Prevalence and characteristics of choking/strangulation during sex: Findings from a probability survey of undergraduate students

From Pornography Consumption to Sexually Violent Practices: Uncovering the Hidden Influence of Sexual Norms

Understanding the dynamics of sexually violent behavior is essential for developing effective interventions and policies that promote safe and respectful sexual relationships. An important area of research in this context is examining the influence of pornography on sexual behavior, which can inform these efforts. This study explores how sexually permissive attitudes and acceptance of the sexual double standard mediate the relationship between pornography consumption and engagement in violent sexual practices among a sample of the general population in Castilla-La Mancha, Spain (N = 1003; 50.7% men). The sexual double standard refers to the societal belief that men and women should be judged differently for the same sexual behaviors, with men often praised or excused for promiscuity, while women face stigma and shame. The findings reveal gender differences in engagement in sexually violent practices during sexual relationships. Men are more likely to perpetrate these behaviors, while women are more likely to experience them. Importantly, both lifetime and last year pornography consumption are associated with an increased involvement in such practices. This relationship is partially mediated by sexually permissive attitudes, with a stronger mediation effect observed in men. Practitioners can leverage these insights to develop comprehensive strategies that mitigate the risks associated with pornography consumption.

Prevalence of Sexual Strangulation/Choking Among Australian 18-35 Year-Olds

In Australia, strangulation has been explicitly criminalized in all states and territories. However, it continues to be a "normalized" sexual practice despite its potentially fatal consequences and associated short and long-term sequelae. This research aimed to establish the prevalence of strangulation during sex and examine predictors of positive perceptions toward sexual strangulation in Australia. Confidential, cross-sectional online surveys were conducted with 4702 Australians aged 18-35 years. Participants were 47% cis-men, 48% cis-women, and 4% trans or gender diverse. A total of 57% reported ever being sexually strangled (61% women, 43% men, 79% trans or gender diverse) and 51% reported ever strangling a partner (40% women, 59% men, 74% trans or gender diverse). Differences were found across genders on all variables of sexual strangulation, including frequency of engagement, level of pressure on the neck, consequences, wanting and enjoyment, and how consent was given/received. However, when split by gender, sexual orientation of men and women revealed further differences in behaviors, consequences, and wanting, particularly among straight and bisexual women. After accounting for exposure to strangulation in pornography and previous experience of sexual strangulation, positive perceptions of being strangled (R2 = .51) and strangling a partner (R2 = .53) were predicted by ratings that it could be done safely and social normative factors. These findings suggest strangulation is common during sex among young Australians. Non-stigmatizing education strategies are needed to engage with young people so they have a better understanding of the risks involved and how to negotiate consent and safety regarding sexual strangulation.

Choking/Strangulation During Sex: Understanding and Negotiating "Safety" Among 18-35 Year Old Australians

Despite its potentially fatal consequences, sexual choking/strangulation is an increasingly common sexual practice. Existing research suggests that its growing prevalence is partly a consequence of its popular construction as "risky yet safe." Few studies have directly examined how people frame and engage in choking/strangulation in terms of "safety"-what people think it means for strangulation to be (or not be) "safe" and how people think safety during strangulation can be achieved. Drawing on qualitative text responses from a survey collected in 2023, this paper examined whether and how Australian adults aged between 18-35 perceived choking/strangulation in terms of "safety." We identified and discussed four main themes arising from the data: choking/strangulation during sex can be safe; pressure/intensity is a safety mechanism; consent is a safety mechanism; and trust and communication are necessary. In consideration of these themes, we suggest that many Australian young people are not aware of the risks of choking/strangulation during sex and frequently equate pressure/intensity and consent, within a trusting relationship, with safety. Given the significant risks and harms associated with any sexual choking/strangulation and the resultant difficulty in achieving safe use, we concluded that appropriate education and information should be provided to young people.

Prevalence and Correlates of Sexual Choking and Consensual Non-Consent (CNC) Among College Students: Findings from a Campus-Representative Survey

Rough sex has become prevalent among young adults, yet little is known about the prevalence of consensual non-consent (CNC)-which is often enacted as role-playing sexual assault-or the correlates of either sexual choking or CNC. In a U.S. college campus probability survey, we assessed the prevalence and correlates of choking and CNC. More women (45%) and gender diverse participants (61%) had ever been choked than men (25%). Also, 10.0% of students had ever engaged in CNC, with no significant gender differences. Both choking and CNC were related to alcohol use and to a history of partner violence.

Is "Rough Sex" a Thing? A Survey of Meaning

The term "rough sex" is widely used, but it is not always clear what it means. Through exploring people's working definitions of "rough sex," we asked what they revealed about the underlying phenomenon it is applied to, and whether it is actually a thing. Our online survey of 567 New Zealand respondents (73.7% women, 21% men, 5.3% gender diverse; mean age, 35.6 years, SD = 10.8) identified various behaviors that many considered to be part of "rough sex" - including hair pulling, holding down someone forcefully, slapping and "choking." While this behavioral profile was similar to previous U.S. studies, our survey was designed with novel features that allowed us to look more closely at the variation in how people make sense of "rough sex." Embedded within a critical psychology approach, our descriptive analysis highlighted areas of ambiguity and difference, including points of contradiction across people's working definitions. Critical qualitative analysis of open-ended textual data further examined categorical misalignments and the difficulties in interpreting behavioral indicators as defining of "rough sex" - especially without more contextual information. Overall, we found considerable variability and some contradictions in people's definitions of "rough sex" and the meanings they ascribed to it. Our findings led us to argue that the term "rough sex" does not map onto a coherent phenomenon, and that use of the term can be misleading, with potentially problematic implications.

Sexual choking/strangulation and its association with condom and contraceptive use: Findings from a survey of students at a university in the Midwestern United States

INTRODUCTION

Consensual sexual choking has become prevalent among young United States (US) adults. In sex between women and men, women are overwhelmingly the ones choked, perhaps reproducing traditional heteronormative power dynamics. No research has examined the relationship between being choked during consensual sex and the use of external condoms and other contraceptives.

METHODS

We administered a cross-sectional campus-representative survey to 4989 undergraduate students at a large public Midwestern US university.

RESULTS

Half of respondents (n = 1803) had ever been choked during sex. Having been choked was associated with a significantly lower likelihood of event-level condom use (OR = 0.32 [0.19, 0.54] for >5 times lifetime choking among men and OR = 0.35 [0.27, 0.45] for >5 times lifetime choking among women compared to those with no choking experiences) and in the past 6 months (OR = 0.42 [0.24, 0.72] for >5 times lifetime choking among men and OR = 0.59 [0.43, 0.81] for >5 times lifetime choking among women compared to those with no choking experiences). Also, having ever been choked was associated with a significantly greater likelihood of having used an implant/intra-uterine device in the past 6 months (OR = 1.85 [1.28, 2.68] for >5 times lifetime choking compared to those with no choking experiences).

CONCLUSION

Recognition that sexual choking is prevalent among young people has only recently emerged and educational programs are lacking. Study findings could be used to engage people in discussions about choking in relation to gender, power, and reproductive health agency.

"What Is Normal?": A Qualitative Exploration of Health Practitioners' Reports of Treating Patients Presenting with Unpleasant Sexual Experiences

Sexual health, including sexual pleasure, is fundamental to holistic health and well-being, and is considered an area of priority health in Australia. Despite the importance of sexual functioning, women experience significant gaps in sexual well-being compared to men and often do not seek medical care or treatment. Health practitioners are central to the identification and treatment of sexual dysfunction, including fostering sexual well-being for patients. Despite this, minimal research has explored health practitioners' experiences in treating reports of unpleasant sex. This study aimed to explore health practitioners' experiences, responses, and confidence in treating patients presenting for unpleasant sexual experiences. An online, mixed-methods survey was completed by 96 participants. Thematic analysis identified 11 core themes. These themes included five patient centred themes (health risks, diverse sex acts, painful vaginal intercourse, relationship breakdown and violence, unwanted sex) and six health practitioner centred themes (communication and counselling, what is normal, ongoing care and follow up, emotional response, limited practical training, and highly prevalent). Participants described a complex sexual health landscape, with social contexts impacting women's sexual experiences and engagement in treatment. Additionally, health practitioners reported the need for a biopsychosocial approach to understanding and responding to unpleasant sexual experiences for patients, while simultaneously reporting limited education in this area. Findings reflect the need for health practitioners to be cognisant of matters related to sexual function, consent, coercion, client engagement, and treatment pathways, identifying a need for greater education and holistic approaches to sexual healthcare across medical settings.

Sexual Violence Among Higher Education Students in the United Kingdom: Results from the Oxford Understanding Relationships, Sex, Power, Abuse and Consent Experiences Study

Sexual violence (SV) experienced by higher education students is a prevalent public health problem. Collecting data on SV through self-report surveys in higher education institutions (HEIs) is essential for estimating the scope of the problem, the first step to adequately resourcing and implementing prevention and response programming and policies. However, in the United Kingdom, data is limited. We used data from the cross-sectional Oxford Understanding Relationships, Sex, Power, Abuse and Consent Experiences survey, administered to all students at a university in the United Kingdom in May 2021 (n = 25,820), to estimate the past year prevalence of SV. We analyzed data from respondents who answered at least one question on SV (n = 1,318) and found that 20.5% of respondents experienced at least one act of attempted or forced sexual touching or rape, and 52.7% of respondents experienced at least one act of sexual harassment (SH). We found that women experienced the highest rates of SV. Attempted forced sexual touching was far more common than forced sexual touching, or rape. Sexist remarks or jokes were the most common act of SH. Most acts of SV took place at the university. These findings reveal that the prevalence of SV in HEIs in the United Kingdom could be far higher than what is experienced in the general population. While this study reflects the context in only one institution, it underlines the need for continued monitoring to develop rigorous, evidence-based, and targeted prevention and response strategies.

#ChokeMeDaddy: A Content Analysis of Memes Related to Choking/Strangulation During Sex

Recent research indicates that some young people initially learn about sexual choking through Internet memes. Thus, a qualitative content analysis was performed on 316 visual and textual memes collected from various social media websites and online searches to assess salient categories related to choking during sex. We identified nine main categories: communication, gendered dynamics, choking as dangerous, choking as sexy, sexualization of the nonsexual, shame and worry, romance/rough sex juxtaposition, choking and religious references, instructional/informational. Given that memes, through their humor, can make difficult topics more palatable and minimize potential harm in the phenomenon they depict, more concerted, synergistic effort that integrates media literacy into sexuality education programming on the potential risks that may ensue for those engaging in sexual choking is warranted.

Sexual Repertoire, Duration of Partnered Sex, Sexual Pleasure, and Orgasm: Findings from a US Nationally Representative Survey of Adults

In a confidential U.S. nationally representative survey of 2,525 adults (1300 women, 1225 men), we examined participants' event-level sexual behaviors, predictors of pleasure and orgasm, and perceived actual and ideal duration of sex, by gender and age. Event-level kissing, cuddling, vaginal intercourse, and oral sex were prevalent. Sexual choking was more prevalent among adults under 40. While women and men reported a similar actual duration of sex, men reported a longer ideal duration. Participants with same-sex partners reported a longer ideal duration than those with other-sex partners. Finally, findings show that gendered sexual inequities related to pleasure and orgasm persist.

Doula Support Challenges and Coping Strategies during the COVID-19 Pandemic: Implications for Maternal Health Inequities

The COVID-19 pandemic has made birthing more stressful and isolating, which has raised particular concern for populations of birthing people affected by maternal health inequities. Doulas have been proposed as one means of improving health outcomes by providing emotional, physical, and informational support to patients and their families before, during, or after labor. However, the social and economic conditions of the COVID-19 pandemic have posed new challenges for doula care. We conducted thematic analysis on 25 semi-structured interviews with practicing doulas in the United States to explore changes to doula care during the pandemic. Although doulas have faced many challenges in providing virtual and socially-distanced support during the pandemic, the rising use of telehealth among doulas has revealed new coping strategies and opportunities for virtual communication with the doula community. Our findings indicate that doula experiences during the pandemic can inform future doula care practices, particularly for birthing people of color and low-income birthing people.

Frequency, Method, Intensity, and Health Sequelae of Sexual Choking Among U.S. Undergraduate and Graduate Students

Although sexual choking is now prevalent, little is known about how people engage in choking in terms of frequency, intensity, method, or potential health sequelae. In a campus-representative survey of undergraduate and graduate students, we aimed to: (1) describe the prevalence of ever having choked/been choked as part of sex; (2) examine the characteristics of choking one's sexual partners (e.g., age at first experience, number of partners, frequency, intensity, method); (3) examine the characteristics of having been choked during sex; and (4) assess immediate responses of having been choked including the extent to which frequency and method (e.g., hand, ligature, limb) of having been choked predicts the range of responses endorsed by participants. A total of 4254 randomly sampled students (2668 undergraduate, 1576 graduate) completed a confidential online survey during Spring 2021. The mean age of first choking/being choked was about 19, with more undergraduates than graduate students reporting first choking/being choked in adolescence. Women and transgender/gender non-binary participants were significantly more likely to have been choked than men. Participants more often reported the use of hands compared to limbs or ligature. Common responses to being choked were pleasurable sensations/euphoria (81.7%), a head rush (43.8%), feeling like they could not breathe (43.0%), difficulty swallowing (38.9%), unable to speak (37.6%), and watery eyes (37.2%). About 15% had noticed neck bruising and 3% had lost consciousness from being choked. Greater frequency and intensity of being choked was associated with reports of more physical responses as was use of limb (arm, leg) or ligature.

Frequent and Recent Non-fatal Strangulation/Choking During Sex and Its Association With fMRI Activation During Working Memory Tasks

Being strangled, or “choked,” by a sexual partner has emerged as a prevalent, often wanted and consensual sexual behavior among adolescent and young adult women, yet the neurological consequences of repeated exposure to this behavior are unknown. The objective of the study was to examine the association between a history of repeated, recent choking/strangling episodes during sex and fMRI activation during working memory tasks in young adult women. This case-control study involved young adult women (18–30 years old) at a large, public university, and consisted of two study groups: a choking group consisting of participants who were recently and frequently choked/strangled during sex by a partner (≥4 times in the past 30 days) and a choking-naïve (control) group who had never been choked/strangled during sex. Participants completed two variations of the N-back (0-back, 1-back, and 2-back) working memory task during functional magnetic resonance imaging (fMRI): verbal and visual N-back tasks. Data from 20 participants per group were available for analysis. Between-group differences for accuracy and reaction time were not significant for either variation of the N-back task. Significant differences in fMRI activation patterns were detected between the choking and the choking-naïve groups for the three contrasts of interest (1-back > 0-back, 2-back > 0-back, and 2-back > 1-back). The choking group exhibited increased activation in multiple clusters relative to the choking-naïve group for the contrasts between the 1-back and 2-back conditions compared to the 0-back conditions (e.g., superior frontal gyrus, corpus callosum). However, the choking-naïve group exhibited increased activation relative to the choking group in several clusters for the 2-back > 1 back contrast (e.g., splenium, middle frontal gyrus). These data indicate that recent, frequent exposure to partnered sexual strangulation is associated with different neural activation patterns during verbal and visual working memory tasks compared to controls, suggesting that being choked/strangled during sex may modify the allocation of neural resources at increasing levels of cognitive load. Further investigation into the neurologic effects of this sexual behavior is warranted, given the prevalence of sexual choking among adolescent and young adult women.

"Don't Just Randomly Grab Someone's Neck during Intercourse!" An Analysis of Internet Articles about Choking/Strangulation during Sex

Sexual choking/strangulation has become prevalent among young U.S. adults, yet little is known about media articles that teach readers about choking. We conducted a content analysis of 27 Internet articles, examining how choking is described, information related to health risks and healthcare, and article accuracy. Most articles described choking in positive terms and indicated choking can be done safely or properly, even while acknowledging potential dangers. Only two articles indicated having undergone expert/medical review. Few gave information about signs that would warrant seeking healthcare. Sexuality professionals need to be aware of choking-related information and misinformation in online media articles.

Pornography and Women's Experience of Mixed-Gender Sexual Choking/Strangulation: Eroticization Mediates, Perceived Similarity Moderates

Sexual choking, which is a form of strangulation, can lead to various health consequences, including death. Recent surveys suggest that sexual choking is prevalent among young U.S. adults, a demographic also likely to view pornography. Pornography professionals, social commentators, and scholars have noted that mixed-gender choking is normative in contemporary pornography. Further, the pornographic portrayal of sexual choking is gendered; men choke women more often than women choke men. Guided by the sexual script acquisition, activation, application model (₃AM) of mediated sexual socialization, the present campus-representative probability study explored associations between heterosexual-identified women's pornography exposure and sexual choking behavior. The more frequently women viewed pornography, the more often they were exposed to pornographic depictions of sexual choking. Exposure to sexual choking, in turn, was associated with being choked by men, but not choking men. The link between choking exposure and being choked was mediated by the eroticization of choking (rather than reduced agency to stop rough sex) and became stronger the more women perceived themselves as similar to actors in pornography. These results suggest that women's experience of sexual choking is influenced by their use of pornography, but in an active and willing, rather than a passive and unwilling, manner.

Meanings of Rough Sex across Gender, Sexual Identity, and Political Ideology: A Conditional Covariance Approach

The purpose of this study was to investigate how various subgroups based on gender, sexual identity, and political ideology conceptualize rough sex. We used available data from a 2020 survey of randomly sampled undergraduate students at a large public university in the Midwestern U.S. (n = 4,989). The dichotomous responses to 13 items on the rough sex meaning scale were analyzed using a conditional covariance approach to better understand which behaviors commonly described as rough sex behaviors were prevalent. Our results showed that rough sex was conceptualized largely as a two-dimensional construct for vast majority of subgroups. Across all subgroups, nine of the 13 behaviors clustered along two dimensions in the same way. Specifically, four behaviors related to hair pulling, being pinned down, hard thrusting, and throwing someone onto a bed clustered together as one dimension (spanking and tearing clothes off being present along this dimension for vast majority of the subgroups). Being tied up, slapping, choking, punching, and making someone have sex behaviors formed a separate dimension of rough sex across all studied groups (with biting and scratching being associated with this dimension for vast majority of subgroups).

Non-Fatal Strangulation/Choking During Sex and Its Associations with Mental Health: Findings from an Undergraduate Probability Survey

Choking/strangulation during sex is prevalent among young adults in the United States. We examined associations between having ever been choked and participants' current mental health symptoms (e.g., feeling depressed, anxious, sad, lonely) in the prior 30 days and in the prior year. Participants were 4352 randomly sampled undergraduates who completed a confidential online survey and reported lifetime partnered sexual activity. 33.6% of women and 6.0% of men reported having been choked more than five times. After adjusting for demographic characteristics, having been choked remained significantly associated with all four mental health outcomes, except for overwhelming anxiety among men.

"If Their Face Starts Turning Purple, You Are Probably Doing Something Wrong": Young Men's Experiences with Choking During Sex

Choking/strangulation during sex has become prevalent in the United States. Yet, no qualitative research has addressed men's choking experiences. Through interviews with 21 young adult men, we examined the language men use to refer to choking, how they first learned about it, their experiences with choking, and consent and safety practices. Men learned about choking during adolescence from pornography, partners, friends, and mainstream media. They engaged in choking to be kinky, adventurous, and to please partners. While many enjoyed or felt neutral about choking, others were reluctant to choke or be choked. Safety and verbal/non-verbal consent practices varied widely.