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Evidence of Brain Damage Caused by Choking During Sex

Scientific studies show that women who are choked have more psychological problems and changes in brain connectivity

Two blond women in underwear on a bed, one choking the other.
Shutterstock picture ID 1728028183, by Dm_Cherry.

I strongly recommend not to practice choking. This article is part of a series intended to show that choking is unsafe, may cause brain damage, and is potentially lethal.

Health problems in women who have been choked during sex

Even serious brain injury can go undetected because the brain is very good at hiding it. Hence, there have been studies aiming to determine if women who had been choked showed signs of brain injury.

Women who had been choked during sex more than five times in the last month were more likely to feel sad, lonely, anxious and depressed than women who had never been choked (Herbenick et al., 2022).

“Women with a history of being choked more than five times during sex within the past 30 days were 2.19 times as likely to endorse experiencing overwhelming anxiety, 2.16 times more likely to report feeling very sad, 1.59 times more likely to report being very lonely, and 1.77 times more likely to feel ‘so depressed that it was difficult to function’ than women who had never been choked.” (Huibregtse et al., 2022).

Women who had been choked during intimate partner violence

There are also detailed studies of psychological and cognitive problems in women who had been choked during intimate partner violence.

One of them (Valera et al., 2022) found that these women showed deficits in long-term memory, had higher levels of depression and presented symptoms of posttraumatic stress.

However, some of these problems may derive from the psychological trauma produced by the assault and not from the strangulation itself.

A review of 30 papers about strangulation during domestic and sexual violence (Bichard et al., 2022) showed that the victims presented the following problems:

  • Pathological: tears in the arterial wall and stroke.

  • Neurological: loss of consciousness, seizures, motor and speech disorders and paralysis.

  • Psychological: posttraumatic stress, depression, suicidal ideation and dissociation.

  • Cognitive: memory loss.

  • Behavioral: aggression, compliance with the aggressor and lack of help-seeking.

Obviously, strangulation during violence is much more severe than that occurring during consensual sex and BDSM. Still, its consequences show what can happen if choking is taken too far. In particular, loss of consciousness should be considered a sign that choking is extreme enough to produce brain injury.

Brain imaging studies in women who had been choked during sex

But, is there evidence that choking during sex produces brain damage?

I found two studies that did this using brain imaging (fMRI) and tests of brain function.

One study (Hou et al., 2022) compared 21 women who had never been choked with 20 women who had been choked four times or more during the last month, using fMRI to measure the functioning of the cortex and brain connectivity. The paper reports that women who had been choked showed an imbalance in neural activation between the brain hemispheres. They also showed higher than normal connectivity between the angular gyrus and brain regions involved in motor control, emotion and consciousness. The angular gyrus is involved in comprehension while reading, number processing, spatial cognition, memory retrieval and attention. It is hard to tell what these increases in connectivity mean, or even if they are caused by the choking.

Another study (Huibregtse et al., 2022) used a similar sample: 20 women who had been choked at least four times during the last month and 20 women who had never been choked. Their brains were imaged using fMRI while they did verbal and visual tasks to measure their working memory. Both groups of women performed equally well in these tasks.

However, the fMRI revealed that, during the verbal memory task, women in the choked group showing increased activation of their corpus callosum, left posterior thalamic radiation, left caudate nucleus and left insula. The corpus callosum is the bundle of fivers that connect the brain hemispheres. The thalamus is the sensory relay in the middle of the brain. The caudate nucleus is part of the striatum and reward system, and is involved in motor control and learning. The insula processes the emotions associated with pain and pleasure, and other emotions.

During the visual memory task, women in the choked group showed more activation of the superior and right middle frontal gyri. As the difficulty of the task increased, the choked group showed less activation of the middle and the right inferior frontal gyri. The frontal gyri are involved in involved in self-awareness, decision-making and impulse control. They are also critical for working memory.

The authors of the study concluded that, although the women who had been choked did not show a decreased ability in the working memory tasks, they had to allocate increased resources to the parts of their brain involved in performing these tasks. This could indicate hypoxic or ischemic damage or reperfusion injury produced by the repeated choking. Or there could be a remodeling of brain networks.

These two studies show that there are definite differences between the brains of choked women and women who had never been choked. These differences appear minor, but they could signal a build-up of brain trauma. Keep in mind that the women in these studies were young college students. Older brains might show more problems after choking.

Is choking worth the risks?

I don’t think choking for fun is worth the risks. There many other ways to have fun with sex and BDSM that are much safer.

I consider choking unsafe and I advise against doing it.

If you put together everything I wrote in this series of articles, you will realize that there are no safe ways to practice choking safely. The analyses of cases of death from choking show that there is a low but significant risk of death that cannot be mitigated by any amount of knowledge and safety precautions.

Recoveries from cardiac arrest are much rarer than what movies make us think they are.

Even if nobody dies, repetitive choking can induce cumulative brain damage. Especially if choking induces loss of consciousness. This article presents evidence that cognitive and psychological deficits occur in people who are frequently choked.

Some people may just like to put a hand on the throat and do some pretend choking. As long as there is no blockade of blood flow to the brain or air entry to the lungs, this is fine. But you should not call it choking, because that normalizes choking for other people.

The safety of choking is still hotly debated in the BDSM community. However, most BDSM organizations and clubs do not allow choking in their facilities. Sex adviser Dan Savage advises against it in The Savage Lovecast, where he has interviewed professor Debbie Herbenick, the author of many of the papers I have cited here.

In the end, whether to choke or not is a risk that should be assumed by the individuals involved, with full consent and plenty of information. However, as we have seen, both things are often lacking when it comes to choking. To be fully informed on this matter requires some in-depth knowledge of physiology and neuroscience.

Weighing pleasure, on the one hand, against a real possibility of brain damage and death, on the other, the decision seems quite obvious to me.

But I also think it’s important that we continue having a conversation about this issue. If people are going to do it, we need to continue to evaluate its risks and disseminate information about the safest way to do it.


  • Bichard H, Byrne C, Saville CWN, Coetzer R (2022) The neuropsychological outcomes of non-fatal strangulation in domestic and sexual violence: A systematic review. Neuropsychol Rehabil 32:1164-1192.

  • Herbenick D, Fu TC, Kawata K, Eastman-Mueller H, Guerra-Reyes L, Rosenberg M, Valdivia DS (2022) Non-Fatal Strangulation/Choking During Sex and Its Associations with Mental Health: Findings from an Undergraduate Probability Survey. J Sex Marital Ther 48:238-250.

  • Hou J, Huibregtse ME, Alexander IL, Klemsz LM, Fu TC, Fortenberry JD, Herbenick D, Kawata K (2022) Association of frequent sexual choking/strangulation with neurophysiological responses: a pilot resting-state fMRI study. J Neurotrauma 40:1339-1351.

  • Huibregtse ME, Alexander IL, Klemsz LM, Fu TC, Fortenberry JD, Herbenick D, Kawata K (2022) Frequent and Recent Non-fatal Strangulation/Choking During Sex and Its Association With fMRI Activation During Working Memory Tasks. Frontiers in behavioral neuroscience 16:881678.

  • Valera EM, Daugherty JC, Scott OC, Berenbaum H (2022) Strangulation as an Acquired Brain Injury in Intimate-Partner Violence and Its Relationship to Cognitive and Psychological Functioning: A Preliminary Study. J Head Trauma Rehabil 37:15-23.

Copyright 2023 Hermes Solenzol.


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