Sexual choking is not a harmless activity

Adapted from BMJ 21-28 Feb 2026 Harmful effects of sexual choking. Anouska Victoire et al NSW Australia.

Strangulation and manual choking during consensual sex is becoming increasingly normalised in the media and also in real life. Medical awareness of the hidden risks, harm, and death in both consensual and non consensual acts is increasing too.

Strangulation is the application of external pressure to the neck that compresses internal structures including blood vessels, the airway, nerves, and endocrine glands. The effects can be serious and can include death. Recent studies have shown that structural and functional changes in the brain can result even during consensual episodes, particularly if these are repeated. Strangulation has also been associated with higher risk of homicide in those experiencing intimate partner violence. Carotid artery dissection, thyroid and brain injury can result.

Mainstream media and pornography tend to romanticise sexual choking and strangulation. But they don’t spell out the risks. In an Australian study of young adults aged 18-35, 57% of respondents said they had been sexually strangled, and 51% reported having strangled a partner. This included men, women, trans and gender diverse individuals. 61% said they had seen this on pornography sites and 40% from films.

Directors of Forensic Sexual Health Services and A and E consultants both in Australia and the UK, suggest that specific enquiries into sexual choking and strangulation should be part of the routine history taking when taking a sexual history.

The UK government is currently implementing legislation banning the publication and possession of pornography depicting strangulation and suffocation.

Education of the general public regarding the dangers of this activity is urgently needed. Sadly, some couples who enjoy this activity and who have got away with it so far, seem reluctant to stop. Sexual choking may be popular in the media and glamorised but it is wrong to portray it as safe as long as it is consensual.