BWell Research Assistants Peyton Luiz (MPH ’26) and Ambree Robinson (MPH ’26) in collaboration with the Brown University Sexual Health Working Group. Illustration of symptoms by Sander Moffitt (BA ’24).