many young people mistakenly believe it can be done safely, our study shows

Around 50% of Australian young people have engaged in choking, or strangulation, during sex. This practice involves one person putting pressure on the neck of another, restricting breathing or blood flow (or both).

Strangulation during sex carries a variety of risks. These range from effects such as bruising and vomiting to brain injury and death.

Although rare, strangulation is the leading cause of death in consensual BDSM play.

There’s no evidence there is any safe way to undertake strangulation. Notably, strangulation can cause injury without leaving any marks and sometimes negative consequences don’t develop until well after the choking episode.

In a new study, we’ve found part of the reason why strangulation during sex is so common may be because many people mistakenly believe that, while risky, it can be made safe through moderating pressure and appropriate communication.

But stopping blood flow to the brain can take less pressure than opening a can of soft drink. And research shows strangulation can result in serious harms even when it’s consensual.

Surveying young Australians

In 2023, we surveyed a representative sample of 4,702 Australians aged between 18 and 35 about their experiences and opinions of strangulation during sex.

In 2024, we published a study about the prevalence of sexual strangulation based on the results of this survey. We found 57% of participants reported they had been strangled during sex, and 51% had strangled a partner.

At the end of the survey, we asked respondents:

What are your thoughts or insights regarding choking during sex?

For this new study, we wanted to understand perceptions around sexual strangulation. More than 1,500 participants commented on issues related to safety in their responses, and we analysed these.

Many mistakenly believed choking could be safe

It was concerning to us that many of the respondents seemed to believe sexual strangulation can be done safely. Most commonly, participants perceived it to be safe when done with a low level of pressure applied to the sides of the neck.

One participant, a 31-year-old straight man, said:

My partner likes a firm hand on the throat but more so not choking off the windpipe, but lightly restricting the blood flow when she can feel an orgasm building up.

A 24-year-old straight woman commented:

I think there should be a conversation before hand about how hard and how much pressure.

Some respondents suggested it was safe to hinder blood flow, rather than oxygen flow. However, restricting blood flow to the brain can also have serious health implications.

While not all pressure on the neck will be fatal, research shows even relatively low pressure can cause death by strangulation.

Also, if the person using strangulation or being strangled has used alcohol and other drugs, differences in pressure may be more difficult to discern, increasing the risks for the person being strangled.

Read more: More than half of Australian young people are using strangulation during sex: new research

Communication and consent

Participants also linked safety – whether emotional or physical – to consenting to sexual strangulation. As a 32-year-old straight woman wrote:

If between two consensual adults who have discussed it prior with a safety plan in place then I do not see any harm in the act however I have been subjected to non consensual choking in a previous sexual encounter which left me angry and scared.

A 23-year-old bisexual woman said:

As long as both parties agree to it and the amount of pressure, it can be an enjoyable experience. Consent must be given.

In general, consent was seen as an ongoing process, where it could be withdrawn at any point. A 32-year-old straight man said:

Should be strictly base on consensus, be aware of your partner body language and breathing and ask them whether they want to continue the activity or not if they say no respect it and back off.

However, research has found a person being strangled may not be able to withdraw their consent using gestures or words, despite wanting to.

Several participants did comment on the limitations of consent as a harm-reduction mechanism, acknowledging that even where it was consensual, strangulation during sex could cause damage.

Worryingly, several respondents expressed concern that consent was often overlooked, intentionally or accidentally. A 35-year-old straight woman said:

The amount of men who just initiate it without asking the woman is scary and they feel entitled to do so.

Some respondents – usually women, but not always – identified pressure to engage in strangulation (both to be strangled and to strangle their partner). A 24-year-old straight man said:

I get scared to do it but my partner kinda makes me feel like i have to sometimes.

A need for better education

Studies from other countries such as the United States have also shown a misunderstanding of the potential dangers of sexual strangulation, and a false perception that it can be safe if undertaken with the “proper precautions”.

Previous research has shown young people commonly learn about sexual strangulation through online pornography, social media and each other. Information from these sources is often misleading.

While consent is a crucial part of any sexual activity, it doesn’t make strangulation safe. Neither does relying on regulating the pressure applied.

It was positive to see many respondents in our survey identified a desire for more information about sexual strangulation. Accurate information about the risks associated with sexual strangulation should be easily available both online and through public health campaigns.