The Dangerous Rise of Sexual Strangulation Among Teens

by Cheralyn Leeby and Stephanie Boye

In an alarming moment during a workshop, 19-year-old Joy casually remarked, “Choking is the new hickey.” This statement underscores a grim and growing trend of sexual strangulation (SS), also known as “breath play,” among young people. Beneath its rise lies something far more disturbing: the increasing normalization of violence in intimate encounters. Tragically, many young people today are either unaware of the risks or dismiss them entirely.

Strangulation vs. Choking: A Dangerous Confusion

The language we use matters. Choking refers to an airway being blocked internally, while strangulation involves external compression of the neck, impairing vital blood flow and oxygen to the brain (Glass, 2008). The term “breath play” misleadingly suggests a benign activity, far from the dangerous reality of strangulation. And, yet, this practice is increasingly glamorized through pornography and popular media, making it appear desirable.

Influence of Pornography and Media

Much of what young people believe about sex is learned, not through education or experience, but through screens. Experts agree that most kids are exposed to pornography by late elementary and middle school (ages 8-12). Sexual relations, as depicted across various media and pornography, have grown increasingly violent, and acts like SS against women are now standard fare. Research reveals that approximately 58 percent of female college students have been choked during sex, and about one-quarter of these women first experienced this between the ages of 12 and 17 (Herbenick et al., 2023). A shocking 26.5 percent of women reported being choked during their most recent sexual event, often without conversation or consent (Herbenick et al., 2023).

When we ask students if men are ever the recipient of SS, the answer is a definitive, “No.”

High-profile influencers like Andrew Tate amplify this trend toward violence against women, glorifying male dominance and control as markers of masculinity. When young minds absorb these messages repeatedly, through TikTok, YouTube, music, and pornography, they become desensitized to the violence, bypass empathy, and wrongly assume this is “normal” sexual behavior (Gunter, 2023). For some individuals, typical neural pathways for empathy are underactive or rerouted as a result of this desensitization.

The Reality of Risks Involved

Brian Bennett, a law enforcement veteran and strangulation expert, notes: “There is no safe way to strangle another person.” The amount of pressure required to cause significant harm is shockingly low. For comparison, it takes about 20 pounds of pressure to open a soda can and 40–60 pounds for a firm handshake. Yet, it only takes 5 pounds of pressure for 8-10 seconds to cause unconsciousness and 11 pounds to restrict blood flow through the carotid arteries (Training Institute on Strangulation Prevention, 2020).

The consequences of SS, either immediate or delayed, can include memory loss, vocal cord damage, stroke, cardiac arrest, and even death. And, yet, many young people engaging in this act believe it to be “safe,” “no big deal,” or “just rough sex,” while unaware of the potential irreversible harm.

Cultural Pressures and Sexual Expectations

Many young women report feeling pressured to engage in SS to appear sexually adventurous. In hookup culture, it may seem easier to acquiesce than speak up. In many cases, consent is replaced with nonchalant compliance. Our students report that “No one wants to be the prude in bed.” As a result, the desire to be desired trumps safety.

The Teenage Brain: Vulnerability to Influence

It’s important to remember that the prefrontal cortex, responsible for judgment, impulse control, and risk evaluation, doesn’t fully mature until around age 25 (Casey et al., 2008). Meanwhile, the limbic system, or the emotional center, is highly active in adolescence, driving sensation-seeking behaviors and reactivity. This imbalance makes teens especially vulnerable to influence, peer pressure, and misinterpreting danger as excitement.

Combine that with an internet culture saturated with eroticized violence, and you have a generation of youth navigating intimacy without the neurological or emotional tools to do so safely.

Social Learning: Modeling What They See

Bandura’s Social Learning Theory (1977) explains how youth observe and model behaviors seen from influential figures, peers, and others. Repeated exposure to violent acts, like SS, in pornography and other media, conditions youth to see it as normal, arousing, or even necessary for desirability and approval. Without media literacy or healthy sexual modeling, teens are replicating what they see without understanding the risks.

Sex Essential Reads

The Neurobiology of Sex

A New Take on Sexual Rehab After Prostate Cancer

Attachment and Trauma: Where Danger Feels Familiar

For some, high-risk sexual behavior feels oddly familiar. Individuals raised with trauma, neglect, or inconsistent caregiving may miss red flags or succumb, longing for love. If a child’s earliest relationships lacked safety, they may unconsciously substitute any attention or sexual activity for connection. Furthermore, with repeated exposure, neurological processes reinforce the arousal response, particularly for young men, linking pain with pleasure.

As Joy shared, “I'll put my hands on his hands, to indicate, that's enough. Sometimes they get it, sometimes they don't. Some [guys] like [it] harder, where it looks like I can't breathe. They get off on that.”

To cope with something she did not want, Joy reported that sometimes she “goes outside her body.” Trauma responses, like dissociating, appeasing, or freezing, can mistakenly look like consent, but, in reality, they are survival strategies. Consent, on the other hand, is an active, informed, engaged, and embodied process of mutual agreement to a particular sexual activity.

Conclusion

The normalization of sexual strangulation is not a trend to be brushed off. What young people are calling “just normal sex” is often a reflection of negative and possibly dangerous cultural, digital, and neurological processes at work.

Real intimacy is not about power, performance, pain, or fear. Real intimacy includes mutual respect, emotional presence, pleasure for both parties, and safety. Through trauma-informed education, honest dialogue, and cultural accountability, we can help the next generation unlearn violence and rediscover the authentic connections they desire.

Stephanie Boye is a sex educator and my co-host on the podcast 7 on Sundays.