Dr. Rachel Rubin is a board certified urologist and sexual medicine specialist who writes a column for Medscape, "Sexual Matters." While the column and podcast is intended for medical professionals, in my opinion, there's a much larger audience that needs to hear this.
It should be no surprise that injuries happen during sexual activity. Vigorous thrusting can cause vaginal bleeding. A penis can slip out and get bent or even broken. And that's during consensual activity. In the CDC survey, 27% of women and 4% of men report the experience of completed or attempted rape.(3) It is only common sense that violent attacks are likely to cause physical harm.
However, what's catching attention this week is the growing incidence of compression on the neck in sexual activity. This is strangulation and in addition to restriction of the airway may also result in the reduction of blood flow to the brain. Doctors who are sensitive to this possibility are finding increasing evidence of this activity among both adults and teenagers.
This isn't new and there are names in the medical literature for it: erotic asphyxiation, breath play, and sexual choking. Usually, this is a male doing this to a female, but it can be done in solo activity or with the roles reversed. WebMD reports one survey finding that 58% of women have been choked during sex play.(4) Some women report being as young as 13 years old at the time they first experienced this.
The light-headedness that results from oxygen deprivation can enhance the sexual high with some people.
In one study, almost 82% of those choked during sex reported euphoria, and almost 44% reported a head rush.(4)
The obvious problem with this is the risk of accidental death, especially when something other than the hands is used to constrict breathing. However, the medical community is finding that there are other risks short of death, including
- Headaches of varying severity
- Hoarseness and trouble swallowing
- Ringing in the ears
- Irregular heart beat
- Cardiac arrest(6)
- Stroke(3)
- Brain damage (cell death from loss of oxygen)
As with most things sexual, the problem is communication. When a patient complains about a headache, many doctors will be oblivious to sexual activity as a possible cause unless there is very obvious bruising. Most patients won't volunteer information about their sexual activity out of embarrassment, fear of judgment, or lack of awareness that it might be relevant.
And parents talking to teens about this?? Speaking of oblivious.
We don't have hard data on how common breath play is. The last national government-sponsored survey was initiated with Obama in office, and the report wasn't released until Biden was President. I've not found any public explanation for the delay.
Sources:
- https://www.rachelrubinmd.com/
- https://www.medscape.com/viewarticle/disturbing-sexual-trend-real-health-consequences-2024a1000daq?form=fpf
- CDC, Center for Disease Control and Prevention, "The National Intimate Partner and Sexual Violence Survey: 2016/2017 Report on Sexual Violence", June 2022.
- https://www.webmd.com/sex/what-is-sexual-asphyxiation
- https://www.psychologytoday.com/us/blog/the-polyamorists-next-door/202312/the-truth-about-breath-play-and-choking-during-sex
- https://www.healthline.com/health/healthy-sex/erotic-asphyxiation
- https://en.wikipedia.org/wiki/Autoerotic_fatality
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