‘There is no safe way to do it': the rapid rise and horrifying risks of choking during sex

The Guardian

07-07-2025

Now that Lucy has been in a steady relationship for a year, she finds herself looking back at previous sexual encounters through a new lens. The slaps to her face. Hands round her neck. The multiple late-night messages from one partner – nine years older and, in her words, 'a Tinder situation': 'Can I come over and rape you?'
'I like to think I enjoyed my single 20s,' says Lucy, now 24. 'I was an avid Hinge and Tinder user and I liked to think of myself as the 'cool girl'. But I've been thinking about it so much – I'm not sure why. There was the friend of a friend who slapped me so hard in the middle of us having sex – no warning, just from nowhere. It actually made my teeth rattle. There was another guy I met at a bar. We got together that night and he started choking me so hard, I felt this sharp pressure, this pain I'd never experienced before. I was drunk but it sobered me up in one second. I still wonder what he did to me to cause that pain.'
Never was 'rough sex' discussed before, during or after. 'Among my friends, there's this competitiveness about not being boring, not being 'vanilla'. I think it's very prevalent for women my age, and no one wants to kink-shame anyone,' says Lucy (not her real name). 'There's a lot of talk about online porn and what that has done to men's brains and expectations, but I also saw a lot of very violent porn when I was a teenager. I don't know why or how I found it. The women in porn never push back or say, 'Don't do that' when they're choked. I think I became quite performative. I like to think I'm a strong woman but … I don't know if it's about male validation.'
Growing concern around the normalisation of 'choking' – ie strangulation – during sex has led to the recent announcement that pornography depicting it will be criminalised in an amendment to the Crime and Policing Bill.
It has become so standard among young people that one recent council-funded sex education presentation for Welsh secondary schoolchildren included 'safe' choking advice such as: 'It is never OK to start choking someone without asking them first …' and: 'Consent should also happen every time sexual choking is an option, not just the first time.' When the presentation was made public, Fiona Mackenzie, the founder of campaigning group We Can't Consent to This (WCCTT), was 'absolutely furious but not at all surprised'.
Mackenzie formed WCCTT at the end of 2018 in response to the growing number of women and girls killed or injured in violence claimed to be consensual. How has the landscape changed in the years since?
'When we began, we were focusing on two aspects,' says Mackenzie. 'The first was the men who were successfully using the 'rough sex defence' to murder women, claiming it was consensual and therefore getting away with it or getting ludicrously short sentences. The other part, which is the part I didn't realise was an issue until a month or two in, was that so many young women were being strangled by their sexual partners.'
Almost seven years on, there's been progress on the first part. The Domestic Abuse Act of 2021 clarified that a person cannot consent to being harmed for the purpose of sexual gratification and also made non-fatal strangulation a specific criminal offence. Before that, it fell under general offences such as battery, the mildest assault possible. 'The major win for us is that [when women are] subjected to a non-fatal or a fatal assault during sex, there will be a much better response from the criminal justice system,' says Mackenzie. 'There have been several cases since where the men have been prosecuted and convicted for murder by juries and given long sentences.'
On the second aspect, though – the normalisation of strangulation during sex – Mackenzie believes the situation has only worsened. 'I'd hoped that lots of other charities and sex educators, the government and academics would get behind it, but instead what we've got is this completely mad idea that we can somehow help women to keep having violent sex but in a safer way. Maybe in a hi-vis jacket?'
Hannah Bows, a professor of criminal law at Durham Law School, believes strangulation is one of a few crimes where public awareness has dramatically regressed. 'I think it's a really troubling sign that 50 years ago most people would probably know strangulation was an offence – just like we all know that stealing is illegal,' she says. 'We're nowhere near that now, especially among young people. There's actually less acknowledgment and understanding, even though we have more laws criminalising it.'
There's good reason for these laws. Necks are alarmingly fragile. Blocking the jugular vein requires less pressure than opening a can of Coke. Evidence suggests that strangulation is now the second most common cause of stroke in women under 40. According to one piece of sobering research, it's more dangerous than the torture known as waterboarding, because strangulation affects blood flow as well as airflow. Though some cases can cause loss of consciousness in seconds and death in minutes, in others consequences can be delayed by weeks. It can cause a change in voice, difficulty swallowing, incontinence, seizures, problems with memory, decision-making and concentration, depression, anxiety, miscarriage.
In a paper published in May, 32 young women were recruited from a large midwestern university in the US and separated into two groups – those who'd been strangled at least four times during sex in the last 30 days and those with no history of strangulation. (There were 15 from the former group and 17 in the second.) Blood was taken from all recruits. The samples from the women who'd been strangled showed elevated levels of S100B, a marker of brain damage.
'There's no safe way to do it, no safe quantity of blood or oxygen you can cut off from her brain for fun,' says Jane Meyrick, a chartered health psychologist who leads work on sexual health at the University of the West of England. She describes being at a sexual health conference last year where data was presented on sexual strangulation – the prevalence and harms. 'Usually, at those conferences, people will be talking about the extremes of what everyone is getting up to in a very sex-positive way,' she says. 'When this was presented, you could feel the tension, the internal conflict, in the room, with professionals being unable to reconcile the gap between what they were hearing and their usual sex-positivity.'
When it comes to prevalence, UK data is patchy. A survey by the Institute for Addressing Strangulation, established with Home Office funding in 2022, after strangulation became a standalone offence, found over a third of 16 to 34-year-olds had experienced this, compared with 16% of 35 to 54-year-olds and 3% of those 55 and above. 'Larger academic studies of college students in the US and Australia put it at much higher,' says Meyrick. US research found that 64% of female college students had been choked during sex. In contrast, data on previous generations, collected between 2006 and 2015, found that most college students didn't include choking when listing rough sexual behaviour (slapping, being pinned down or tied up were all cited) and, overall, choking/strangulation was reported as occurring infrequently. 'It has become normalised practice among younger people and not viewed as problematic,' says Meyrick, 'and most older people have no idea.'
In 2021, a research team led by Debby Herbenick, provost professor at the Indiana University School of Public Health, interviewed 24 women aged 18 to 33 in depth about their experiences of strangulation during sex. Although, for most, their first experience had involved no prior discussion – including one who was having sex for the first time – the majority now viewed it as 'routine and regular'. All believed it was safe, despite experiencing many physical reactions, including coughing, gasping, difficulty swallowing and breathing and vision changes. Some said they accepted being choked for their partner's pleasure, even though they didn't personally find it arousing. Others did enjoy it and sought it out as 'adventurous' and 'exciting'.
The paper notes that historically, autoerotic asphyxiation is rare among women and adds, 'It is curious how sexual asphyxiation, which has long been described as predominantly engaged in by/for men's arousal, has become so frequently enacted by men on women partners.'
Bows makes the same point. 'What's not being talked about is that this is happening overwhelmingly to women by men. If you accept what people will argue – that this is an activity that's enjoyed because it's 'sensual' – then why aren't men the recipients more often? To me, it's just another way we've culturally legitimised men harming women.'
Few doubt its origins. 'It's about porn and the mainstreaming of illegal and violent tropes in porn practices,' says Meyrick. It's not just dedicated porn sites, she says. 'It's a click away on TikTok, it's absolutely everywhere. I've had young people come to me in tears, young women saying, 'I don't want to be strangled' and young men saying, 'I don't want to do it' but both watch porn where it's handed to them in an uncritical way and there's an assumption that that's what has to happen.'
Much research shows the impact of porn consumption on sexual behaviour and beliefs. Another study by Herbenick that looked at behaviours such as choking and spanking found that those who engaged in it viewed porn at a younger age and had a higher lifetime use than those who didn't. The recent proposals to criminalise 'choking' in porn follow the recommendations of a review by Baroness Bertin, commissioned by the previous government and published in February. It noted that strangulation was 'rife' online, with 'competition for clicks' driving the production of increasingly disturbing content. According to the review, 'Non-fatal strangulation or 'choking' sex is perhaps the starkest example of where online violent pornography has changed 'offline behaviour'.'
When it comes to criminalisation, Clare McGlynn, a professor of law at Durham University, who worked on the proposals with Baroness Bertin, says the specifics will be key. 'The provision must be comprehensive and cover all depictions of strangulation and not be based on non-consent,' she says. 'If it requires proof of non-consent, or any other such qualifications … it will make no difference.'
Mackenzie is not optimistic and points out that this is the third such 'ban', given that we already have the Obscene Publications Act 1959 and the Criminal Justice and Immigration Act 2008 (which was introduced after the strangulation of Jane Longhurst and supposedly criminalised the possession of 'extreme pornography'). 'The problem has always been that not one of the millions of people employed by the state will feel it is their job to enforce such a ban,' says Mackenzie. 'If it wanted, the government could start tomorrow to make it uncommon for kids to see strangulation porn, building on existing law – but instead it will ban this content yet again, and hope that state bodies and tech companies will this time take account of the 'vibe shift'. Not a single site will fear prosecution. They will have seen from decades of experience that no one from the state will knock on their door.'
McGlynn says that previous legislation was problematic – the Obscene Publications Act covers 'obscene' material, which, she says, is a 'vague concept'. The 2008 legislation covers 'life-threatening injury', which will apply to some forms of strangulation but not all. 'While there are serious harms and risks, such as stroke, they are not evident on the face of a depiction and not therefore within the existing law on extreme pornography.' However, she does agree that enforcement will be everything. 'The platforms will only act if they think Ofcom will challenge them,' she says. 'I hope this will be the case. It should be and I think it could be – but it might require considerable public and political pressure.'
For Lucy, strangulation during sex has become something she hopes she'll never return to, something she has almost 'grown out' of. 'I've been with my current boyfriend for over a year and at some point, we had a conversation where I asked, 'Why don't you choke me?' He said he had no desire to. I asked if he watched porn and he said the kinkiest porn he'd watch would be massage. This might be too much information, but he's the only man I've been with where I've had constant orgasms. With other men, the sex was always about them. Now it's about us.'
In the UK, call the national domestic abuse helpline on 0808 2000 247, or visit Women's Aid. In the US, the domestic violence hotline is 1-800-799-SAFE (7233). In Australia, the national family violence counselling service is on 1800 737 732. Other international helplines may be found via www.befrienders.org