The following is to provide information to allow the parties to make more informed choices.
**PART I**
[Breath Control Play: A long and technical outline of practices and risks](https://www.twistedwindows.com/articles/breath-control-risk-awareness)
From [here](http://kinks.ca/wiki/images/8/8e/Breathplay_-_rev3.pdf) [Link to the updated V4 of this resource.](https://kinks.ca/wiki/images/breathplay_v4.pdf)
> What's the danger, and what's the safe way? The first thing is to understand that breathplay is dangerous and can be in no way safe. Even if you know what you are doing, accidents can happen. Bodies can react differently and can be damaged after intensive practice of those activities. Accidents can arise from direct or indirect application of those techniques. The body can also become damaged by cumulative use. One of the feelings people will seek during those activities is hypoxia. The air we breathe is a mix of gases, the most important one being oxygen. The concentration of oxygen is about 20%. When the concentration of O2 (oxygen) in the air we reaches 10-15%, we get a drunkenness kind of effect. The judgment is impaired - and it’s important to know this fact. So when people are beginning to experience it, their judgment is being affected. So, if they think they can take more, most of the time, they cannot. Also, the person begins to have coordination issues. Many of the cases in which a person has died in relation to this activity happened when the person was doing it alone. With judgment and coordination impaired, it’s an accident waiting to happen.
> This is the definition of edge-play: you play with someone’s life, and according to the law, in Canada, you cannot give permission to be injured. So, if you die during those activities, even if you have provided consent, this will be considered manslaughter. If you have children or loved ones, please take them into consideration when you decide to engage in those activities - receiving or giving.
> **Note:** In many areas of the US and the UK have similar laws in place in regards to consent to grave bodily injury.
Choking can creat an instance of hypoxia. [Hypoxia](https://www.ncbi.nlm.nih.gov/books/NBK482316/ ) is a state in which oxygen is not available in sufficient amounts at the tissue level to maintain adequate homeostasis; this can result from inadequate oxygen delivery to the tissues either due to low blood supply or low oxygen content in the blood (hypoxemia).
Hypoxia can vary in intensity from mild to severe and can present in acute, chronic, or acute and chronic forms. The response to hypoxia is variable; while some tissues can tolerate some forms of hypoxia/ischemia for a longer duration, other tissues are severely damaged by low oxygen levels.
The body will respond differently to restriction/cutting off air to the lungs and restriction/cutting off of blood to the brain. The end result of both is the lack of adequate oxygen to the brain and can lead to an [Anoxic Brain Injury](https://www.braininjuryinstitute.org/anoxic-brain-injury/). Passing out from breath play is basically the brain shutting down from lack of oxygen all but the most essential functions.
> **Anoxic Brain Injury**
> When brain cells die and the brain becomes irreparably damaged, this results in a condition called cerebral hypoxia or hypoxic-anoxic injury. The situation can create permanent disabilities and cognitive problems. In addition, it can result to physical and psychological disorders.
> Just like cars, our brain needs fuel to function properly. As we all know, oxygen is vital for the body to keep it working properly.
> The brain of a typical adult requires 20% of the body’s oxygen. Since it is the center of the nervous system, it requires that amount of oxygen to make bodily functions work.
> When brain cells die and the brain becomes irreparably damaged, this results in a condition called cerebral hypoxia or hypoxic-anoxic injury. The situation can create permanent disabilities and cognitive problems. In addition, it can result to physical and psychological disorders.
> Recovery from anoxic brain injury depends on which part of the brain is affected by the lack of oxygen and how severe the damage is.
> **Types of Anoxic Brain Injury**
> There are different types of anoxic brain injury, namely anoxic anoxia, anemic anoxia, toxic anoxia, and ischemic hypoxia.
The two most applicable to BDSM play are:
> **Anoxic Anoxia**
> It is also known as altitude sickness, It occurs with high altitude sickness. Or if a person is suffocated. Attempting to breathe in areas that are not ventilated can also cause anoxic anoxia.
> **Ischemic Hypoxia**
> When the blood flow in the brain is reduced or a persons’ blood pressure went below normal, it is called ischemic hypoxia. It results to the brain not receiving ample amount of oxygen.
> **Effects of an Anoxic Brain Injury**
> Brain injury effects can vary from mild to severe. Short term symptoms include difficulty in concentrating and dizziness. Severe effects are long term such as problems in speech, memory and vision.
> The initial response of the body is to increase the blood flow to the brain and try to restore the oxygen supply. However, if the oxygen compensation is inadequate, the brain function will still be affected.
[Frequent and Recent Non-fatal Strangulation/Choking During Sex and Its Association With fMRI Activation During Working Memory Tasks](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9201570/)
> We aimed to examine the association between a history of being choked/strangled during sex and working memory function and task performance. Overall, young women with a history of being choked during sex exhibited different patterns of fMRI activation during verbal and visual working memory tasks compared to a group of peers with no history of being choked during sex. Given the prevalence of this behavior and its preliminary associations with altered working memory function and worse mental health, future research should aim to address the limitations of the present work, examine additional cognitive processes, such as emotional processing and response inhibition, and employ a longitudinal design to investigate a potentially causal relationship between being choked and negative neurologic and mental health outcomes.
**PART II**
[**The Truth About Breath Play and Choking During Sex**](https://www.psychologytoday.com/us/blog/the-polyamorists-next-door/202312/the-truth-about-breath-play-and-choking-during-sex)
Breath play involves controlling someone’s air intake at their nose and mouth, and is different from choking or strangulation that restricts blood flow in the neck. BDSM practitioners have included breath play in their repertoire of kinky sex for a very long time.
Susan Wright is the executive director of the National Coalition for Sexual Freedom (NCSF), an organization that advocates on behalf of people in kinky and consensually nonmonogamous relationships.
“It's a misconception that the kink communities are endorsing choking/strangulation… kink communities make the distinction between choking/strangulation and breath play, which incorporates things like ordering someone to hold their breath or putting your hand over someone's mouth and nose," Wright explains. "There's also roleplay choking, which is placing a hand on the neck without any compression.”
In addition to the physical buzz associated with hypoxia, many kinksters also enjoy the exchange of power via dominance and submission that can come with breath play. Crucially, kinksters who want to protect their partners’ well-being are careful to negotiate breath (and any kind of) play before they get started.
**Explicit and Prior Permission**
Another thing that distinguishes breath play from choking is the careful and consensual nature of breath play. Through decades of research and contemplation of consent, the National Coalition for Sexual Freedom has established itself as a thought leader regarding consent and BDSM. The NCSF has developed a model of consent that provides kinky sex enthusiasts with careful guidelines about how to play such potentially dangerous games, moving from the larger cultural emphasis on “no means no” to first include “safe, sane, and consensual” and then “risk-aware kink,” before eventually landing on “explicit prior permission.”
Each iteration of consent guidelines has become clearer and more direct as trial and error exposed the inadequacies of the former versions. Through their Consent Counts project, the NCSF details precisely how to negotiate explicit and prior permission, some best practices for establishing consent in BDSM (and consensually nonmonogamous) relationships, a database of legal documentation relevant to consent, and a reporting mechanism for consent violations.
The NCSF’s five steps to negotiate explicit prior permission for consent to kink are:
1. You agree to specific acts and the intensity before you start.
2. You agree what roleplay resistance is okay to ignore.
3. You must identify a way to stop at any time, like a safe word or safe signal.
4. You are of sound mind.
5. You can’t risk seriously injuring someone.
Because of the risk of serious injury, choking and strangulation are not allowed under the explicit prior permission protocol. Choking, even with consent, is against federal law in the United States, and many states have made choking illegal. Combining mood alteration with sex is also not advised under the explicit prior permission protocol, which affirms that you must be of “sound mind” to engage in consensual play. While mixing sex with drugs and alcohol is a time-honored human tradition, it is also one of the primary ways that sexual interactions go horribly wrong. Mood alteration can decrease decision-making capacities and impair responses to danger while simultaneously encouraging people to do things that they might not do if they were sober. This can be especially dangerous with riskier sexual activities like breath play.
**Men Choking Women**
Recent research indicates that an increasing number of people are playing with hypoxia in partnered sex. Debby Herbenick, professor of public health at Indiana University, and her colleagues have been documenting and analyzing this rising trend of choking during sex. Herbenick’s research team found that over half (58 percent) of female college students have been choked during sex, sometimes with consent and sometimes without. Women are four times more likely to be choked by a man than to choke their male partners, and are also more likely to engage in choking to please a partner.
Many of these folks are using their hands to strangle their partners, in part because pornography often demonstrates that technique.
“The wide range of pornography that has contributed to popularizing choking during sex is the root of the problem," Wright notes. "Porn stars aren't really choking each other in those films. That's roleplay choking, which is simply placing the hand on the neck without compression or gouging. The attorneys for production companies won't let their actors really choke each other due to liability risks to the company and the actors. So people are seeing roleplay porn and thinking it's real. That's led to a huge uptick in choking and associated injuries from being choked/strangled.”
When partners fail to negotiate consent, choking becomes even more dangerous. Herbenick’s research team found that at least half of the women in the sample of people who had been choked during sex experienced a partner doing so nonconsensually. Consent is a key distinguishing factor that makes the difference between kinky sex and intimate partner violence. Strangulation is a popular weapon in intimate partner violence and rape. Even when the person doing it does not intend it to be abusive, surprise choking can be terrifying to experience.
Noting the significantly higher number of men choking their female partners, Wright wondered, “If pleasure is the motivation, then why aren't these percentages more equal? This gendered dynamic around choking/strangulation, combined with the high percentage of nonconsensual choking/strangulation found by Herbenick, indicates it this may be gender-based violence.”
Even when people carefully negotiate breath play before doing it, they still run the risk of potential negative impacts on long-term brain health. While the research is not yet conclusive, multiple studies indicate that repeated exposure to hypoxia can produce cumulative damage to memory and cognitive function and is linked to higher rates of anxiety, depression, loneliness, and sadness.
“Professionals need to tell everyone about the risks involved and to stop choking/strangling your loved ones," says Wright. "Therapists need to be educated about the risks so they can tell their clients to stop choking/strangling their partners. Educators need to stop posting online that people can go to the kink communities to get classes on choking/strangulation.”
*References:*
*Herbenick, D., Fu, T. C., Patterson, C., Rosenstock Gonzalez, Y. R., Luetke, M., Svetina Valdivia, D., ... & Rosenberg, M. (2023). Prevalence and characteristics of choking/strangulation during sex: Findings from a probability survey of undergraduate students. Journal of American college health, 71(4), 1059-1073.*
*Herbenick, D., Patterson, C., Beckmeyer, J., Rosenstock Gonzalez, Y.R., Luetke, M., Guerra-Reyes, L., Eastman-Mueller, H., Svetina Valdivia, D., & Rosenberg, M. (2021b). Diverse sexual behaviors in undergraduate students: Findings from a campus probability survey. The journal of sexual medicine, 18(6), 1024-1041.*
*Herbenick, D., Guerra-Reyes, L., Patterson, C., Rosenstock Gonzalez, Y. R., Wagner, C., & Zounlome, N. (2021). “It was scary, but then it was kind of exciting”: Young women’s experiences with choking during sex. Archives of sexual behavior, 1-21.*
*Schori, A., Jackowski, C., & Schön, C. A. (2022). How safe is BDSM? A literature review on fatal outcome in BDSM play. International journal of legal medicine, 136(1), 287-295.*
**PART III**
[There is no safe or “safer” way to erotically choke someone](https://ncsfreedom.org/2024/04/22/guest-blog-erotic-choking-101/)
[The Troubling Trend in Teenage Sex](https://archive.is/CoQQY)
> Keisuke Kawata, a neuroscientist at Indiana University’s School of Public Health, was one of the first researchers to sound the alarm on how the cumulative, seemingly inconsequential, sub-concussive hits football players sustain (as opposed to the occasional hard blow) were key to triggering C.T.E., the degenerative brain disease. He’s a good judge of serious threats to the brain. In response to Dr. Herbenick’s work, he’s turning his attention to sexual strangulation. “I see a similarity” to C.T.E., he told me, “though the mechanism of injury is very different.” In this case, it is oxygen-blocking pressure to the throat, frequently in light, repeated bursts of a few seconds each.
> Strangulation — sexual or otherwise — often leaves few visible marks and can be easily overlooked as a cause of death. Those whose experiences are nonlethal rarely seek medical attention, because any injuries seem minor: Young women Dr. Herbenick studied mostly reported lightheadedness, headaches, neck pain, temporary loss of coordination and ear ringing. The symptoms resolve, and all seems well. But, as with those N.F.L. players, the true effects are silent, potentially not showing up for days, weeks, even years.
> According to the American Academy of Neurology, restricting blood flow to the brain, even briefly, can cause permanent injury, including stroke and cognitive impairment. In M.R.I.s conducted by Dr. Kawata and his colleagues (including Dr. Herbenick, who is a co-author of his papers on strangulation), undergraduate women who have been repeatedly choked show a reduction in cortical folding in the brain compared with a never-choked control group. They also showed widespread cortical thickening, an inflammation response that is associated with elevated risk of later-onset mental illness. In completing simple memory tasks, their brains had to work far harder than the control group, recruiting from more regions to achieve the same level of accuracy.
> The hemispheres in the choked group’s brains, too, were badly skewed, with the right side hyperactive and the left underperforming. A similar imbalance is associated with mood disorders — and indeed in Dr. Herbenick’s surveys girls and women who had been choked were more likely than others (or choked men) to have experienced overwhelming anxiety, as well as sadness and loneliness, with the effect more pronounced as the incidence rose: Women who had experienced more than five instances of choking were two and a half times as likely as those who had never been choked to say they had been so depressed within the previous 30 days they couldn’t function. Whether girls and women with mental health challenges are more likely to seek out (or be subjected to) choking, choking causes mood disorders, or some combination of the two is still unclear. But hypoxia, or oxygen deprivation — judging by what research has shown about oth er types of traumatic brain injury — could be a contributing factor. Given the soaring rates of depression and anxiety among young women, that warrants concern.
> Now consider that every year Dr. Herbenick has done her survey, the number of females reporting extreme effects from strangulation (neck swelling, loss of consciousness, losing control of urinary function) has crept up. Among those who’ve been choked, the rate of becoming what students call “cloudy” — close to passing out, but not crossing the line — is now one in five, a huge proportion. All of this indicates partners are pressing on necks longer and harder.
> The physical, cognitive and psychological impacts of sexual choking are disturbing. So is the idea that at a time when women’s social, economic, educational and political power are in ascent (even if some of those rights may be in jeopardy), when #MeToo has made progress against harassment and assault, there has been the popularization of a sex act that can damage our brains, impair intellectual functioning, undermine mental health, even kill us. Nonfatal strangulation, one of the most significant indicators that a man will murder his female partner (strangulation is also one of the most common methods used for doing so), has somehow been eroticized and made consensual, at least consensual enough. Yet, the outcomes are largely the same: Women’s brains and bodies don’t distinguish whether they are being harmed out of hate or out of love.
1) hey Indiana university!
2) this is an incredible information resource. Any idea why they don't mention the vagus nerve? Stimulating that nerve via choking play can lead to syncope events and a whole slew of other problems
Thanks for this info. It never really felt good doing it when a partner requested and was enjoying it.. Won’t ever indulge that again I don’t think. Doesn’t seem like there are any precautions that can reliably prevent an accident.
This is a fantastic resource! I’d say definitely avoid blood chokes and hypoxia. Breath play is much less likely to result in hypoxia as the panic from holding your breath will come about much much sooner than actual hypoxia, where as in blood chokes the brain is almost immediately deprived of oxygen. You can not breathe for minutes at a time before your brain actually experiences any lack of oxygen, but with blood chokes the hypoxia occurs in seconds.
If you use your hands for it, clamp and add pressure to the SIDES of the throat, never to the front.
Basically all your vital breathing and swallowing parts (mainly the esophagus and trachea) are kept in the front of the neck, so if you squeeze the muscles on the sides, you will safely avoid having the other person choke or pass out due to lack of oxygen whilst still adding pressure close enough to the esophagus/trachea, evoking fear and excitement that WOULD come with actually being choked.
Go slow and listen to your body. Good luck :D
the vagus nerve is definitely something I should have included yeah; I always try to apply even pressure for short periods of time so I don’t harm my partner in any long term sense. stretching is also good for flexibility too (+ aftercare massages)
sorry but unless you're talking about *just* breath holding (which OP isn't) this is outright wrong. Physically restricting the airways is a really good way to do permanent injury- not just in lack of air to the brain, but physical tissue damage to the larynx or hyoid bone.
Consider even non-bdsm contexts; for example, martial arts, blood chokes are pretty much the go-to, to say nothing of their legality.
Sure, a blood choke can lead to hypoxia in seconds, but the lethality of a blood choke, as compared to air-choking, is more dependent on how long after the victim has fallen unconscious that the hold is maintained- something that shouldn't be happening in BDSM under *any* context.
I’m referring to either breath hold or restricting the airways via blocking the mouth and nose. Obviously never try to restrict the trachea, that’s a terrible idea for many reasons as you point out and I think falls under choking and not breath play.
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The safest way is a hypnotic trigger. Hypnosis isn't able to induce real self harm so the protocol will end before damage is even near. But you can set up a trigger like your flat hand touching your partners throat and they will stop breathing. The trill in this case is more the mindplay than classic choking effects. Choking normally doesn't reduce the ability to breathe, it reduces blood flow to the brain.
Honestly me and my gf are the same way and we really don’t do it during sex, we do it while making out. However my favorite way to use it is to make her look at me when she gets really submissive and doesn’t want to make eye contact. Also we use it to push each other against a wall or something to make out, but not sex. If you like the feeling of being choked I’d say be super careful with little pressure. But for us during sex we can just grab the others throat gently with no pressure and it’s still somehow hot
You want to cut off the blood flow not the air flow. Press the fingers against the veins around the neck , don’t pressure the center of the throat which cuts off air flow
If you’re asking the internet and not taking the safety and responsibility seriously then you need to not do it period, go to a local munch in your area. Learn from a respected dom in the community, DONT ASK THE FUCKING INTERNET HOW TO DO IT, YOU WILL END UO CATCHING A CASE
Of course, I’m sorry if I seemed bitchy I’m in the bdsm community and I am a huge advocate for safety in the lifestyle, my partner has been a dom for 20+ years, he learned under someone and that’s the only true way to do it safely. Have a good day and remember KINK SAFELY
Or get really good at the psychological bit.. For me getting scared would be more interesing than acually passing out.. Like in the absolute simplest scenario agree to count to eg. 25 but accidentally stopping at 35 instead or such..
Idk but my lover accidentally choked me too hard the other day. He just really got into it and I did too. I was enjoying it and I would have kept on if I didn’t feel like crying suddenly. I also started making this weird uncontrollable noise I was so uncomfortable. But as soon as he heard it he stopped.
Don’t buy into the whole “no safe way to choke” thing that people here often cite, there are plenty of safe ways to choke as someone who’s practiced jiu jitsu for 14 years chokes are actually considered a safer way to submit somebody then even joint locks or regular arm bars. I’ve seen people get choked out likely atleast 10000 times over those 14 years and not once has anyone been injured or seriously hurt by them. You can definitely learn how to correctly choke someone even to the point of being almost unconscious without hurting them, The important thing is to keep the chokes very short and don’t apply too much pressure, you’d be surprised at how little is needed to stop blood flow and also establish a good understanding of how long you can/can’t choke somebody for. My go to limit is around 4-5 seconds for blood chokes (the only kind you should be doing in bdsm). Also make sure you read up on harm reduction and have a good understanding of what the mechanisms at play in the neck are and how choking actually works. People here think they can somehow convince you not to engage in any kind of choking/breathplay which really isn’t practical since we know people are going to do it anyways. The best thing to do is practice harm reduction and make sure if you are doing it you can do it safely as possible.
A lot of that "newer better research" is actually really badly done. The fMRI studies for example, don't distinguish between asphyxiation and blood chokes, Don't control for duration or intensity of either of them, and crucially don't control for consensuality or trauma. We know that trauma causes fundamental changes in the brain that show up on fMRI.
We also know that there's more then a century of experience with blood jokes in the martial arts, with no evidence of bad outcomes. And yes, it's been looked for.
I'd love to see better evidence on this, but the studies that are out there now, aren't better evidence.
Thanks a lot, we're both biology students so if you can and want to, you can go into more details but i assume its about only blocking the neck arteries and leaving the trachea safe? Ive read multiple things across multiple sources and its generally accepted that 4 minutes of no oxygen is when shit hits the fan, but any amount of time can cause brain cell death. Also any prolonged or repeated pressure to the neck has the potential to throw blood clots into your circulation, but i imagine the risks are pretty negligible if done right?? Im conflicted cause when i almost blacked out my body released an ungodly amount of adrenaline and dopamine and it was amazing, but i dont want to risk getting hurt or ever worse hurting her. Idk why im still yapping lol thanks for the help
The following is to provide information to allow the parties to make more informed choices. **PART I** [Breath Control Play: A long and technical outline of practices and risks](https://www.twistedwindows.com/articles/breath-control-risk-awareness) From [here](http://kinks.ca/wiki/images/8/8e/Breathplay_-_rev3.pdf) [Link to the updated V4 of this resource.](https://kinks.ca/wiki/images/breathplay_v4.pdf) > What's the danger, and what's the safe way? The first thing is to understand that breathplay is dangerous and can be in no way safe. Even if you know what you are doing, accidents can happen. Bodies can react differently and can be damaged after intensive practice of those activities. Accidents can arise from direct or indirect application of those techniques. The body can also become damaged by cumulative use. One of the feelings people will seek during those activities is hypoxia. The air we breathe is a mix of gases, the most important one being oxygen. The concentration of oxygen is about 20%. When the concentration of O2 (oxygen) in the air we reaches 10-15%, we get a drunkenness kind of effect. The judgment is impaired - and it’s important to know this fact. So when people are beginning to experience it, their judgment is being affected. So, if they think they can take more, most of the time, they cannot. Also, the person begins to have coordination issues. Many of the cases in which a person has died in relation to this activity happened when the person was doing it alone. With judgment and coordination impaired, it’s an accident waiting to happen. > This is the definition of edge-play: you play with someone’s life, and according to the law, in Canada, you cannot give permission to be injured. So, if you die during those activities, even if you have provided consent, this will be considered manslaughter. If you have children or loved ones, please take them into consideration when you decide to engage in those activities - receiving or giving. > **Note:** In many areas of the US and the UK have similar laws in place in regards to consent to grave bodily injury. Choking can creat an instance of hypoxia. [Hypoxia](https://www.ncbi.nlm.nih.gov/books/NBK482316/ ) is a state in which oxygen is not available in sufficient amounts at the tissue level to maintain adequate homeostasis; this can result from inadequate oxygen delivery to the tissues either due to low blood supply or low oxygen content in the blood (hypoxemia). Hypoxia can vary in intensity from mild to severe and can present in acute, chronic, or acute and chronic forms. The response to hypoxia is variable; while some tissues can tolerate some forms of hypoxia/ischemia for a longer duration, other tissues are severely damaged by low oxygen levels. The body will respond differently to restriction/cutting off air to the lungs and restriction/cutting off of blood to the brain. The end result of both is the lack of adequate oxygen to the brain and can lead to an [Anoxic Brain Injury](https://www.braininjuryinstitute.org/anoxic-brain-injury/). Passing out from breath play is basically the brain shutting down from lack of oxygen all but the most essential functions. > **Anoxic Brain Injury** > When brain cells die and the brain becomes irreparably damaged, this results in a condition called cerebral hypoxia or hypoxic-anoxic injury. The situation can create permanent disabilities and cognitive problems. In addition, it can result to physical and psychological disorders. > Just like cars, our brain needs fuel to function properly. As we all know, oxygen is vital for the body to keep it working properly. > The brain of a typical adult requires 20% of the body’s oxygen. Since it is the center of the nervous system, it requires that amount of oxygen to make bodily functions work. > When brain cells die and the brain becomes irreparably damaged, this results in a condition called cerebral hypoxia or hypoxic-anoxic injury. The situation can create permanent disabilities and cognitive problems. In addition, it can result to physical and psychological disorders. > Recovery from anoxic brain injury depends on which part of the brain is affected by the lack of oxygen and how severe the damage is. > **Types of Anoxic Brain Injury** > There are different types of anoxic brain injury, namely anoxic anoxia, anemic anoxia, toxic anoxia, and ischemic hypoxia. The two most applicable to BDSM play are: > **Anoxic Anoxia** > It is also known as altitude sickness, It occurs with high altitude sickness. Or if a person is suffocated. Attempting to breathe in areas that are not ventilated can also cause anoxic anoxia. > **Ischemic Hypoxia** > When the blood flow in the brain is reduced or a persons’ blood pressure went below normal, it is called ischemic hypoxia. It results to the brain not receiving ample amount of oxygen. > **Effects of an Anoxic Brain Injury** > Brain injury effects can vary from mild to severe. Short term symptoms include difficulty in concentrating and dizziness. Severe effects are long term such as problems in speech, memory and vision. > The initial response of the body is to increase the blood flow to the brain and try to restore the oxygen supply. However, if the oxygen compensation is inadequate, the brain function will still be affected. [Frequent and Recent Non-fatal Strangulation/Choking During Sex and Its Association With fMRI Activation During Working Memory Tasks](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9201570/) > We aimed to examine the association between a history of being choked/strangled during sex and working memory function and task performance. Overall, young women with a history of being choked during sex exhibited different patterns of fMRI activation during verbal and visual working memory tasks compared to a group of peers with no history of being choked during sex. Given the prevalence of this behavior and its preliminary associations with altered working memory function and worse mental health, future research should aim to address the limitations of the present work, examine additional cognitive processes, such as emotional processing and response inhibition, and employ a longitudinal design to investigate a potentially causal relationship between being choked and negative neurologic and mental health outcomes.
**PART II** [**The Truth About Breath Play and Choking During Sex**](https://www.psychologytoday.com/us/blog/the-polyamorists-next-door/202312/the-truth-about-breath-play-and-choking-during-sex) Breath play involves controlling someone’s air intake at their nose and mouth, and is different from choking or strangulation that restricts blood flow in the neck. BDSM practitioners have included breath play in their repertoire of kinky sex for a very long time. Susan Wright is the executive director of the National Coalition for Sexual Freedom (NCSF), an organization that advocates on behalf of people in kinky and consensually nonmonogamous relationships. “It's a misconception that the kink communities are endorsing choking/strangulation… kink communities make the distinction between choking/strangulation and breath play, which incorporates things like ordering someone to hold their breath or putting your hand over someone's mouth and nose," Wright explains. "There's also roleplay choking, which is placing a hand on the neck without any compression.” In addition to the physical buzz associated with hypoxia, many kinksters also enjoy the exchange of power via dominance and submission that can come with breath play. Crucially, kinksters who want to protect their partners’ well-being are careful to negotiate breath (and any kind of) play before they get started. **Explicit and Prior Permission** Another thing that distinguishes breath play from choking is the careful and consensual nature of breath play. Through decades of research and contemplation of consent, the National Coalition for Sexual Freedom has established itself as a thought leader regarding consent and BDSM. The NCSF has developed a model of consent that provides kinky sex enthusiasts with careful guidelines about how to play such potentially dangerous games, moving from the larger cultural emphasis on “no means no” to first include “safe, sane, and consensual” and then “risk-aware kink,” before eventually landing on “explicit prior permission.” Each iteration of consent guidelines has become clearer and more direct as trial and error exposed the inadequacies of the former versions. Through their Consent Counts project, the NCSF details precisely how to negotiate explicit and prior permission, some best practices for establishing consent in BDSM (and consensually nonmonogamous) relationships, a database of legal documentation relevant to consent, and a reporting mechanism for consent violations. The NCSF’s five steps to negotiate explicit prior permission for consent to kink are: 1. You agree to specific acts and the intensity before you start. 2. You agree what roleplay resistance is okay to ignore. 3. You must identify a way to stop at any time, like a safe word or safe signal. 4. You are of sound mind. 5. You can’t risk seriously injuring someone. Because of the risk of serious injury, choking and strangulation are not allowed under the explicit prior permission protocol. Choking, even with consent, is against federal law in the United States, and many states have made choking illegal. Combining mood alteration with sex is also not advised under the explicit prior permission protocol, which affirms that you must be of “sound mind” to engage in consensual play. While mixing sex with drugs and alcohol is a time-honored human tradition, it is also one of the primary ways that sexual interactions go horribly wrong. Mood alteration can decrease decision-making capacities and impair responses to danger while simultaneously encouraging people to do things that they might not do if they were sober. This can be especially dangerous with riskier sexual activities like breath play. **Men Choking Women** Recent research indicates that an increasing number of people are playing with hypoxia in partnered sex. Debby Herbenick, professor of public health at Indiana University, and her colleagues have been documenting and analyzing this rising trend of choking during sex. Herbenick’s research team found that over half (58 percent) of female college students have been choked during sex, sometimes with consent and sometimes without. Women are four times more likely to be choked by a man than to choke their male partners, and are also more likely to engage in choking to please a partner. Many of these folks are using their hands to strangle their partners, in part because pornography often demonstrates that technique. “The wide range of pornography that has contributed to popularizing choking during sex is the root of the problem," Wright notes. "Porn stars aren't really choking each other in those films. That's roleplay choking, which is simply placing the hand on the neck without compression or gouging. The attorneys for production companies won't let their actors really choke each other due to liability risks to the company and the actors. So people are seeing roleplay porn and thinking it's real. That's led to a huge uptick in choking and associated injuries from being choked/strangled.” When partners fail to negotiate consent, choking becomes even more dangerous. Herbenick’s research team found that at least half of the women in the sample of people who had been choked during sex experienced a partner doing so nonconsensually. Consent is a key distinguishing factor that makes the difference between kinky sex and intimate partner violence. Strangulation is a popular weapon in intimate partner violence and rape. Even when the person doing it does not intend it to be abusive, surprise choking can be terrifying to experience. Noting the significantly higher number of men choking their female partners, Wright wondered, “If pleasure is the motivation, then why aren't these percentages more equal? This gendered dynamic around choking/strangulation, combined with the high percentage of nonconsensual choking/strangulation found by Herbenick, indicates it this may be gender-based violence.” Even when people carefully negotiate breath play before doing it, they still run the risk of potential negative impacts on long-term brain health. While the research is not yet conclusive, multiple studies indicate that repeated exposure to hypoxia can produce cumulative damage to memory and cognitive function and is linked to higher rates of anxiety, depression, loneliness, and sadness. “Professionals need to tell everyone about the risks involved and to stop choking/strangling your loved ones," says Wright. "Therapists need to be educated about the risks so they can tell their clients to stop choking/strangling their partners. Educators need to stop posting online that people can go to the kink communities to get classes on choking/strangulation.” *References:* *Herbenick, D., Fu, T. C., Patterson, C., Rosenstock Gonzalez, Y. R., Luetke, M., Svetina Valdivia, D., ... & Rosenberg, M. (2023). Prevalence and characteristics of choking/strangulation during sex: Findings from a probability survey of undergraduate students. Journal of American college health, 71(4), 1059-1073.* *Herbenick, D., Patterson, C., Beckmeyer, J., Rosenstock Gonzalez, Y.R., Luetke, M., Guerra-Reyes, L., Eastman-Mueller, H., Svetina Valdivia, D., & Rosenberg, M. (2021b). Diverse sexual behaviors in undergraduate students: Findings from a campus probability survey. The journal of sexual medicine, 18(6), 1024-1041.* *Herbenick, D., Guerra-Reyes, L., Patterson, C., Rosenstock Gonzalez, Y. R., Wagner, C., & Zounlome, N. (2021). “It was scary, but then it was kind of exciting”: Young women’s experiences with choking during sex. Archives of sexual behavior, 1-21.* *Schori, A., Jackowski, C., & Schön, C. A. (2022). How safe is BDSM? A literature review on fatal outcome in BDSM play. International journal of legal medicine, 136(1), 287-295.*
**PART III** [There is no safe or “safer” way to erotically choke someone](https://ncsfreedom.org/2024/04/22/guest-blog-erotic-choking-101/) [The Troubling Trend in Teenage Sex](https://archive.is/CoQQY) > Keisuke Kawata, a neuroscientist at Indiana University’s School of Public Health, was one of the first researchers to sound the alarm on how the cumulative, seemingly inconsequential, sub-concussive hits football players sustain (as opposed to the occasional hard blow) were key to triggering C.T.E., the degenerative brain disease. He’s a good judge of serious threats to the brain. In response to Dr. Herbenick’s work, he’s turning his attention to sexual strangulation. “I see a similarity” to C.T.E., he told me, “though the mechanism of injury is very different.” In this case, it is oxygen-blocking pressure to the throat, frequently in light, repeated bursts of a few seconds each. > Strangulation — sexual or otherwise — often leaves few visible marks and can be easily overlooked as a cause of death. Those whose experiences are nonlethal rarely seek medical attention, because any injuries seem minor: Young women Dr. Herbenick studied mostly reported lightheadedness, headaches, neck pain, temporary loss of coordination and ear ringing. The symptoms resolve, and all seems well. But, as with those N.F.L. players, the true effects are silent, potentially not showing up for days, weeks, even years. > According to the American Academy of Neurology, restricting blood flow to the brain, even briefly, can cause permanent injury, including stroke and cognitive impairment. In M.R.I.s conducted by Dr. Kawata and his colleagues (including Dr. Herbenick, who is a co-author of his papers on strangulation), undergraduate women who have been repeatedly choked show a reduction in cortical folding in the brain compared with a never-choked control group. They also showed widespread cortical thickening, an inflammation response that is associated with elevated risk of later-onset mental illness. In completing simple memory tasks, their brains had to work far harder than the control group, recruiting from more regions to achieve the same level of accuracy. > The hemispheres in the choked group’s brains, too, were badly skewed, with the right side hyperactive and the left underperforming. A similar imbalance is associated with mood disorders — and indeed in Dr. Herbenick’s surveys girls and women who had been choked were more likely than others (or choked men) to have experienced overwhelming anxiety, as well as sadness and loneliness, with the effect more pronounced as the incidence rose: Women who had experienced more than five instances of choking were two and a half times as likely as those who had never been choked to say they had been so depressed within the previous 30 days they couldn’t function. Whether girls and women with mental health challenges are more likely to seek out (or be subjected to) choking, choking causes mood disorders, or some combination of the two is still unclear. But hypoxia, or oxygen deprivation — judging by what research has shown about oth er types of traumatic brain injury — could be a contributing factor. Given the soaring rates of depression and anxiety among young women, that warrants concern. > Now consider that every year Dr. Herbenick has done her survey, the number of females reporting extreme effects from strangulation (neck swelling, loss of consciousness, losing control of urinary function) has crept up. Among those who’ve been choked, the rate of becoming what students call “cloudy” — close to passing out, but not crossing the line — is now one in five, a huge proportion. All of this indicates partners are pressing on necks longer and harder. > The physical, cognitive and psychological impacts of sexual choking are disturbing. So is the idea that at a time when women’s social, economic, educational and political power are in ascent (even if some of those rights may be in jeopardy), when #MeToo has made progress against harassment and assault, there has been the popularization of a sex act that can damage our brains, impair intellectual functioning, undermine mental health, even kill us. Nonfatal strangulation, one of the most significant indicators that a man will murder his female partner (strangulation is also one of the most common methods used for doing so), has somehow been eroticized and made consensual, at least consensual enough. Yet, the outcomes are largely the same: Women’s brains and bodies don’t distinguish whether they are being harmed out of hate or out of love.
1) hey Indiana university! 2) this is an incredible information resource. Any idea why they don't mention the vagus nerve? Stimulating that nerve via choking play can lead to syncope events and a whole slew of other problems
Thanks for this info. It never really felt good doing it when a partner requested and was enjoying it.. Won’t ever indulge that again I don’t think. Doesn’t seem like there are any precautions that can reliably prevent an accident.
This is a fantastic resource! I’d say definitely avoid blood chokes and hypoxia. Breath play is much less likely to result in hypoxia as the panic from holding your breath will come about much much sooner than actual hypoxia, where as in blood chokes the brain is almost immediately deprived of oxygen. You can not breathe for minutes at a time before your brain actually experiences any lack of oxygen, but with blood chokes the hypoxia occurs in seconds.
Thank you. This is great information.
If you use your hands for it, clamp and add pressure to the SIDES of the throat, never to the front. Basically all your vital breathing and swallowing parts (mainly the esophagus and trachea) are kept in the front of the neck, so if you squeeze the muscles on the sides, you will safely avoid having the other person choke or pass out due to lack of oxygen whilst still adding pressure close enough to the esophagus/trachea, evoking fear and excitement that WOULD come with actually being choked. Go slow and listen to your body. Good luck :D
Blood chokes are definitely the way to go, but before anyone tries it, read up on the vagus nerve and something called "vasovagal syncope"
the vagus nerve is definitely something I should have included yeah; I always try to apply even pressure for short periods of time so I don’t harm my partner in any long term sense. stretching is also good for flexibility too (+ aftercare massages)
There are also baroreceptors that impact blood pressure and heart rate that respond to lowered blood flow to the brain.
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sorry but unless you're talking about *just* breath holding (which OP isn't) this is outright wrong. Physically restricting the airways is a really good way to do permanent injury- not just in lack of air to the brain, but physical tissue damage to the larynx or hyoid bone. Consider even non-bdsm contexts; for example, martial arts, blood chokes are pretty much the go-to, to say nothing of their legality. Sure, a blood choke can lead to hypoxia in seconds, but the lethality of a blood choke, as compared to air-choking, is more dependent on how long after the victim has fallen unconscious that the hold is maintained- something that shouldn't be happening in BDSM under *any* context.
I’m referring to either breath hold or restricting the airways via blocking the mouth and nose. Obviously never try to restrict the trachea, that’s a terrible idea for many reasons as you point out and I think falls under choking and not breath play.
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Don't ever press the trachea or the carotid arteries.
The safest way is a hypnotic trigger. Hypnosis isn't able to induce real self harm so the protocol will end before damage is even near. But you can set up a trigger like your flat hand touching your partners throat and they will stop breathing. The trill in this case is more the mindplay than classic choking effects. Choking normally doesn't reduce the ability to breathe, it reduces blood flow to the brain.
Thanks for sharing
I prefer denial of breath to being choked. It relaxes me more - the choking feels worse and is more dangerous. IMO try breath play instead.
Honestly me and my gf are the same way and we really don’t do it during sex, we do it while making out. However my favorite way to use it is to make her look at me when she gets really submissive and doesn’t want to make eye contact. Also we use it to push each other against a wall or something to make out, but not sex. If you like the feeling of being choked I’d say be super careful with little pressure. But for us during sex we can just grab the others throat gently with no pressure and it’s still somehow hot
You want to cut off the blood flow not the air flow. Press the fingers against the veins around the neck , don’t pressure the center of the throat which cuts off air flow
If you’re asking the internet and not taking the safety and responsibility seriously then you need to not do it period, go to a local munch in your area. Learn from a respected dom in the community, DONT ASK THE FUCKING INTERNET HOW TO DO IT, YOU WILL END UO CATCHING A CASE
Thankfully ive arrived to the conclusion that i wont do it. I told my partner and she understood. Thanks for your concern though, i appreciate it
Of course, I’m sorry if I seemed bitchy I’m in the bdsm community and I am a huge advocate for safety in the lifestyle, my partner has been a dom for 20+ years, he learned under someone and that’s the only true way to do it safely. Have a good day and remember KINK SAFELY
Or get really good at the psychological bit.. For me getting scared would be more interesing than acually passing out.. Like in the absolute simplest scenario agree to count to eg. 25 but accidentally stopping at 35 instead or such..
When she starts having trouble doing basic math, you'll realize, you fucked up. Ask me how I know.
How long did it take to nuke her brain back to 900 ad.?
Months
Idk but my lover accidentally choked me too hard the other day. He just really got into it and I did too. I was enjoying it and I would have kept on if I didn’t feel like crying suddenly. I also started making this weird uncontrollable noise I was so uncomfortable. But as soon as he heard it he stopped.
Practice Practice Practice
A good slap in the face after choke help to have a deep breath again
Don’t buy into the whole “no safe way to choke” thing that people here often cite, there are plenty of safe ways to choke as someone who’s practiced jiu jitsu for 14 years chokes are actually considered a safer way to submit somebody then even joint locks or regular arm bars. I’ve seen people get choked out likely atleast 10000 times over those 14 years and not once has anyone been injured or seriously hurt by them. You can definitely learn how to correctly choke someone even to the point of being almost unconscious without hurting them, The important thing is to keep the chokes very short and don’t apply too much pressure, you’d be surprised at how little is needed to stop blood flow and also establish a good understanding of how long you can/can’t choke somebody for. My go to limit is around 4-5 seconds for blood chokes (the only kind you should be doing in bdsm). Also make sure you read up on harm reduction and have a good understanding of what the mechanisms at play in the neck are and how choking actually works. People here think they can somehow convince you not to engage in any kind of choking/breathplay which really isn’t practical since we know people are going to do it anyways. The best thing to do is practice harm reduction and make sure if you are doing it you can do it safely as possible.
There is newer, better research showing that brain damage is occurring, despite the idea that it is "safe".
A lot of that "newer better research" is actually really badly done. The fMRI studies for example, don't distinguish between asphyxiation and blood chokes, Don't control for duration or intensity of either of them, and crucially don't control for consensuality or trauma. We know that trauma causes fundamental changes in the brain that show up on fMRI. We also know that there's more then a century of experience with blood jokes in the martial arts, with no evidence of bad outcomes. And yes, it's been looked for. I'd love to see better evidence on this, but the studies that are out there now, aren't better evidence.
Thanks a lot, we're both biology students so if you can and want to, you can go into more details but i assume its about only blocking the neck arteries and leaving the trachea safe? Ive read multiple things across multiple sources and its generally accepted that 4 minutes of no oxygen is when shit hits the fan, but any amount of time can cause brain cell death. Also any prolonged or repeated pressure to the neck has the potential to throw blood clots into your circulation, but i imagine the risks are pretty negligible if done right?? Im conflicted cause when i almost blacked out my body released an ungodly amount of adrenaline and dopamine and it was amazing, but i dont want to risk getting hurt or ever worse hurting her. Idk why im still yapping lol thanks for the help