The single most dangerous act that porn has managed to popularize is the idea that women like to be choked during sex.

How Dangerous? As dangerous as a police chokehold.

How Popular? According to a female reader who attends a major university: “Several male partners have choked me during sex, without asking!” In case you think she is exaggerating, consider these findings from a recent study of almost 5,000 undergraduates at a large university in the Midwest (Herbenick et al):

“A majority of undergraduates in our sample have choked or been choked during sex… More than half of women reported having asked partners to choke them, and most men reported having been asked to choke a partner. These patterns suggest that choking is becoming (or is already) a common aspect of college students’ partnered sexual repertoires.” ²

Few of these women and men understand how dangerous it is to be choked during sex.

“Permanent Ischemic Damage”

There are two types of police chokeholds that have been banned in many of the nation’s largest police forces: One type is called the carotid hold, which limits the flow of blood to the brain. This is what happens when a partner is choked during sex. According to a report about this by leading neurologists:

“Approximately 70% of the blood to the brain flows through the carotid arteries. Interruption of blood supply to the human brain for as little as 4 seconds can lead to a loss of consciousness. The human brain generally demands at least 15% to 20% of the total blood in circulation, with some brain structures vulnerable to permanent ischemic damage when this amount falls to even half that.”¹

That’s four seconds! As for how little pressure it takes on a person’s neck to stop the flow of blood into the brain: “A force of only 6 kg is needed to compress the carotid arteries, which is about the average weight of a household cat.”

But isn’t it different if it’s your hands on a partner’s neck and you can stop choking her or him as soon as something bad happens?

“The negative health consequences of carotid manipulation are not a matter of ‘dose’: Neither the duration nor the strength of the force applied fully mitigate potential health risks. Even gentle manipulation of the carotid arteries to control a rapid heart rate vis-à-vis a ‘carotid massage’ has fallen out of favor because of risk of iatrogenic harm to the patient, even at the hands of master clinicians with decades of experience.”¹

I asked the neurologists who had written the report whether their concerns would also apply to choking a partner during sex. The response I received was an unequivocal Yes!

The Origins of Choking During Sex: Breath Play, or Erotic Asphyxiation

I first became aware of the dangers of breath play more than 10 years ago, when a reader informed me that he puts his hands around his partner’s neck and squeezes tightly when they are having sex—at her request. She told him it makes sex feel more intense. He was concerned because she was asking him to ratchet up the choking by using a belt around her neck.

This was before choking became mainstream, and it was limited to a practice in BDSM called breath play, or erotic asphyxiation. Other terms for it were scarfing and terminal sex. There were two distinct groups of people who enjoyed doing it: males who would partially suffocate themselves while masturbating and couples in which one partner liked to be choked.

Boys and young men who are into erotic asphyxiation are known as baggers or gaspers. They put plastic bags over their heads or tight ropes around their necks while they masturbate. The few studies I could find said that baggers often fit in well socially and they keep their sexual secrets well-hidden. Up to a quarter of them wear women’s underwear while they are masturbating on death’s doorstep.

Several boy baggers die each year in this country. Their deaths are often reported as suicides. But people who are trying to kill themselves don’t hang from door knobs while naked, and they don’t design safety releases into their death devices. Boy baggers fully intend to free themselves after squeezing out their blurry-eyed orgasms.

Horrified parents often spruce up the death scene before the ambulance arrives. Instead of reporting the death as masturbation gone awry, the coroner thinks it’s a suicide. None of the kids’ friends can understand why someone who seemed so well-adjusted would want to off himself.

The other group into breath play are normal-appearing couples. They assume the person who is doing the choking is like a designated driver who can put the brakes on before it’s too late. So, I asked BDSM expert Jay Wisemen whether this is true. He said:

“Not so! As a person with years of medical education and experience, I know of no way whatsoever that either suffocation or strangulation can be done in a way that does not put the recipient at risk of cardiac arrest. If the recipient does arrest, the probability of resuscitating them, even with optimal CPR, is distinctly small.”

In other words, you could be hooked up to state-of-the-art heart monitors and have a board-certified cardiologist for a sex partner, and breath play would still be like playing Russian roulette. Charles Moser, a physician who is highly respected in the world of kink, also expressed his concern about the long-term consequences of breath play in causing brain damage. He spoke about these concerns years before the public outcry against chokeholds.

The Herbenick et al. study also found that an alarming number of women had been slapped by a partner during sex or had a partner aggressively engage their face in a sexual maneuver.

The individuals who were studied by Herbenick, et al. weren’t sex workers whose clientele consisted of privileged executives or paroled prisoners. They were 5,000 undergraduate students at a major university.