Strangulation During Sex: Can You Ever Consent?

This article was originally published in 2024. It was updated in 2025.

Strangulation is one of the most dangerous tactics of abusive partners, and yet for a good number of individuals in non-abusive relationships, what’s more regularly referred to as “choking” is a common kink during sex. According to a 2020 survey of nearly 5,000 undergraduate students at a large U.S. university, 64 percent of women, 29 percent of men and 56 percent of gender diverse students report they’ve been choked during sex. Comparatively, 28 percent of women, 59 percent of men and 58 percent of gender diverse students said they had choked a partner during sex. 

The mistaken assumption is that, if done consensually, strangulation during sex, also known as “sexual choking” or “erotic asphyxiation,” doesn’t hold the same dangers as when strangulation comes as a violent assault. But that’s simply not true, says Dr. Debby Herbenick, Provost Professor at the Indiana University School of Public Health and author of Yes Your Kid: What Parents Need to Know About Today’s Teens and Sex. “Many people don’t know that you can die during strangulation,” says Herbenick. “Very few seek care after choking in sex. They felt better quickly and didn’t see it as a big deal, or it was something they wanted to happen.”

And yet, a partner squeezing one’s neck during sex can kill you—sometimes in the moment and sometimes days later. While the number of deaths from strangulation during sex is still being studied, the number of people who die yearly from autoerotic asphyxiation, or restricting one’s own airflow for sexual pleasure, is estimated to be anywhere from 500 to 1,000 people yearly in the U.S., the majority of whom are white men in their mid-20s. 

Your Brain Cells Are Literally Dying

Jacquelyn Campbell, PhD, RN, a renowned domestic violence researcher and professor at the Johns Hopkins University School of Nursing, has spent more than 40 years immersed in advocacy and education. Yet even with her deep experience, she finds the emerging trend of strangulation “for pleasure” deeply disturbing and almost beyond comprehension. 

“It scares the heck out of me that there are all these TikToks about strangulation enhancing sexual pleasure,” she says.

 The perception of strangulation during intimacy is that it’s a spicy, slightly dangerous kink. But most of the information around sexual choking leaves out one very vital part: as the air and blood flow is cut off to your brain, you are risking permanent brain damage. 

The brain is made up of roughly 86 billion neurons—the specific type of cell tasked with transmitting information in the brain. The “fuzzy feeling” a person gets while being strangled can indicate that these neurons are dying, an irreversible type of brain damage. 

“If we could get that message across somehow—that it is, in fact, happening—that you’re losing oxygen to your brain,” says Campbell. “If you’re doing it multiple times – you’re doing real harm to your partner. I don’t know, to tell you the truth, it really worries me.”

Strangulation of any duration can result in the closure of blood vessels or the airway and can cause major internal injuries that may cause serious long-term health consequences or even death. The carotid arteries and the jugular veins can both be damaged or occluded in a strangulation event and, when pressure is applied to either, the effects can happen in seconds.

After 5-10 seconds, a victim may lose consciousness.

After 15 seconds, a victim may experience loss of bladder control and urinate if pressure is applied after she loses consciousness.

After 30 seconds, a victim may experience loss of bowel control and defecate. 

After 1 to 3 minutes, a person can be killed by strangulation. 

Advocates Say Consent Cannot Be Given for a Potentially Deadly Act

Skydiving can be a deadly hobby, but no one is throwing their date out of an airplane in the middle of sex just for kicks (are they?). If they did, they would likely be charged with attempted murder. 

In the same, but more realistic token, partners cannot be expected to consent to something that could potentially kill them, especially when it’s hard to revoke consent after the partner has been rendered unconscious. 

Casey Gwinn is the co-founder of the Training Institute on Strangulation Prevention, a program of the Alliance for HOPE International. It’s the leading research and training organization on the impacts of strangulation in domestic violence and sexual assault. They train 10,000 professionals a year to recognize, prevent and prosecute strangulation.

“The more we’re learning, these victims are not consensually strangling,” says Gwinn, a former San Diego city attorney. “They say it happens too fast. We’re hearing from hundreds of thousands of women who say, ‘He kissed me and then he grabbed my neck.’ It’s becoming almost instantaneous.”

In a recent survey by the Institute, over 75 percent of the respondents who said they had been strangled during an intimate act report the strangulation was nonconsensual. Over 84 percent said they wanted the strangulation to stop. Only 32 percent said their partner did stop.

For those whose partners continued to strangle them even after being asked to stop, 11 percent reported losing consciousness while others reported terrifying reasons the strangulation came to an end.

Partner lost interest when I wasn't fighting the strangulation.

I think he stopped temporarily when I lost consciousness, and I came back to breathe and then when he tried again I was able to move. I think he thought I was dead.

I acted like I passed out and went limp.

Along with other Institute staff, including co-founder Gael Strack, Gwinn is authoring the first bench book for judges in Florida that includes sections on sexual choking. 

“Probably for the last 20 years or so, there has been a perception among cops, prosecutors and judges that somehow, strangulation during sex is different than a rage-filled assault. If the victim is compliant or doesn’t object or doesn’t try to stop it, somehow it isn’t a legal issue,” says Gwinn

In his line of work, Gwinn has heard a lot of frightening tactics abusers utilize for power and control, but gaslighting women into believing choking during sex is pleasurable is a new low.  

“It has been allowed to say [in court] ‘She’s into rough sex,’ and it has reduced the seriousness of a strangulation charge.”

Strack says that, in her research, many states’ legal definitions of sexual activity don’t include strangulation, therefore, “Sexual choking is not considered sexual activity you can consent to. The minute you apply pressure to somebody’s neck, you have defeated the consent defense.”

Strangulation is considered a felony crime in all 50 states and the three U.S. territories. Strangulation and suffocation laws are also included in Federal, Military and at least 20 tribal codes that have made strangulation a crime, says Strack. The only states that may accept the consensual strangulation defense are Florida, Virginia, Pennsylvania, West Virginia and Kentucky. However, if harm occurs, prosecutors may still pursue charges under other criminal statutes, says Strack. 

In both her and Gwinn’s perspectives, there should be no consent option for applying pressure to someone’s neck. Much like minors can’t legally consent to sexual activity, no one should be able to legally consent to being strangled. 

Even the National Coalition for Sexual Freedom, a sex-positive advocacy and educational organization, does not condone “choking during sex,” says Strack, due to the high number of deaths that occur in the BDSM community.

Individuals who survive strangulation, stay conscious or don’t suffer any immediate effects, still run the risk of a stroke, cardiac arrest or a blood clot days or weeks later, which can be fatal. They also run the risk of a TBI or traumatic brain injury. A mild TBI, which strangulation more commonly leads to, may not even show up on an MRI and CAT scan, and symptoms like headaches, difficulty thinking, memory problems, attention deficits, mood swings and frustration can be easily overlooked or misdiagnosed. The more often a person is strangled, the higher their risk for brain damage. 

“There is the possibility of cumulative harm to the brain … due to the repeated exposure to lack of oxygen, lack of blood flow and glucose, and to the stress of these forms of deprivation,” says Herbenick. But isn’t very gentle pressure safe? Casey Gwinn, co-founder of the Training Institute on Strangulation Prevention along with Strack, says there is no safe way to strangle during sex. 

“It takes only 4 pounds per square inch of pressure to the neck to occlude [close off circulation to] the jugular veins.  Once they are occluded and the carotid arteries keep pumping blood up to the brain, brain cells start to die within 10 to 15 seconds. Externally, little red spots appear called petechial hemorrhages. You can see those.  But if those petechiae are on the outside of skin they are also inside the brain—and that is permanent brain damage.” 

How Did Sexual Choking Become a Trend?

There’s no telling how choking during sex became a thing, but one can only hope this alarming trend will be short-lived. Right now, however, purveyors of social media and pop culture (read: young people) are inundated with references to choking during sex. 

“Teenagers and young adults have largely learned about sexual choking from social media videos, memes, fanfiction, and seeing it in pornography and in popular TV shows like Euphoria and The Idol as well as hearing about it in popular songs like Jack Harlow’s ‘Lovin On Me.’ None of these forms of media are set up to provide fact-based, thoughtful health information,” says Herbenick.

In ‘Lovin’ on Me’ Harlow’s lyrics include the line, “I'm vanilla, baby, I'll choke you, but I ain't no killer, baby,” which has spawned a viral dance trend that depicts individuals holding out a hand to choke someone. Interestingly enough, when men are filmed doing the dance, their hand is often outstretched; when women are filmed, their hands are at their own throat. 

A recent story from the BBC reported boys as young as 14 are asking their health teachers how to “choke” a girl during sex, insisting this was something girls regularly wanted.

"How much harm do we need to see happen before we’re brave enough to have these conversations?” asked Johanna Robinson, Wales’ national adviser on violence against women and girls.

Gwinn says much of the cultural norming around strangulation during sex has come from pornography where strangulation sex videos are now viewed regularly by millions of men and boys. He says the Institute analyzed pornography sites last year and found more than 2.6 million websites that included videos on strangulation during sex.

In addition, young people are being offered a slew of articles that instruct them how to “choke safely” when, says Herbenick, there isn’t such a thing. 

“When they do come across people talking about safety issues, we’ve found in our research that online articles often do not discuss the wide range of short-term and long-term health consequences of being choked during sex. Indeed, many articles about sexual choking say that there is a ‘safe’ or ‘proper’ way to choke someone during sex, even though this is not true,” says Herbenick. Mel Magazine posted an article in 2022 titled, “The Proper Way to Choke Someone in Bed,” which reads, in part, “When it comes to sexual choking, the trick is to aim for the sides of the neck, not the windpipe — it’s made of tissue that can easily collapse under pressure. You want to restrict blood flow from carotid arteries where oxygen-rich blood flows to your head and brain.”

Can’t we just go back to the kama sutra days?

The Institute recently produced its own public service announcement that makes clear that strangulation kills brain cells very quickly–whether it is consensual or assaultive. The PSA focuses on the pressure placed on women in particular to agree to strangulation during sex with no understanding of the profound health risks.

It should go without being said at this point, but there is no “safe” way to be strangled. Anyone who experiences strangulation should be seen by a medical professional immediately, even if they don’t lose consciousness and even if there are no visible effects afterward. 

Strack says the key is disseminating more education and information about this practice. The Advocacy Committee of the Training Institute on Strangulation Prevention is working on producing resource materials for advocates and other professionals to help their to clients understand the medical and legal consequences of strangulation during sex and help them make intelligent and informed decisions. 

The Overlap of Strangulation and Domestic Violence 

Last March, a Texas man admitted to police he and his girlfriend were engaged in erotic asphyxiation during sex but that she became unresponsive as he pressed down on her throat. The 27-year-old woman was pronounced dead at the scene and her boyfriend was charged with manslaughter. The victim’s family said they didn’t believe she would engage in consensual sex with the perpetrator and that he was lying to cover up her murder. 

Herbenick says that because strangulation during sex has become so common, it’s harder to say if it’s a red flag of abuse or just sex trend someone is experimenting with. 

“Our research shows that nearly half of male college students report having choked or strangled a partner during sex. Some do it because they enjoy it, but very often they describe doing it because they have heard that that’s what’s expected of them during sex or it’s what makes for ‘good sex,’” she says. 

The more blatant red flags that Herbenick’s research has uncovered is when individuals say a partner has strangled them with two hands instead of one, or when the person doing the strangulation has “a scary look in their eyes.” There’s also the issue of consent. 

Many survivors of domestic violence say their abusive partners used strangulation during sex without consent. Anyone who engages in strangulation consensually with a partner should know that they can withdraw consent at any time—during the act or in future intimate acts. A red flag for abuse is a partner who doesn’t respect those boundaries or who engages in nonconsensual violent sex.   

According to Casey Gwinn, “Abusers who strangle are practicing for what they’re going to do.” Gwinn says that someone who strangles is showing their partner what they’re capable of—and what they’re capable of is murder. 

Gabby Petito’s high profile murder by her boyfriend Brian Laundrie made news around the world.  She was strangled to death by Laundrie on September 19, 2021 in Grand Teton National Park.  The Institute says they have been working closely with her parents and just learned that Laundrie regularly strangled Petito while they had sex.  

“He was strangling her during sex and some would say that was ‘consensual’ but it should not be missed that Brian Laundrie was practicing,” says Gwinn. “When he decided to kill her, he knew exactly how fast he could do it after practicing during sex with her.” 

 The Institute has also published their research of the Petito case and her interaction with law enforcement in Moab, Utah a month before she was killed. 

“We believe Gabby Petito was not only being strangled during sex, but she was being strangled when Brian assaulted her as well.  Sadly, it appears the Moab Police Department did not properly analyze the history of ‘consensual’ and ‘nonconsensual’ strangulation of Gabby. Their failure to intervene when they had the chance ultimately led to her death,” assesses Gwinn.

Ending the Strangulation Trend

By normalizing strangulation through pop culture and pornography, society has cast it as a male sexual ideal—prompting some partners to participate out of fear of losing the relationship. This dynamic also allows abusers to weaponize strangulation, masking coercion as consensual sex.

While laws can help drive change, Gwinn proposes a different solution to prevent young people from choking each other in pursuit of so-called sexual pleasure.

“The best place to start is not criminalizing everything. The best thing is educating. I think we need a public awareness campaign.”