Risk of serious injury as strangling during sex becomes normalised among young Australians

Strangling a partner during sex is widely perceived as normal especially among young people, with more than half of adults aged 35 and under reporting they have been strangled, many of them unaware of potentially serious health consequences.

It is a finding that has sexual violence experts so concerned that they launched the “Breathless” campaign and website on Tuesday to highlight that strangulation – often referred to as “choking” – is unsafe, and often occurs with no or inadequate communication or consent.

An Australian survey of 4,702 people aged from 18 to 35, published in the journal the Archives of Sexual Behavior on Tuesday, found 57% had been strangled during sex at least once, and 51% had strangled a partner at least once.

Led by researchers from the University of Queensland and the University of Melbourne, the study found 31% of respondents reported being strangled by a partner for the first time between the ages of 19 and 21.

More women (61%) than men (43%) reported having been strangled, along with 78% of trans or gender-diverse people. More men (59%) than women (40%) said they had strangled a partner.

While choking, which involves the partial or total obstruction of the trachea, is different to strangulation, which refers to external pressure on the neck that restricts breathing or blood flow, young people commonly use the term “choking” when referring to strangulation during sex.

Many respondents who had a positive view of choking or strangling believed the act could be safe, the study found.

Study co-author Prof Heather Douglas, from Melbourne University Law School, said choking a person during sex can cause brain injury, even when the person remains conscious, and even when there are no visible injuries. It can also cause death.

“The risks associated with brain injury increase with each subsequent strangulation,” Douglas said.

“So it’s a little bit like head injury in that injuries can accumulate. Miscarriage can also result from strangulation, and can occur a week or months down the track. Strangulation can lead to stroke. There can also be an incremental reduction in memory.”

Douglas said among the most concerning findings was that many respondents had not clearly consented to strangling, with consent given during one sexual encounter perceived as consenting to strangling during subsequent encounters with that partner.

Women (9.6%) and men (8%) were more likely than trans and gender diverse participants (3.6%) to report that they “did not consent, but did not ask or motion for them to stop”. Participants who were strangled more frequently also more frequently said consent was not given beforehand.

Douglas said she was concerned because research from the US has found those who want strangling to stop sometimes “freeze”, either due to feeling trauma or experiencing health impacts, leaving them unable to speak or gesture to withdraw consent.

She added that if people are unaware of the health risks, it raises serious questions around whether consent can truly be given in the first place.

Respect Victoria CEO Serina McDuff said; “I don’t think there’s research that says if you do strangulation in the bedroom, you’re more likely to experience strangulation in domestic violence.”

“But in some relationships, both are happening, and it’s problematic when the perpetrator who is exerting coercive control is also the one giving the victim and survivor information about the safety of sexual choking,” she said.

She added that as rough sex becomes normalised, “it becomes harder, particularly in a coercive relationship, to resist it”.

“Women especially often agree to rough sex, or sex that they don’t want, as a protective behaviour to avoid other forms of violence,” she said.

McDuff said given strangulation is now normalised it was important to better understand why people are engaging in it, along with their ideas around consent.

The study found pornography was the most common avenue by which people reported first hearing about choking during sex (34.8%), followed by discussions with friends (11.5%). But social media, movies, friends and partners were also influential, the study found.

Maree Crabbe is the project director of It’s Time We Talked, which educates young people about the harms associated with child and youth exposure to pornography.

The organisation developed the materials for the “Breathless” strangulation education campaign, which carries the key message that there is no safe way to strangle someone.

“We’ve been working on this campaign for a couple of years after many interviews with young people and experts,” Crabbe said.

“We want to support young people to think critically about the influences that shape norms and expectations around sex, including the normalisation of sexual strangulation.”

Crabbe said sexual strangulation was a significantly gendered practice because it also more often harmed women. One 18-year-old teenager interviewed for the campaign said: “The longer you’re not breathing for, the more sort of panicked you get and the less, you know, mobility you have.”

Another teenager, also 18, said young people have “… accepted that in sexual encounters it’ll [strangulation] probably happen”.

“They won’t ask first.”

While strangulation that causes serious harm and committed without consent is a criminal offence across Australia, most of those surveyed did not know that even consensual strangulation could be seriously harmful, and few knew whether non-consensual strangulation was a criminal offence in their state or territory.

“The gendered drivers of violence include ideas around men being in control and women’s independence being limited in private and public spheres,” Crabbe said.

“To have male dominance, control and aggression also normalised as part of the script in a lot of pornography, I think is really concerning.”