Rougher, Harder, Stronger—Is Choking During Sex Safe?

Certain BDSM-centric acts, such as using blindfolds or exploring rope bondage, are less taboo than in decades past, thanks to their portrayal in popular media. But no matter how mainstream BDSM gets, certain kinks fall into a gray area because of the risks they pose. Want to choke or be choked by a partner during sex? Proceed with caution.

Erotic choking "involves restricting the air supply for yourself or your partner in a sexual capacity," explained Megan Harrison, a Florida-based kink expert and licensed marriage and family therapist. "It can be very dangerous."

When it’s done solo, erotic choking is called autoerotic asphyxia (AEA), where an individual might loop a rope or belt around the neck and attach the other end to a doorknob or other fixed structure (Harrison advised against ever doing this and said you should never be alone when blocking your airway). Otherwise, erotic choking involves one person grabbing the throat of another during intercourse or other sexual activity.

If you're curious about exploring choking with a partner, it's important to educate yourself as much as possible and understand the risks before a partner takes your breath away.

Why do people do it?

Close to a quarter of women in the U.S. between the ages of 18 to 60 have been choked during sex, a 2020 survey by the Journal of Sexual Medicine indicated—but that same survey also found that most of the respondents reported lifetime pornography use, suggesting a "statistically significant" relationship between porn and sexual behavior.

It’s possible people are recreating what they see in pornography: On Pornhub, which reports 130 million viewers every day, there are pages of videos depicting choking during sex. Authors such as Wendy Tuohy and sexual health researcher Maree Crabbe and others have argued that this is part of an overall trend in porn toward rougher, harder, more aggressive types of content, although a 2018 study by The Journal of Sexual Research found no evidence to support this claim.

According to Harrison, the physiological impact of choking may produce a "fuzzy rush" throughout the body that might make sex feel more euphoric to some people. "When the oxygen begins to flow again [after choking], it causes a release of feel-good endorphins, including dopamine and serotonin," she said.

Psychologically, breath play—an umbrella term in the kink community for activities involving the restriction of oxygen—can solidify power dynamics, such as those often seen in a dominant and submissive relationship. Giving someone permission to choke you can seem like the ultimate act of submission—or vice versa, of control—and might intensify the sense of emotional closeness between you and a partner.

"The folks I know who have incorporated [choking] into their intimate play often tell me that they do so because they experience an increased emotional bond," said Stefani Goerlich, a Michigan-based sex therapist certified by the American Association of Sexuality Educators, Counselors and Therapists and author of "The Leather Couch: Clinical Practice with Kinky Clients." "They know it’s dangerous, and the choice to engage in a dangerous activity builds trust and love between them.”

Just how risky is it?

Choking during sex can be fatal. In 2019, a 19-year-old New Jersey woman died during the act, and thousands more die each year from suffocation, which was the fourth-leading cause of preventable death in 2019, according to the National Safety Council. Not only that, but AEA results in up to 1,000 deaths per year in the U.S., based on findings from a 2016 study in Case Reports in Psychiatry.

Aside from the risk of death, choking has other side effects. "The most common form of consensual strangulation actually doesn't focus on restricting airflow," said Goerlich, "but rather on temporarily cutting off blood flow through the carotid arteries to the brain."

Feelings of dizziness, lightheadedness, loss of consciousness and potential brain damage or cardiac arrest can occur as a result, according to Goerlich. Using toys, belts or bodyweight to restrict a person’s airflow may result in trachea injuries, the full impact of which may not be immediately apparent until after a sexual encounter is over, she added. A 2021 review published by Neuropsychological Rehabilitation found PTSD, depression, dissociation and suicidal thoughts could also be side effects of non-fatal strangulation.

Even within the kink community, choking is controversial, and there are disagreements about whether it should be considered "breath play" at all. "I believe choking to be an entirely separate practice and wildly more dangerous," said Nina, a breath-play practitioner for about 25 years and co-moderator of the /r/breathplay subreddit, which has more than 6,000 subscribers. Her fellow moderator, Vicky Devika, added that “the risks are much higher [with choking or strangulation practices], whether you are playing solo or with a partner. I don't practice choking [or] strangulation and do not advocate for it.”

According to both Nina and Devika, breath play is a practice that involves modifying breathing patterns, which may happen through rebreathing the same air as a partner, or using devices—such as plastic bags, special masks, hoses and/or medical gear (such as ventilators or O2 concentrators)—to restrict or control breathing but not dangerously cut it off, as can happen with choking.

Additionally, there are legal risks to take into account. Most states in the U.S. consider strangulation a felony, and while being interested in erotic choking does not automatically make someone an abuser, non-consensual choking is often considered a strong predictor of homicide for women, according to a 2008 study by the Journal of Emergency Medicine. Even more startlingly, a 2003 study by the National Institute of Justice found that women who had been non-consensually strangled by partners were 10 times more likely to be killed by them.

Choking can also be a source of fear. Close to a quarter of women in the U.S. felt scared during sex at one point in their lives, according to a 2019 study by the Journal of Sex and Marital Therapy, and 23 of the 347 female respondents said this was because their partner tried to choke them unexpectedly.

Can you safely incorporate choking into sex?

"Education is always the key and never play alone," advised Nina, when it comes to exploring breath play. Make sure you have the tools to create a comfortable sexual space before introducing breath play into the bedroom. Creating a safe word (which will stop all play immediately) and/or using a safe gesture (like holding up a finger) can be essential during play sessions.

However, the potential dangers are always there, especially if you’re not engaging in breath play as Nina and Devika describe it, but in choking. "[Choking during sex] is an incredibly high-risk activity with very little room for error before causing significant damage to the receiving partner," Goerlich explained. "It is really important for everyone to understand that there is no safe way to engage in breath play or consensual strangulation."

Talking with a partner about the act and pinpointing what it is about choking that arouses you could help you and your partner explore alternatives. If it’s the sense of helplessness, loss of control and the feeling of closeness that choking can produce, there could be other forms of kink—such as tying someone down (not by the neck) or restricting their hands—that can help you explore that fantasy, without the same measure of risk. Writing or reading erotica together might also be a sensual way to explore the fantasy.

However, if your partner is the one who’s interested in choking during sex but it makes you uncomfortable, it’s okay to say no or keep it confined to the realm of fantasy. “There are some things that can be really erotic to imagine that don't ever need to be acted on,” Goerlich said.

Erotic choking isn't something to take lightly and could result in the potential for injury or death. If you’re still interested in exploring it with an enthusiastic partner despite knowing all of these dangers, be as careful as possible. After all, you might not get a second chance to do it right.