Understanding Consent and Sexual Strangulation/Choking

Oct 28

Content Warning: this article discusses sexual strangulation (sexual choking), sexual violence, and associated health risks.

In recent years, sexual choking has become an increasingly normalised sexual practice for young people. It’s referenced in mainstream media, TV series (including the popular show Euphoria), pornography and social media trends.

However, these portrayals omit key information about sexual choking, including the serious health risks involved, and the gendered dynamics that often underpin the practice, as well as the importance of informed and ongoing consent.

Why we are talking about sexual strangulation

At Learning Consent, we talk a lot about consent as a communicative approach. What this really means is that consent is a constant conversation that happens before, during, and after sexual activity. It’s about the ways people express desire, comfort, and boundaries through words, tone, and body language and how we respond to these communications in real time.

While commonly referred to as sexual choking, the practice is more accurately defined as non-fatal sexual strangulation. Strangulation is when pressure is applied on or around the neck and interferes with blood circulation in the brain, breathing, or both. This pressure can be applied with one or both hands, other body parts, or an object.

From a health perspective, the risks are serious. Strangulation can cause serious internal injuries such as carotid artery dissection, blood clots, stroke, seizures, and memory or concentration problems, and even some cases, death. Often these injuries occur without any visible signs. Information from It Left No Marks, shows that about half the time, strangulation leaves no visible injuries, even when major internal injuries have occurred.

Because it can look “gentle” or “controlled,” people often don’t realise how harmful this practice can be. This lack of awareness means that many people saying “yes” do not fully understand the health risks, and without this understanding, consent is not truly informed. Which then poses the question of whether consent can truly be given.

A complex and gendered issue

Sexual strangulation is a complex, gendered issue that sits on a spectrum from consensual sexual exploration to coercion and violence.

Evidence shows that sexual strangulation is most often experienced as a form of sexual violence and is a rising concern for both health professionals and domestic violence responders. From a domestic violence prevention perspective, non-fatal strangulation is recognised as a key indication that violence within a relationship is escalating, and victim survivors are at an increased risk of being killed. Evidence shows that sexual strangulation is often experienced as part of sexual violence and is a rising concern for both health professionals and domestic violence responders.

Recent Australian research on the Prevalence of Sexual Strangulation/Choking Among Australian 18–35 Year-Olds, found that women and gender-diverse people are far more likely to be strangled or choked, with partners most often identifying as men. The study also found that men who had strangled or choked a partner, often reported that consent was typically discussed only once, with future consent often being assumed.

It’s also important to know that non-fatal strangulation is recognised in Australian law as a serious offence. Across all states and territories, choking, suffocating or strangling someone without consent is a criminal act that carries significant penalties.

Strangulation represents one of the clearest expressions of power and control in violent relationships. Yet in some consensual sexual contexts, those same dynamics of dominance and vulnerability are intentionally explored in the context of desire and sexual play.

Sexual exploration, communication and informed consent

By playing with the dynamics of power and surrender, some people experience heightened trust, intimacy, and arousal. However, even when explored as a consensual sexual experience, the physical risks of sexual strangulation remain significant and must be fully understood by everyone involved.

Within kink and BDSM contexts, there is a strong focus on negotiation, ongoing communication, and clearly defined boundaries before engaging in any activity. Even within these contexts of clear and strong practices of consent, sexual strangulation, referred to in the kink space as “breath play”, is considered one of the most extreme forms of play and recognised as having no truly safe way to practice.

The Progressive Therapeutic Collective in their article on breath play notes that this high-risk activity requires extensive trust, knowledge and caution with a partner and that safety is always the number one priority. Here safety first means informed consent, to never play alone, establish clear signals and to always have an emergency plan.

Why affirmative and informed consent is key

Within kink communities, sexual practices like breath play are approached with structured communication, informed consent, and a shared understanding of risk.

However, for many young people, sexual choking is being learned through porn, social media, or peer influence, often without the context, communication, or understanding needed to make it safe. Research from La Trove University and Melbourne University, found that over half of young Australians had engaged in sexual choking, with many unaware of the serious health risks involved.

True consent requires all parties to have accurate information of any risks involved; it means recognising everyone’s personal limits and boundaries and having the freedom to communicate them at any time, knowing they will be heard and respected. But due to the serious and unpredictable risks involved in sexual strangulation, it is widely recognised that there is no safe way to apply pressure to the neck, and therefore no way to practise consent in this way when it comes to sexual strangulation.

Moving toward understanding and safety

To learn more about non-fatal strangulation and sexual choking, please visit itleftnomarks.com.au

It Left No Marks is an online learning hub created by Women’s Health NSW as a pathways project for women, healthcare providers and other service providers. The It Left No Marks hub increases support, strengthens professional understanding and local capacity to respond to sexual assault related to non-fatal strangulation and sexual choking. ⁠

If you or someone you know has experienced strangulation or feels unsure about a sexual experience, support is available: