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Breathe: Risks, Realities, and Safer Alternatives to Choking and Breath Play

CONTENT NOTE: We very strongly advise against any kind of intentional choking, sexual⁠ or otherwise. By that, we mean obstructing your own or someone else’s throat or limiting or stopping the ability to breathe on purpose. It is incredibly dangerous, all the more so when done alone without another person present, when done in certain ways, and when anyone involved is in any way abusive. Recent studies exploring the prevalence of sexual strangulation have drawn widespread attention to these practices, with experts commonly stating that there is no safe way to practice. While the authors agree with this statement on the whole, we also acknowledge that people of all ages and genders will continue to be curious about, practice or attempt to practice various kinds of breath play, including choking. This article is not an endorsement of any activities. We acknowledge and want to make very clear that, as with many sexual activities, there are no zero-risk ways to physically engage in breath-play.

Perhaps a partner⁠ has brought up choking with you as something they want to try, or maybe you're interested in choking and want to know more. Perhaps you’ve heard about sexual choking and just want to know what the deal is with it. There's a lot to unpack about sexual choking. We are going to share some of the science, including some very real dangers, and offer some guidance, to help anyone make informed decisions in this arena to ensure safer, healthy, consensual and mutually-enjoyable experiences alone, or between themselves and any partners.

Recent studies have shown that sexual choking (also known as: breath play, strangulation or erotic⁠ asphyxiation), the act of blocking airways for sexual pleasure, has become more popular recently, especially among young adults⁠ A recent study in Australia found that out⁠ of 4702 individuals 18–35 years old, of all genders, a total of 57% reported being sexually strangled. Another study done in 2021 of 4254 randomly sampled American students, at both the undergraduate and graduate levels, found that among those with any partnered sexual experience, 43.0% had choked a partner, 47.3% had been choked, that the mean age of first choking/being choked was about 19, and that more undergraduates than graduate students reported first choking/being choked in adolescence. That study also found that women, transgender⁠ and other gender⁠ -expansive participants were significantly more likely to have been choked than cisgender⁠ men.

A normalization of sexual choking has been growing, where choking is viewed more positively and as risky but – falsely – as somewhat safe. Please understand that the problem with choking isn’t a moral one: an interest in or being turned on by the idea or act of consensual breath play isn’t something for anyone to be ashamed about, it’s just that actually doing this can be incredibly dangerous. That danger is the sole reason why we advise against it.

Research by Giselle (one of the authors of this piece) and her colleagues at Edith Cowan University in Australia explored the perspectives of pornography⁠ and the sexuality education of people between the ages of 11 and 17. While chatting about pornography and the effect porn may have on sexual scripts, a number of teens discussed sexual choking and reported that some of them and their peers have taken part in choking. Those interviewed recognized that there was room for danger, given their peers did not know how to practice the activity in ways they considered (whether they actually are) safe. Some expressed a desire⁠ for more support or resources on how to engage in choking or things like it without causing harm. We had a hard time finding those resources.

It’s apparent with all these studies that choking is a fairly common sexual practice, that people of all ages can and will engage in it, and that everyone could benefit from information about it that is more balanced and relevant than what’s currently available. We’ve collated and created the following information to consider a harm-reduction lens when thinking about sexual choking. We talk about why people may want to engage in choking and other activities like it, why it can be so dangerous, and offer some safer ways to explore this kind of activity if it’s something you or someone else you know wants to do.

Why choking?

Choking and other kinds of breath play involve multiple methods to block airways or restrict or otherwise change the usual intake of oxygen. Breath play may include choking but can include an array of activities that restrict the ability to breathe.

People who want to choke or otherwise restrict or explore limiting the breathing of others may want to for a number of reasons: they may want to play with power dynamics; to enjoy feeling a sense of control with or over someone else or a loss of control, if they are the one whose breath is potentially being restricted or otherwise played with; to enjoy stimulating a partner’s neck, or providing a partner feelings of lightheadedness and the release of chemicals that happen when engaging in breath play; or because they feel aroused by the idea of an act often considered high-risk, taboo or forbidden. 

It’s very important to note that a substantial  number of  people want to do this to others to control them in an abusive, unhealthy, and often non-consensual way, to scare them, or to intentionally do them harm. In fact, “Strangulation in any context is known to be the biggest predictor of homicide later on by that partner. In a study of homicide victims killed by an intimate partner, it was found that 43 percent had experienced a non-fatal strangulation by their partner prior to their murder. In attempted homicides by an intimate partner, 45 percent of victims had been strangled before the attempted murder. Researchers in the study…determined that being strangled by a partner even one time increases a victim’s risk of homicide by that perpetrator over 600 percent.” Choking is always a dangerous practice, but its appearance in relationships can potentially be a strong signal that the relationship⁠ itself is already or is becoming dangerous.

anatomical illustration of the anatomy of the neck and throat
Illustration: Jesse Pyles, UN|HUSHED Design Team

Any ethical and informed sexuality educator, medical professional or practitioner of these activities will advise that there is no 100% safe way to engage in breath play. Because of the delicacy of the anatomy⁠ of the neck and throat, especially the front portions, it can take alarmingly little pressure or time spent choking – mere seconds, sometimes – to create very serious injuries, stroke and even death. As explained in this recent piece in The Guardian, “The risks associated with sexual strangulation include the obvious: death. Women [editor’s note: and people of all genders] have died in this way. But there are numerous other risks, including long-term changes in the brain that can occur whether the person being choked remains conscious, as well as miscarriage⁠ , thyroid injuries and short-term impacts including vomiting and loss of bowel control.”  Sexual choking also poses risks of larynx (the voice box, just above the trachea) and hyoid (one of the delicate bones of the neck) damage, long-term breathing problems due to aspiration, hematoma, and cardiac arrest.  So, you can probably see why, just like we advise people against, say, ways of engaging in sexual intercourse⁠ that pose big risks of serious harm, we’d advise against many ways of doing this. At the same time, we know some people may still want to explore this kind of play, and sometimes still will regardless of the safety risks. Where we find middle ground with this kind of situation is by utilizing harm reduction frameworks, and suggesting ways people can experience or explore the same kinds of feelings and dynamics in safe or safer ways, just like we use harm reduction to help people engage more safely in kinds of sex⁠ that present risks of sexually transmitted illness.

Safety Frameworks

In Giselle’s research it was clear that sexual media can show activities often considered to be part of BDSM⁠ /kink without any of the very important safety parameters which many informed BDSM practitioners and communities consider essential and often engage in. Because most sexual media is created both for entertainment and for profit, it doesn't tend to provide good education about risk, and may even depict certain acts that are high-risk as risk-free. Depictions of sex in porn and other media rarely show things like negotiation, other kinds of active consenting, aftercare, safety or communication before, during or after.

One of the things that many kinds of sexual or sexualized media – be it in porn or a billboard fragrance advertisement – tend to be terrible at is presenting any real processes of consent. Since our whole world still largely does a substandard job of modeling and teaching consent⁠ , and all the more with any kind of sex considered kinky⁠ or unusual, this can be a real double-whammy. No matter the activity, and regardless of whether you consider it part of kink or not, active, freely-given, fully informed mutual consent is one of the things that best reduces harm and decreases risks with any sexual activity, and it also happens to be something frequently absent, incomplete, or outright ignored with choking in media and IRL.

There are also a number of frameworks and guidelines that exist within and outside the kink community that can assist in ensuring safer, consensual sexual experiences, whatever the kind of sexual activity:

  • Using safewords, including a safeword⁠ that isn't spoken words at all, but gestures, are one of those frameworks. Verbal cues may not always be possible or useful with some kinds of play. It may work better to use a gesture or signal to sign to a partner to stop (for any reason). Tapping, raising a hand, holding a tennis ball and releasing it to signal to stop or any agreed upon gesture beforehand are kinds of gestures that can help to communicate limits and be recognized as a symbol to immediately stop any activity.
  • RACK⁠ (Risk-Aware Consensual Kink) and SSC⁠ (Safe, Sane and Consensual)
  • Aftercare can be applied to any kind of sexual activity, and we believe, should really be administered after every sexual experience. There is a framework from the kink community (but that is by no means exclusive⁠ to kink or any one kind of sexual role), known as ‘sub drop’ . It follows the idea that what goes up, must come down; that after sexual play, often-euphoric highs of engaging with power dynamics in consensual ways, potentially including orgasm⁠ and the headspace of submission, there will be a coming-down’ effect when elation dissipates and a person comes back to the reality of their daily life. Aftercare can involve things like bringing water to a partner, affirmations, sweet talk or cuddling or asking how they felt during the scene. Aftercare can also look like reaffirming your relationship, checking in days after the experience, or physical check-ins like checking restraint marks and any potential abrasions. In the event that any injury, even minor, does occur with any kind of play, this sexual first aid guide may also come in handy for that arena of aftercare.

How can you achieve the same kinds of feelings choking can elicit?

Before we get into that, let’s start where we need to with any sexual activity. Let’s talk about desire, consent and whether you or another person really wants to do this.

What we want to do sexually with partners, whatever our age, tends to be based in a variable mix of what we like and want for ourselves, and what our partners want for themselves. It’s important to consider what we want to experience together, and what we think we should or shouldn’t do based on a whole host of influences: our families, friends, media of all kinds and other sources. Sometimes we agree to do things that a partner wants to do when we don’t know yet if it’s something we want or will like, and are curious to try and see how we feel about it.  There can also be partner or peer pressure to engage in choking. This can be due to perceived or real social caché in engaging in high-risk sexual activity, or felt pressure to meet all of a  partner’s desires.

You might find yourself impacted by wider society and feel this is something you should do, rather than something you actually want to do. This can sometimes be a really difficult distinction to make, as sometimes we are so heavily impacted by the world around us, it’s hard to tell, ‘what is it, that I truly desire and want’. Where introspective skills like self-reflection, journaling and tuning in to what you want, regardless of anyone else, can be useful.

You might also have experienced times when you’ve agreed to do something with or for a partner when you already know you aren’t interested in it, that it just isn’t your thing, or even when you know you don’t like it at all. There are a bunch of different reasons we can find ourselves in that situation. You might have the belief that if a partner wants something, you’re either obligated to do it (you’re not, ever, for the record) or worry that if you don’t, your partner will break up with you or seek out another partner who will do the things they want. You might even just want to please your partner, something most of us want in our sexual interactions and relationships. You might have been raised to (falsely) believe that people of a certain gender or certain role in a relationship are supposed to say yes to anything a partner wants, regardless of what they want themselves or even feel safe doing.

You might be being pressured by a partner to do sexual things that they want, a dynamic that’s sometimes all the more likely if and when a partner wants to do things to have control over you. Activities like choking and other kinds of restraint are common choices for people who want to dominate or control, and that can be the case when those desires are in the context of healthy interactions or relationships, but also when they are part of abusive dynamics.

Doing something because we feel obligated or pressured, or because we have been coerced or forced is never an emotionally safe or healthy situation. When coercion or force is combined with activities like choking that are unsafe in and of themselves, it’s a very, very unsafe situation. If a partner is pressuring you in any way to engage in choking with them, we not only encourage you to say no and set a hard limit around it, we encourage you to reconsider being part of that relationship as a whole. If you want a guide to checking in on the general health and safety of your relationship, you can look at this one here.  If you want help making a safety plan so you can most safely leave a relationship, this piece can help you do that.

Okay. If this is something everyone potentially involved wants to do, how can you achieve the same kinds of feelings choking might create without engaging in choking?

Because there is no safe way to practice choking or strangulation breath play, we recommend people consider engaging in alternate activities that do or might bring about similar effects but don’t carry the same level of risk. As with any kind of sexual activity, these all still require pre-negotiation, a discussion of limits and boundaries and communication⁠ throughout (some additional frameworks listed towards the end of the article) and ongoing consent.  Here are some suggestions we have for how you and your partner(s) can play instead:

If you’re interested in choking because of the power dynamics it can involve:

Power dynamics is a term we use to talk about how the power each of us has as an individual can or does play out with others, including in our sexual interactions or relationships. Power play or power exchange are ways of exploring power between people sexually, and for many people who like or want to do that, that includes dynamics like domination and submission, controlling or the loss of control, or directing or following someone else’s directions. There are many ways people who explore those dynamics do so, and you can through any kind of activity, but doing so through restraint – and restricting breath falls under that umbrella – is one popular avenue. There are a number of ways that power dynamics can be played with without restricting oxygen. You can act out a scene⁠ with roleplay, play with safer kinds of restraint (like safe rope, scarf or tie play, or a partner holding parts of the body with their hands that are much less delicate than the throat), or use a collar for both feeling sensation around the neck and a sense of ownership or being owned.

If you’re interested in choking because of how it feels to have your neck stimulated:

The neck – which is full of sensory nerve endings, so it’s no wonder many people like sensory play that involves the neck and throat – can be stimulated in many safe ways, like light tickles, gentle massage, the use of feathers, ice, heat or other objects to create different sensations on the neck (and other areas of the body), or with the lips and tongue. Holding the neck without applying any pressure or choking can also be just as arousing as choking and, for those who are looking for this, can still allow for a sense of being controlled or dominated, or controlling or dominating. The back of the neck is also much less delicate than the front of the neck, where the windpipe is, so if someone wants more sensation or deeper massage, the back of the neck can be a much safer way to explore those things. Just keep in mind that the cervical vertebrae – the bones of the spine in the neck– is also the most delicate part of the spine.

If you’re interested in choking because you or a partner like how it feels sexually to do something considered taboo or that's high-risk:

Sexually risky sexual activities or those that feel forbidden can feel dangerous, vulnerable or naughty, and those aspects can feel exciting, just like other things in life that are risky or forbidden can feel exciting. There are other ways to explore those kinds of feelings or dynamics that are safer than choking, though. CNC (Consensual Non-Consensual) role play – where everyone is actually consenting but are role-playing nonconsent – can be one way to safely do things that feel taboo or risky. Since we still live in such a largely sex-negative culture, finding a range of activities that can feel like you shouldn’t be doing them can actually be pretty easy. Things like pegging, strap-on play, anal sex⁠ , perhaps even some kinds of oral sex⁠ .

If you’re interested in choking for the feeling of being constrained:

Consider other, safer means of restraint, like using hands to hold down more resilient body parts like the forearms, thighs or ankles, mattress restraints, and safe items like scarves or ties, always tied loose enough to keep someone’s circulation flowing just like it would be without any restraint. These safety tips from Pleasure Mechanics are also clear and easy to keep in mind, and this thread right here on our boards may also prove helpful.

If you’re interested in choking because of the intimacy and trust involved:

As above, safe restraint is also a useful way to play with trust, intimacy, surrender and risk. Role play can also meet this need. It is worth mentioning here that engaging in any such play involves a high level of trust, so these activities may not be suitable with someone you just met or an otherwise brand new sexual partner⁠ . The level of trust required just means an established, ongoing relationship(s) may be better suited to these activities.

If you’re interested in choking for  feelings of lightheadedness and euphoria that can come from breath restriction:

The allure of sexual choking and breath play can often be the restriction of oxygen  known as erotic asphyxiation or autoerotic asphyxiation (when playing by oneself). Oxygen deprival can trigger⁠ a chemical release which can feel euphoric, and it may feel as if this can’t be met without obstructing the trachea and carotid arteries.

However, there are ways to engage with alternate sexual activities that can elicit these feelings and sensations instead of choking. For example, chest compressions can make a person whose chest is being compressed feel euphoric and have a feeling of losing breath. Holding your own nose closed or having a partner hold your nose can also elicit similar physical feelings and still involve trust, intimacy and the feeling of a loss of control.

Different objects that still permit someone to breathe – like a surgical mask, stockings, or gauze – can also be carefully used to obstruct the mouth, and activities like sitting on someone’s face or using breasts on the face for this end are other options.

If you’re interested in choking to experience pain-as-pleasure:

Integrating forms of impact play, like spanking or striking less delicate parts of the body – like the buttocks, thighs, forearms, or upper back (but below the neck) with the hands or other object used safely can be a way to explore and experience pain-as-pleasure sexually with much lower risk than anything to do with the neck. You can also use something like a TENS unit for safe electrical play (though this is also something where it is not safe to use on the neck, nor the brain, heart, eyes, or genitals⁠ ), or safely use things like a wartenburg wheel, ice, or nipple clamps that can also provide sensations of pain-as-pleasure much more safely than choking. Always communicate with your partner about the level of pain you, or they, expect, want, and can handle.

Remember! Sexual fantasy is always a great way to make something part of our sexual activities that isn’t safe to do in action. 

Thoughts about choking don’t and can't do anyone harm: it’s actual choking that has the potential to cause serious harm.  So, if the idea of choking or being choked is exciting to you, this is always something you – or you and a partner, both – can fantasize about during masturbation⁠ or sex with partners. If you are fantasizing with someone, you can tell each other what you’re thinking out loud as you are fantasizing to enjoy that fantasy together safely (but you also don’t have to: it’s okay to keep fantasy to yourself during sex with partners if you like that better). That’s also a way you can engage in this and many other kinds of activity virtually or long-distance.


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