“Kids, Stop (sex) choking!” What parents need to know.
Back in the day, if you saw your children wrestling and one of them started to strangle the other, you would instinctively yell out, “Stop choking him” and intervene seconds later if they didn’t listen. Most of us have a reactive protective reflex when someone’s hands get too close to our neck. Perhaps the only self-defense manoeuvre I remember is when someone tries to strangle you: raise your arms above your head and twist away.
Sexual Strangulation
Following Debra Soh’s recent opinion in the Globe and Mail (Sexual strangulation is derailing a generation of girls), I was alarmed to learn that sexual strangulation ("choking") has become a common practice among adolescents and young adults. Sexual strangulation carries under-recognized neurological, psychological, and fatal risks, and is widely misperceived as consensual and harmless. The behaviour disproportionately affects young females, is normalized through pornography and social media, and produces injury even when no external marks are visible. For some adolescents, choking has become part of their very first sexual encounter!
In response to this growing concern and related deaths, the UK has made it a criminal offence for tech platforms and others to possess or publish porn featuring strangulation.
Following a recent death in Australia, there is a call for advocates and politicians to do more in providing consent education for young people and accountability measures for tech companies.
While we wait for social protections, perhaps the best antidote, however; is for parents to have several direct conversations with their children. We need to tell them to say “No” to sexual strangulation.
Seriously, I have to talk to my son or daughter about this? Yes!
Sex alone can be uncomfortable to talk about, not to mention sexual strangulation. As a child psychiatrist working with children and families, I live in the space of awkward conversations. It is not uncommon for me to talk about matters that might be considered private or embarrassing. I am mindful that we are all entitled to a private life and that it is developmentally appropriate for youth to keep secrets from their parents and parents to keep secrets from their children. Sexual activity is probably at the top of the list for both parties. However, when it comes to personal health and safety, some of these areas need to be explored and conversations need to occur, repeatedly.
The reality is that our children are learning about “sex, consent, intimacy and relationships” from online platforms, online strangers and online pornography. On average, children are 12 when they first see porn, and not magazine centrefolds, but rather online and graphic videos or even AI generated content. I know what you’re saying, “Nobody talked to me about sex and I turned out okay.” And from your perspective, that may be true; however, we know too much about online and sex related harms these days that it is impossible to ignore it if we want to protect and support our children.
It is also important for you to know that having conversations with your child may matter more than you realize. You may assume that what you say can’t control your son or daughter’s behaviour; however; parents communicating their care and concern can have a profound impact on their child’s decisions. Explicitly stating to your child: “I want you to be safe. I care about you. I love you. You deserve to always be treated with respect” can go a long way. Parents are also among the most influential and trusted sources of prevention messaging, especially for pre-adolescents. This parental love and security has been associated with adolescents making healthy choices. When we don’t talk to our kids they might make wrong assumptions about what matters to us, or that we don’t care. Both listening and talking also strengthens the connection between dads and their children. Daughters in particular, have better health outcomes when they have a positive relationship with their father, including delayed sexual activity and reduced likelihood of early pregnancy.
Dads matter. And we are one of the most adaptive creatures on the planet, so let’s lean into our protective instincts and tackle this uncomfortable topic.
What is sexual strangulation?
Sexual strangulation - commonly called "choking" during sex - refers to the application of external pressure to a person’s neck during sexual activity, partially or fully obstructing cerebral blood flow, venous return, and/or the airway. What was once considered aggravated assault, has become a more common part of modern dating and considered ubiquitous among Gen Z (aged 14-29). It can still be considered an act of sexual violence.
Sexual strangulation is also an act of power as one person overpowers the other by choking them.
How common is sexual strangulation?
There is a reported rise in sexual strangulation, especially among young people. It is highly prevalent in college-aged populations. The mean age at first choking/being choked is 19; however the age of initial experience is getting younger. More than half of young adult women surveyed report a lifetime history of being strangled during sex, and a substantial proportion report repeated exposure. One university study found that 33.6% of female students had been choked more than five times. Women and transgender/gender non-binary participants were significantly more likely to have been choked than men. Some youth are engaging in sexual strangulation during their very first sexual encounter.
Why is it happening?
More and more young people are exposed to aggressive sexual imagery in online pornography that influences sexual behaviour. Repeated viewing of such content suggests this practice is normal, common and benign, and the viewing of online behaviours can shift into mainstream conversation and practice.
I doubt that young people are fully aware of what sexual strangulation actually is, why they are doing it, and the risks associated with this aggressive act. Sexual strangulation is most often suggested by the person wanting to strangle their sexual partner, suggesting curiosity or arousal in the partner who wants power during the sexual activity. For the youth being strangled it is very unlikely to cause any sexual pleasure. One might only be saying yes because they want to satisfy the other’s request, feel too uncomfortable to say "No", or are unclear what exactly it is and are curious.
How dangerous is sexual strangulation?
There is no safe way to partake in choking because it doesn’t require much pressure on a person’s neck for unwanted side effects to happen including memory loss, headache, stroke and brain damage. Some individuals have died during sexual strangulation. Adding drugs or alcohol to the mix amplifies this risk.
The consequences of sexual strangulation can be immediate or cumulative. Acute non-lethal negative effects include dizziness, head rush, visual disturbances, disorientation, difficulty breathing/swallowing, and loss of consciousness. Cumulative or longer-term effects that have been reported in pilot studies of young women strangled ≥4 times in a month include changes in neurophysiology such as differences in the brain on MRI, elevated blood inflammatory markers, as well as cognitive and mental health symptoms.
How does one get consent to strangle their sexual partner?
We don’t talk enough about consent around sexual behaviour with our children. In the case of sex, consent should be about knowing the potential risks, harms and benefits of saying “Yes”. Undesired outcomes are not just about getting pregnant or acquiring a sexually transmitted infection. Saying yes or no will also have psychological implications on how one sees themselves and their relationship.
First and foremost, consent to engage in sexual activity should be met primarily with feelings of confidence and enthusiasm, not with apprehension or fear. It needs to be continuous with the option of saying stop and the act ending immediately. Consent is to be given voluntarily, not coerced, forced, threatened or under the influence of substances. It is important to be mutually aware of what exactly you are agreeing to do.
So if someone is asking consent of their sexual partner to strangle them while having sex, perhaps the request should start off with something like this:
"Hi, when we have sex today can I strangle you? This would mean that I have my hands wrapped around your neck causing you to have less oxygen to your brain making you feel lightheaded. It could cause you to pass out, pee yourself, have a seizure, stroke or even death. You won’t be able to speak, such as say “No” or “Stop” or a “Safe-word” while I am doing it. You are going to feel powerless and helpless and feel out of control. Does this sound exciting to you? Can I strangle you when we have sex?”
How to approach a conversation with your children about sexual strangulation:
A previous article I wrote, Embracing the Awkward, reflects on how dads and parents can address topics of puberty and related matters with their children. I invite you to start there for some suggestions on how to talk with your children about awkward matters.
Be sure to take some time to think about it and get support from your own partner, friend, or health care provider if needed in order to understand this topic and how you want to support your child.
Here are a few things to keep in mind:
Start early and keep it going. Aim for many short, calm conversations over time rather than one big, scary "talk."
Stay calm and non-judgmental. A shame-free tone keeps your child willing to talk. Try curiosity: "Have you heard about choking during sex? What do people say about it?"
Lead with the facts that matter to teens. The message that it can cause death or permanent brain damage is more convincing than lecturing.
Bust the "safe if careful" myth directly. Explain that consent, trust, gentleness, and communication do not make neck pressure safe.
Talk about what they see online. Help them see that pornography and social media are performances, not safety guides.
Teach consent and the right to say no. Consent must be freely given, can be taken back at any time, and cannot be assumed. Being pressured—or being unable to say no—is not consent.
Watch, without spying, for warning signs. Unexplained neck marks, bloodshot eyes or tiny red spots on the face/eyes, frequent headaches, or marks/ligatures (belts, cords, scarves) tied to furniture can be clues.
Final statement about sex and power.
It is no surprise that sex and power are finely interwoven. I view sexual strangulation as an excessive act of power differential between two partners, where one has far more power than the other. The reason one might want to have all or none of the power during sex is a complicated one. If one feels most connected when they are on either end of this power spectrum while having sex it might be worth taking a moment to reflect on why that is.
For our children, I hope that their future sexual experiences will include power that is equal and shared. This is my goal and reason for having these awkward conversations.
