Dr. Elisabeth Sheff, PhD, CASA, CSE posted: " Image: Color photo of Wonder Woman toy figure with clear plastic tape around her head From children playing "the choking game" as a way to achieve a blissful light-headed feeling to adults who restrict their own or others' air or blood flow, many huma" Dr. Elisabeth "Eli" Sheff
Image: Color photo of Wonder Woman toy figure with clear plastic tape around her head
From children playing "the choking game" as a way to achieve a blissful light-headed feeling to adults who restrict their own or others' air or blood flow, many humans seem to enjoy the physical sensation of hypoxia, which is the feeling that people get when they have inadequate oxygen to their brains. Rising public awareness of kinky sex and the accessibility of a wide range of pornography have contributed to popularizing choking during sex, colloquially termed breath play among people who engage in BDSM. When done in controlled settings, partial asphyxiation can be an intensely erotic and euphoric experience. When taken too far, choking can be traumatic, damaging, or even deadly. There are safe(ish) ways to play with hypoxia, and people who want to try it should be very careful to do it right.
Autoerotic Asphyxiation
One of the ways that people enjoy hypoxia is to pair it with masturbation, something sexologists call autoerotic asphyxiation. Generally a solo practice in which people will restrict their air or blood flow with ligatures around their necks or things covering their faces, many people enjoy this activity fairly safely. Significant and even fatal problems arise, however, for those who pass out and can't shift their bodies to allow air or blood to flow again. Brains require a constant supply of fresh blood and oxygen, and can suffer significant damage quite rapidly if deprived of that inflow. Outside of a few (in)famous celebrities found naked and dead with something tied around their necks, many deaths due to autoerotic asphyxiation are labeled as accidents or suicides.
Breath Play
While autoerotic asphyxiation is usually a solo activity, an increasing number of people are playing with hypoxia in partnered sex as well. Recent research finds that over half (58%) of women college students have ever been choked during sex, sometimes with consent and sometimes without. Women are more likely to be choked than to choke their partners, and are also more likely to engaged in choking to please a partner.
BDSM practitioners have been including breath play in their repertoire of kinky sex for a very long time. In addition to the physical buzz associated with hypoxia, many kinksters also enjoy the power exchange of dominance and submission that can come with choking and breath play. Crucially, kinksters who want to protect their partners' wellbeing are careful to negotiate breath (and any kind of) play before doing it. If the partners fail to negotiate, however, having a lover suddenly start to choke their sex partner can be a terrifying and traumatic experience with lasting negative impacts. Even if people carefully negotiate breath play before doing it, they still run the risk of potential negative impacts on long-term brain health. While the research is not yet conclusive, some studies indicate that repeated exposure to hypoxia can produce cumulative impacts on cognitive function.
Safer Hypoxia
Given the popularity of hypoxia play, it is abundantly clear that lots of people like it and will continue to do it. In light of the potentially tragic consequences of mishandling breath play, it makes sense for those folks who want to include it in their sex lives to learn to do it as safely as possible. One of the most obvious ways is to use hypoxia quite sparingly, and then only briefly. Other important steps include negotiating explicit and prior permission (EPP) and following a set of best practices to ensure the safest play possible.
Explicit and Prior Permission
Image: National Coalition for Sexual Freedom logo in black and red letters
Through decades of research and contemplation of consent, the National Coalition for Sexual Freedom (NCSF) has established itself as a thought leader regarding consent and BDSM. NCSF has developed a model of consent that provide kinky sex enthusiasts with careful guidelines about how to play such potentially dangerous games, moving from the larger cultural emphasis on "no means no" to first include "safe, sane, and consensual" and then "risk aware kink," before eventually landing on "explicit prior permission." Each iteration of consent guidelines has become clearer and more direct as trial and error exposed inadequacies of the former versions. Through their Consent Counts project, NCSF details precisely how to negotiate explicit and prior permission, some best practices for establishing consent in BDSM (and consensually nonmonogamous) relationships, a database of legal documentation relevant to consent, and a reporting mechanism for consent violations.
NCSF's five steps to negotiate Explicit Prior Permission for consent to kink are as follows, and they have many more resources on their website:
1. You agree to specific acts and the intensity before you start.
2. You agree what roleplay resistance is ok to ignore.
3. You must identify a way to stop at any time, like a safeword or safe signal.
4. You are of sound mind.
5. You can't risk seriously injuring someone.
Best Practices for Breath Play
One of the most important ways to ensure sexual safety is to play sober. While mixing sex with drugs and alcohol is a time-honored human tradition, it is also one of the primary ways that sexual interactions go horribly wrong in all sorts of ways. Mood alteration can decrease decision making capacities and impair responses to danger while simultaneously encouraging people to do things that they might not do if they were sober. All of these factors add up to serious trouble if combined with breath play, so it is important to play sober especially at first or with a new partner.
Rather than wrapping anything around the neck or compressing any part of the throat, the safest way to restrict a partner's airflow is to cover the nose and mouth with a hand. Using a hand is the easiest to remove rapidly, and can feel the responses of the person beneath it. Any pressure or compression to the front or sides of the neck runs the risk of damage to the windpipe or collapsing veins and arteries that fail to spring back even after the pressure has been released.
Phoenix Mandel, sexuality educator and relationship coach, teaches about additional ways to safely incorporate breath play. They recommend that people who want to try breath play for the first time approach the experience well fed, rested, and hydrated. Then "Start slowly. Make sure you and your partner are seated or lying down. Be able to communicate with each other (so not too dark nor too loud) and be able to change position to stop play easily (so no bondage yet). Make a J-shape with your pointer finger and thumb (or a backwards J if you're left-handed). Hook that J underneath your partner's chin and flatten your palm to rest on the front of their throat. Do not apply any pressure; simply the weight of your hand here can be a heady experience. Depending on your hand size relative to your partner's throat size, you may wish to spread your fingers for more neck coverage. Congratulations, you've dipped a toe into the waters of breath play! Remember that people do this because it's hot and you can engage in more luscious play for longer if you proceed carefully."
Partnered breath play and autoerotic asphyxiation can be sexy fun, or deadly games. If you want to play seriously with hypoxia, consider taking a workshop or getting some mentoring so that you can gain the important skills required for safer and consensual play.
Herbenick, D., Patterson, C., Beckmeyer, J., Rosenstock Gonzalez, Y.R., Luetke, M., Guerra-Reyes, L., Eastman-Mueller, H., Svetina Valdivia, D., & Rosenberg, M. (2021b). Diverse sexual behaviors in undergraduate students: Findings from a campus probability survey. Journal of Sexual Medicine
Herbenick, D., Guerra-Reyes, L., Patterson, C., Rosenstock Gonzalez, Y. R., Wagner, C., & Zounlome, N. (2021). "It was scary, but then it was kind of exciting": Young women's experiences with choking during sex. Archives of sexual behavior, 1-21.
Lohner, L., & Sperhake, J. P. Autoerotic Deaths. Forensic and Legal Medicine, 531-536.
Schori, A., Jackowski, C., & Schön, C. A. (2022). How safe is BDSM? A literature review on fatal outcome in BDSM play. International journal of legal medicine, 136(1), 287-295.
Sheff, E. (2021). Kinky sex gone wrong: legal prosecutions concerning consent, age play, and death via BDSM. Archives of sexual behavior, 50(3), 761-771.
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