More than two in five sexually active under-18s in the UK have either been non-fatally strangled or have strangled someone during sex, with that number rising to more than half of people aged under 35, according to a study by the Institute for Addressing Strangulation (IFAS).[1]

If this wasn’t shocking enough, the same study also shows an alarming consent gap: a higher percentage of perpetrators report believing their partner consented in advance compared to the percentage of recipients who actually agreed.

It’s no wonder then that non-fatal strangulation during sexual activity – also referred to as choking or breath play – has become a topic of increasing concern among healthcare providers, therapists, educators, researchers, and violence prevention professionals.

We have covered the topic multiple times on our socials.  But this issue requires nuance and expertise from the professionals who are dealing with people’s lived experience of non-fatal strangulation, not least in covering the risks involved.

Pornography plays a key part; as does popular culture.  Whilst the law is trying to catch up by outlawing non-fatal strangulation in pornography, in reality these aspects continue to intersect with the power, consent and health dynamics of the people involved.

The dangers of non-fatal strangulation

We understand that some individuals engage in strangulation during sex consensually, but we are also aware of growing numbers of people who are consenting without fully understanding the risks involved. Frequent strangulation can cause stroke, brain swelling, tears in neck arteries, miscarriage, and long-term neurological deficits like memory or cognitive impairment.[2]

Research carried out by clinicians working at the North Wales Brain Injury Service and Bangor University found that:

• Up to 10% of the population have experienced strangulation.  This rises to over 50% of women subject to routine domestic abuse, and up to 20% of women who have been sexually assaulted.
• Even an isolated incident comes with risk: Sexual Abuse Referral Centres (SARCs) advise that medical support is sought after a single incident of strangulation due to the risks involved and the fact that the onset of symptoms can be delayed.
• Strangulation is an overwhelmingly gendered crime with the vast majority of cases involving men strangling women.
• If a woman has been strangled, the chance of her subsequently being murdered rises eightfold.
• Consciousness can be lost within as little as 4 seconds of arterial pressure. Losing consciousness indicates at the very least a mild brain injury. [3]

Many individuals who experience dangerous physical symptoms (like dizziness or brief loss of consciousness) do not seek medical attention, unaware of delayed-onset consequences.

The need for a wider conversation

Consent needs to be informed for it to be valid. How many of the people you work with fully understand the risks involved?

The normalisation of strangulation within some sexual scripts raises questions about how expectations are formed. For some individuals, strangulation is viewed as a routine aspect of sexual activity rather than a high-risk practice, mirroring the shift from it being an aspect of extreme pornography to the mainstream. This shift makes non-fatal strangulation seem casual, easy and low-risk, when in reality it is anything but.

It isn’t enough, therefore, to simply outlaw the depiction of strangulation in porn, or to insist on consent: the gap between perceptions of risk and the medical realities associated with neck compression also needs to be highlighted. A person may consent to an activity that still carries the potential for serious injury. This distinction is particularly important when discussing non-fatal strangulation, as significant harm can occur rapidly and sometimes without immediate symptoms.

Targeted, accurate Relationships and Sex Education (RSE) is vital given how many young people are experiencing it. If you are based in Nottinghamshire, Equation deliver expert sessions to children and young people in schools. Find out more about their programmes and teacher training here: https://equation.org.uk/our-projects/.

Conversations about sexual consent should include not only autonomy and communication but also this informed understanding of risk. Individuals cannot meaningfully evaluate choices if they lack accurate information about potential consequences.

Links

[1] Study by Institute for Addressing Strangulation (IFAS): https://ifas.org.uk/wp-content/uploads/2025/11/Strangulation-During-Sex-in-the-UK-Full-Report-November-2025.pdf

[2] The neuropsychological outcomes of non-fatal strangulation in domestic and sexual violence: A systematic review: https://osf.io/preprints/psyarxiv/c6zbv_v1

[3] We Can’t Consent to This research summary: https://wecantconsenttothis.uk/blog/2020/12/21/the-horrifying-harms-of-choking-new-research