Sexual strangulation is sometimes referred to as choking. However, there is a difference between strangulation and choking.

Choking refers to a blockage of the airway from inside the neck, (such as food, toys or even a penis.)

On the other hand, sexual strangulation specifically involves putting external pressure on the neck using body parts (such as hands and forearms) or other items (including things known as ‘ligatures,’ such as ties or ropes).

While many people refer to their experiences of sexual strangulation as ‘choking,’ Breathless refers to ‘strangulation’ both because it is more accurate and because the alternatives, including ‘choking’ and ‘breath play,’ can obscure the reality – and the seriousness – of the practice. But we also recognise that because many people may not have thought about their experiences as ‘strangulation,’ using this term may make it difficult for some people to see the campaign’s relevance to them. Working out the best language to use on this issue is challenging and is always compromised in some way.

Here’s what sexual and reproductive health researcher Professor Debby Herbenick has to say about the language around sexual strangulation.

No. Strangulation does not always result in visible or obvious signs of harm, but that doesn’t stop damage from occurring.

There is a whole range of health consequences related to sexual strangulation that aren’t visible, including headaches, blurry vision, depression, anxiety and impaired cognitive functioning. Strangulation can also cause serious injury to any of the internal structures of the neck, such as the blood vessels, airway and thyroid gland without showing any visible signs on the outside of the neck. This internal injury can cause serious health problems and even death.

People may not link their physical, mental and emotional health symptoms to sexual strangulation. The risks can be cumulative – meaning that the damage increases over time with each instance of strangulation.

Whether or not there are signs of damage, there can be value in getting support from an appropriate service or medical practitioner after experiencing strangulation.

In this video, sexual and reproductive health researcher Professor Debby Herbenick explores some of the hidden risks of sexual strangulation.

Some people say that blocking the blood flow to the neck – often referred to as ‘blood choking’ – is a safer way of engaging in sexual strangulation. But this is not the case.

Medical strangulation experts assert that there is no safe way to strangle – regardless of whether blood flow or air flow is blocked.

In this video, clinical neuroscientist Associate Professor Keisuke Kawata discusses the function and importance of the blood vessels in delivering oxygen to the brain. As he explains, cutting off blood circulation to the brain is not a safe alternative to blocking airways because the oxygen that our brains need is carried in our blood – the oxygen is transferred from our airways to our blood and then transported to our brains. Without the oxygen and the blood that supplies it, our brains can be harmed. And the risks increase the more often it occurs, even with low levels of pressure.

There is a whole range of information available online about sexual strangulation. Unfortunately, most of this content isn’t developed by people who understand the risks of engaging in the practice.

The medical experts we interviewed have affirmed that there is no safe way to strangle. And the risks are not only at the moment of strangulation. The consequences of sexual strangulation may occur in the minutes, hours, days, weeks and months that follow.

In this video, sexual and reproductive health researcher Professor Debby Herbenick speaks about her research into online information sources that claim to provide safe ways to strangle.

The neck is a critical, yet extremely fragile part of the body. It includes arteries and veins which carry oxygenated and deoxygenated blood between the brain and the heart, an airway that draws air to and from the lungs, as well as the esophagus which is part of the digestive system, and the spine.

Notwithstanding all these critical parts the neck remains particularly vulnerable (especially when compared with the brain which is protected by the skull and the heart and lungs which are protected by the ribs and sternum of the chest).

The idea of safely using external pressure on the neck to deprive the body of oxygen fundamentally misunderstands the complex physiology of the neck, the importance of oxygen to the brain, and the level of unpredictability of the practice.

The risk levels vary for different people due to a whole range of physiological factors – so there is no way of knowing or predicting when sexual strangulation will cause irreversible damage and even death.

Medical experts including forensic medical examiner Dr Jane Van Diemen assert that there is no safe way to strangle.

The significant health risks of sexual strangulation do not disappear if people engage in it ‘consensually.’

There are also questions about whether it is even possible to consent to sexual strangulation given the lack of understanding about the risks and how unpredictable they are. Free and full consent requires being fully informed about potential consequences. We also know that people who have had the blood flow to their brains cut off describe being unable to move when it happens – so even if sexual strangulation started out as consensual, the person being strangled may not be able to stop it if they tried, or even indicate that they want it to stop.

In some places it is illegal to strangle someone during sex, even if the act is consensual. And even when sexual strangulation is not explicitly against the law, whether or not consent has been given may not protect someone from legal consequences that arise as a result of injury or death due to the practice.

In this video, sexual and reproductive health researcher Professor Debby Herbenick explains that there can be legal consequences for sexual strangulation if injury occurs – even when the act is consensual.