A 19-year-old named Joy once told a group of researchers, almost casually, that "choking is the new hickey." She wasn't being provocative. She meant it as an observation about her generation that pressing a hand around a partner's throat during sex has become so normalized among teenagers and young adults that it barely registers as risky anymore. In one workshop, a 19-year-old casually remarked that choking had become "the new hickey," underscoring a grim and growing trend of sexual strangulation among young people.
That line is worth sitting with, because it captures exactly how this practice has slipped into youth culture: not through a deliberate choice weighed against clear information, but through osmosis porn, social media, playground rumor, and a pop-culture shrug that says everyone's doing it, so it must be fine.
The problem is that it isn't fine. It has never been fine. And the growing body of medical and public health research on sexual strangulation is now blunt about something teenagers are rarely told: there is no such thing as a safe amount of pressure on the neck.
This article walks through what the data actually shows, why the myth of "safe choking" took hold, what happens inside the body when the neck is compressed, and most importantly how the adults in a teenager's life can start having a conversation that most schools, and most parents, are still avoiding.
How Common Is This, Really?
If you assume this is a fringe practice limited to a small subculture, the numbers will surprise you.
A recent nationally representative U.S. survey of adults aged 18 to 60 found that 21% of sexually active women reported having been choked as part of a partnered sexual experience, compared with 11% of men. But that overall figure hides a much sharper generational divide. The prevalence is significantly higher among young adult women and adolescent girls: 58% of randomly sampled female college students reported having ever been choked during sex, and a quarter of them first experienced it between the ages of 12 and 17. Separately, one in three undergraduate women said they had been choked during their most recent sexual encounter.
It isn't only cisgender women reporting this. In a large survey of roughly 5,000 randomly sampled college students conducted by Dr. Debby Herbenick's team at Indiana University, 64% of women, 29% of men, and 56% of trans and nonbinary students said they had been choked at some point. And this isn't a one-off experiment for most of them about one in five reported having been choked more than 25 times.
The picture outside the U.S. looks similar. A 2024 Australian survey of 4,702 people aged 18 to 35 found that 57% reported ever having experienced sexual strangulation, 51% reported ever having strangled a partner, and 43.9% reported having done both. The same research found stark gender patterns: young women were more likely to report having been strangled (61%), young men were more likely to report strangling a partner (59%), and rates were even higher among trans and gender-diverse young people, with 78% reporting ever having been strangled and 74% reporting having strangled someone else.
Herbenick herself has described her reaction to seeing this data for the first time. When she ran her first nationally representative U.S. survey on sexual choking a decade ago, she said "the data came back and I was just floored" while only a small percentage of adults in midlife and beyond reported being choked, more than a third of 18-to-39-year-olds reported having experienced it. When she brought the findings to her own students, their reaction told her everything about how normalized the practice had already become in that age group.
A Practice That Escalates
One detail researchers keep flagging is that choking rarely stays a one-time experiment. It tends to become a repeated, almost routine part of a couple's sexual script which matters, because repeated sub-concussive pressure on the neck and brain is not the same risk category as a single incident. This is one of the quieter but more important findings in the literature: the danger isn't just about the worst-case, catastrophic event. It's cumulative.
The Myth of "Safe Pressure"
Ask most teenagers who've tried it, or watched it modeled in pornography, how you do it "safely," and you'll hear a familiar list of rules: don't press too hard, don't hold it too long, check in with your partner, avoid the front of the throat, use two fingers instead of a full grip. These rules get passed around in group chats and TikTok comments like established fact.
They are not established fact. They are folklore.
Medical literature is unambiguous that there is no pressure threshold that reliably separates "safe" from "dangerous" when it comes to the neck. Only about 2 kilograms (roughly 4.4 pounds) of external pressure is required to compress the jugular veins, and this venous congestion not airway blockage is the main cause of death in most fatal strangulations. Separately, applying around 11 pounds of pressure to the carotid arteries can cause a person to lose consciousness in about 10 seconds.
To put that in perspective: 4.4 pounds of pressure is roughly the force of holding a can of soup. That is the threshold at which blood flow out of the brain can start to become obstructed. The idea that there's a "gentle" way to apply pressure to the neck that avoids all of this simply isn't supported by how the anatomy works.
The Body Doesn't Wait for "Too Far"
Loss of consciousness during strangulation can occur within roughly 7 to 10 seconds of sustained compression, driven primarily by the sudden cutoff of oxygen to the brain. That's faster than it takes to read this sentence out loud. There is very little margin between "this feels intense" and "this person has passed out" and once consciousness is lost, the person applying pressure often can't tell in real time whether they're looking at brief unconsciousness or the beginning of something far more serious.
The neck also contains the vagus nerve and the carotid sinus, both of which are highly sensitive to external pressure, and stimulating the carotid sinus can trigger a sudden drop in heart rate and blood pressure a reflex that can cause rapid loss of consciousness even before blood flow is fully blocked. In rare cases, bilateral pressure on the carotid bodies can trigger dangerous heart rhythm disturbances, potentially leading to cardiac arrest.
None of this is something a partner can "read" from experience or intuition. The line between arousal and a medical emergency is invisible from the outside, and it moves depending on someone's health, hydration, anatomy, and even how they're positioned.
Consent Doesn't Make It Safe
This is one of the hardest parts of the conversation, and one of the most important. Consent is essential nobody should ever be choked without full, enthusiastic, ongoing agreement. But consent changes the ethics of the act. It does not change the physiology.
A person can genuinely, enthusiastically want to be choked and still be at real risk of a stroke, brain injury, or death. Consent tells us whether an act is a violation of someone's autonomy. It tells us nothing about whether their carotid artery can tolerate the pressure being applied to it. Researchers studying this topic are careful to separate these two questions, because conflating them is exactly how the "safe if consensual" myth spreads.
Damage You Can't See and Might Not Feel
Perhaps the most unsettling research finding is that strangulation frequently causes injury without leaving any visible mark and without the person even necessarily reporting classic symptoms.
In alert patients, warning signs of a serious strangulation injury include reported loss of consciousness, changes in voice, difficulty swallowing, small red spots on the face called petechiae, and visible marks on the neck but internal injuries frequently don't correlate with how severe things look from the outside. Brain damage in survivors of manual strangulation can occur acutely or with a delayed onset, most often linked to dissection or thrombosis of the carotid artery though there are also documented cases of brain injury with no visible vascular abnormality at all.
One emerging area of research is specifically about frequent, "low-level" choking the kind many teens and young adults consider harmless because it doesn't cause loss of consciousness or obvious injury. Scientists have begun testing for biomarkers of brain injury in women who are choked repeatedly during sex, precisely because there's growing concern that even choking that "feels fine" in the moment may be doing cumulative, silent damage to brain tissue over months and years. That research is still developing, but the direction of the evidence is not reassuring.
And when things go wrong quickly rather than gradually, the consequences are catastrophic. Case reports describe otherwise healthy young adults suffering strokes secondary to strangulation-induced carotid artery injury, with permanent weakness and speech loss. Global oxygen deprivation to the brain can also cause traumatic brain injury resulting in long-term cognitive difficulties, impaired decision-making, and personality or behavioral changes requiring lifelong care.
Where Teenagers Are Learning This
If sexual strangulation isn't being taught as a "safe practice" in health class, where is the idea coming from?
Experts point to pornography and mainstream media, where sexual strangulation has become increasingly normalized and glamorized, making it appear both desirable and unremarkable. Much of what young people come to believe about sex is now learned not through formal sex education or lived experience, but through screens and most children are exposed to pornography by late elementary or middle school age. As sexual content across media and pornography has grown more aggressive, acts like sexual strangulation directed at women have become standard, expected content rather than an edge case.
Research on this specific behavior among young adults is genuinely new recognition that sexual choking is widespread has only recently emerged, and structured educational programs addressing it are still largely absent. In other words: teenagers are absorbing a script from porn and peer culture years before any adult, teacher, or clinician sits down to talk with them honestly about what it actually does to the body.
It's also worth naming the gendered pattern researchers keep finding. In heterosexual encounters, women are overwhelmingly the ones being choked, which some researchers suggest may reflect and reproduce traditional gendered power dynamics within sex rather than simply reflecting mutual, symmetrical experimentation. This isn't a reason to shame anyone involved but it is a reason to be skeptical of the framing that this is simply a "fun new kink" free of any broader context about gender, pressure, and expectation.
When It Goes Fatally Wrong
The consequences aren't hypothetical, and they aren't rare enough to dismiss.
A clinical sexologist and certified sexuality educator in Florida has described strangulation-related deaths during sex as becoming "frighteningly common" in recent years. One widely reported case involved a 27-year-old New Zealand man convicted of murder after a 21-year-old British backpacker he'd met through a dating app died during sex; he said she had asked to be choked. Other coverage of this trend has pointed to a police investigation into the death of a 16-year-old girl believed to have lost consciousness from asphyxiation during sex a case that pushed the issue back into national headlines and prompted researchers to speak publicly about just how young this behavior starts.
These cases share a pattern: someone who wanted intimacy, who may have believed (because they'd been told, repeatedly, by porn and peers) that this was a normal, low-risk thing to try and a body that did not cooperate with that belief.
Why This Conversation Keeps Getting Skipped
There are a few reasons adults have been slow to address this directly with teenagers.
It's uncomfortable. Most parents struggle to talk about sex at all, let alone a specific practice with a real risk of death or stroke.
It sounds like "kink-shaming." Conversations about sexual safety can get tangled up with legitimate, separate conversations about sexual freedom and stigma, and some adults worry that raising concerns about strangulation will come across as moralizing about sex in general.
The information genuinely wasn't available until recently. Recognition that this behavior is prevalent among young people is a recent development, and educational material addressing it directly has lagged behind actual usage. Many parents, teachers, and even doctors are only now catching up to how common this is.
It doesn't look dangerous. Because there's often no bruising, no obvious injury, and no immediate collapse, it's easy for everyone involved including the people doing it to conclude that nothing happened. The body's response to strangulation is largely invisible from the outside, which makes it easy to underestimate.
None of these are good reasons to stay silent. They're simply the reasons the silence has lasted this long.
How to Actually Talk to Teens About This
The goal isn't to deliver a lecture that shuts a teenager down before the conversation starts. It's to give them accurate information they can act on the same way you'd talk about drunk driving or drug interactions: not as a moral judgment, but as a matter of basic physical safety.
Start from curiosity, not accusation. Asking "have you heard people talk about choking during sex?" opens a door. Asking "are you doing this?" closes one.
Separate the physiology from the morality. Teenagers are quick to sniff out lectures dressed up as science. The most credible message is the simplest one: this isn't about whether choking is "bad" or "wrong" it's that there is no pressure level, technique, or amount of trust between partners that makes it physically safe. That's true regardless of gender, relationship, or experience level.
Correct the "hand vs. pressure" myth directly. Many teens believe the danger comes from squeezing hard, so a light touch feels risk-free. Make it concrete: it takes only a few pounds of pressure less than the weight of a laptop to interfere with blood flow out of the brain, and loss of consciousness can happen in under 10 seconds.
Name that consent and safety are two different questions. Wanting something, and even clearly consenting to it, doesn't change what it does to blood vessels and brain tissue. This is a distinction worth stating explicitly, because pop culture rarely makes it.
Talk about where the idea is coming from. If porn is shaping expectations before anyone has a chance to offer real information, it helps to say that plainly: what's shown as routine in porn is often not filmed safely, is not representative of consent negotiations, and is designed to look appealing rather than to be medically accurate.
Make it a two-way, ongoing conversation, not a single talk. This isn't a "one and done" topic, the same way seatbelt use or safe drinking isn't. Revisiting it as new headlines, shows, or songs reference the practice keeps the information current and relevant.
What Needs to Change Beyond the Family Dinner Table
Individual conversations matter, but researchers studying this issue are also pointing to bigger structural gaps.
Sex education curricula are behind the culture. If a practice is common enough that a majority of young women report experiencing it, it needs to be addressed directly in health classes not left to be self-taught through pornography.
Clinicians need better training. Doctors and nurses aren't always asking about strangulation history the way they might ask about smoking or drug use, even though it's now recognized as a genuine risk factor for stroke and neurological injury in young, otherwise healthy patients.
Platforms shape norms. Because so much of this behavior is learned from media that glamorizes it without context, there's a growing call for platforms from mainstream streaming content to social video apps to think about how casually strangulation is depicted, and whether any context about risk accompanies it.
Research funding needs to catch up to prevalence. Given how recently this issue has been studied at scale, there is still a lot we don't know particularly about the long-term, cumulative effects of repeated low-level choking on the developing adolescent brain.
Sexual strangulation has moved, in the space of a decade, from a niche practice to something a majority of young women report having experienced often starting in their early teens, often learned from pornography rather than any adult, and often carried out with the sincere belief that there's a "safe" way to do it.
There isn't.
The neck contains major blood vessels sitting just under the skin, protected by almost nothing. A few pounds of pressure far less than most people would guess can interrupt blood flow to the brain in seconds. Consent can make an act ethical. It cannot make a carotid artery more durable.
The most protective thing adults can do isn't to panic or moralize. It's to close the information gap early enough that a teenager encounters the facts before they encounter the pressure of a partner's hand and to say, clearly and without judgment, that "everyone's doing it" was never the same thing as "it's safe."
