I’m reposting this article today following the devastating death of a 16-year-old in New South Wales, reportedly in connection with sexual choking. It is a confronting reminder that the normalisation of choking or strangulation in sexual activity can have irreversible consequences.

This blog draws on evidence-based resources to make one clear point: there is no safe way to incorporate strangulation into sexual activity (Institute for Addressing Strangulation, 2024). Pressure to the neck can affect the airway, blood flow and brain even where there are no visible injuries, and serious harm can occur rapidly and unpredictably. If you are a trauma survivor, someone who has felt pressured to participate in choking, or a parent, partner or friend concerned about someone you care about, you deserve clear information and support without shame or judgement.

As a sex therapist and a member of the Society of Australian Sexologists, we are increasingly concerned about the normalisation of strangulation in sexual contexts, particularly among young people. What many people refer to casually as “choking” during sex is, in medical and legal terms, strangulation or asphyxia, and it carries serious, potentially fatal risks that cannot be removed by technique, experience, or communication alone (IFAS, 2024; Outcomes International, 2025). In my professional opinion, there is no safe way to strangle someone, even when it is framed as consensual or “just part of sex”, and I also support the Society of Australian Sexologists’ position on this and uphold current laws that recognise strangulation as dangerous, with harmful and potentially lethal consequences.

This article is not written to shame people in kink communities or anyone who has engaged in strangulation. It is written so that people have access to clear, research‑based safety information that is often missing from porn, social media, and everyday conversations (IFAS, 2024; University of Melbourne, 2024). Adults will ultimately make their own choices, but those choices should be informed by the reality that Australian law and medical evidence treat strangulation as highly dangerous and, in many contexts, as a serious criminal offence (Safe and Equal, 2024; IFAS, 2024).

The dangerous normalisation of sexual strangulation

Strangulation has become increasingly prevalent across society in different contexts, including consensual sexual relationships (Lowik et al., 2022; IFAS, 2024). In the context of consensual sex, sexual strangulation (sometimes referred to as “choking”) is being used particularly, but not exclusively, amongst young people, where for many it appears to have become an expected part of the sexual experience (IFAS, 2024; University of Melbourne, 2024). However, the normalisation of this practice has not been accompanied by honest education about the serious medical and life‑threatening risks involved (IFAS, 2024; Safe and Equal, 2024).

Sexual pleasure and intimacy should never require you to accept injuries, loss of consciousness, or life‑threatening risk as the price of being “good”, “brave”, or “adventurous” in bed – including when strangulation happens automatically or without proper consent.

Strangulation refers to external pressure to the neck caused by a hand or hands, any other body part, or an object (such as a belt or scarf) in a way that restricts the airway and/or blood vessels (IFAS, 2024; Safe and Equal, 2024). More specifically, non‑fatal strangulation involves applying pressure to the front or sides of a person’s neck, obstructing or interfering with any part of their respiratory system (Safe and Equal, 2024).

The reality: what happens during strangulation

The risks of strangulation are severe and immediate. The neck contains vital structures including the airway and major blood vessels. Strangulation can restrict the brain’s blood and oxygen supply, potentially resulting in brain damage and death (IFAS, 2024; International Association of Forensic Nurses [IAFN], 2023). Critically, this can happen in seconds and does not require significant pressure (IFAS, 2024).

Strangulation restricts the flow of oxygen and blood to the brain, leading to hypoxia, which can result in both immediate and delayed health complications, including sudden cardiac arrest where the heart ceases to pump blood to the body and brain (IAFN, 2023; Safe and Equal, 2024). Even in the absence of external injuries, internal damage may be significant. The deprivation of oxygen can cause acquired brain injury (ABI) and may also lead to strokes, seizures, or blood clots (Lowik et al., 2022; Safe and Equal, 2024).

In addition to restricting blood flow, pressure on the carotid arteries stimulates baroreceptors that normally regulate blood pressure. Intense pressure around the neck can cause this protective reflex to overreact, leading to a dangerous drop in blood pressure and heart rate. The result can be loss of consciousness and oxygen deprivation to the brain (IFAS, 2024).

Research suggests that approximately 10 seconds of pressure can render a person unconscious, around 17 seconds may result in seizures due to oxygen deprivation, loss of bowel control can occur within about 30 seconds, and death may occur after roughly 150 seconds of sustained pressure (University of Melbourne, 2024).

“Non‑fatal strangulation is a serious and potentially lethal form of assault and should always be treated as a critical safety warning, even when there are no visible marks.”

Some people say, “But I know CPR if something goes wrong.” In reality, by the time CPR is needed, it is often already too late. Even with effective chest compressions, access to a defibrillator, and rapid paramedic arrival, survival chances are poor; the risk of death remains far higher than any perceived safety from CPR training (IAFN, 2023; IFAS, 2024).

The dangers extend well beyond the immediate moment. Strangulation can damage blood vessels in the neck, leading to blood clots that may result in stroke. Evidence suggests that non‑fatal strangulation is a major cause of stroke and acquired brain injury among younger women and victim‑survivors of domestic and family violence (Lowik et al., 2022; No to Violence, 2022). Fatal outcomes can occur hours, weeks, or even months after the incident, sometimes without warning (Safe and Equal, 2024).

Some signs and symptoms of brain injury may only appear later, particularly after repeated episodes of oxygen deprivation due to strangulation (Lowik et al., 2022; IFAS, 2024).

The absence of visible injury does not mean safety

One of the most dangerous misconceptions about strangulation is that visible injury indicates risk level. In reality, non‑fatal strangulation often leaves no visible injuries, or injuries may emerge only weeks or months later (Safe and Equal, 2024; IAFN, 2023). The absence of bruising or marks does not indicate safety; internal damage can be severe and life‑threatening without any external signs (No to Violence, 2022).

This is why legal reforms in Victoria now classify non‑fatal strangulation as a criminal offence regardless of visible injury (Safe and Equal, 2024). The law recognises what the medical evidence clearly shows: strangulation is inherently dangerous whether or not marks are left behind.

The critical failure of consent in strangulation

While adults can choose the sexual practices they engage in, the idea of informed consent becomes very complicated in the context of strangulation.

True consent requires that a person genuinely understands the significant risks involved. Many people have never been told that strangulation can cause brain injury, stroke, cardiac arrest, or death, even when the pressure feels “light” (IFAS, 2024; University of Melbourne, 2024).

More fundamentally, consent is an ongoing process, and individuals have the right to withdraw consent at any point. However, strangulation directly affects the functioning of the brain – the organ we rely on to make and act on decisions about sexual pleasure and safety (IFAS, 2024).

This creates an impossible paradox: the very act being consented to can rapidly destroy the capacity to withdraw that consent, especially if unconsciousness ensues (IFAS, 2024; Lowik et al., 2022).

During strangulation, individuals may lose the ability to signal for help or to stop what is happening. As oxygen flow to the brain decreases, people often experience an inability to speak or move, and may even forget that they have the option to intervene (IFAS, 2024). The experience can also trigger involuntary trauma responses such as freezing, fawning, or fainting. Because oxygen deprivation directly impairs brain function, a person’s cognitive capacity to withdraw consent – even if previously given – becomes compromised or lost entirely. This neurological reality makes pre‑agreed safety signals or “safe words” ineffective and unreliable (IFAS, 2024).

The legal setting

The legal system recognises the inherent danger of strangulation. In law, individuals cannot consent to serious harm, and this has been restated explicitly in relation to strangulation in several jurisdictions (IFAS, 2024). Where a person has been seriously harmed by strangulation, it is not a sufficient defence to say that they consented.

In Victoria, responding to the tragic death of Joy Rowley, the Crimes Amendment (Non‑Fatal Strangulation) Bill 2023 was introduced and became law on 13 October 2024. This legislation introduced specific criminal offences that criminalise non‑fatal strangulation, with maximum sentences of 5 years for non‑fatal strangulation and 10 years for non‑fatal strangulation intentionally causing injury (Safe and Equal, 2024).

Every Australian state and territory has enacted legislation criminalising strangulation, with most establishing standalone offences targeting non‑fatal strangulation, particularly within domestic and family violence (Safe and Equal, 2024; South Safe, 2026). New South Wales pioneered this approach in 2014, followed by the ACT (2015), Queensland (2016), South Australia, Western Australia and the Northern Territory (2020), Tasmania (2022), and Victoria (2024).

In South Australia, choking, suffocating, or strangling a partner is treated as a serious criminal offence, with penalties of up to 7–10 years in prison in some circumstances (Criminal Law Consolidation Act 1935 (SA) s 20A(1), (a1); Legal Services Commission of South Australia, 2025). Even where people say they “consented” during sex, the law around strangulation is complex, and there are many situations where what one person experiences as pressure, fear, or survival may not be recognised as consent at all. Consent is not a reliable legal shield here, and this article is not legal advice, but the key message is that strangulation is legally and medically high‑risk, not a neutral “kink” to negotiate.

The myth of “safe” strangulation techniques

There are messages circulating in some kink communities, organisations, and media outlets suggesting that there are “safe” ways to strangle – for example, by applying pressure to specific areas of the neck, using particular hand positions, or limiting duration. This is dangerous.

Based on existing research and expert consensus, there is no safe way to strangle (IFAS, 2024; IAFN, 2023). The Institute for Addressing Strangulation is unequivocal: any strangulation that restricts blood flow or breathing creates significant risk (IFAS, 2024).

Any pressure to the neck that restricts blood flow or breathing can create risk of:

• Acquired brain injury.
• Stroke, including delayed strokes.
• Death, sometimes occurring long after the event.
• Long‑term cognitive impairment, including memory loss, confusion, and difficulty concentrating.

(Lowik et al., 2022; Safe and Equal, 2024).

Physical and psychological impacts

Beyond physical harm, the psychological impacts of non‑fatal strangulation are profound. Being strangled, particularly by an intimate partner, can trigger intense fear, powerlessness, and terror. These responses often persist long after the assault, contributing to ongoing anxiety, depression, and post‑traumatic stress (Lowik et al., 2022; No to Violence, 2022).

Evidence shows that a history of non‑fatal strangulation is one of the strongest predictors of intimate partner homicide (Lowik et al., 2022; IFAS, 2024). While many of these data come from domestic and family violence settings, they highlight the potentially lethal nature of this act in any context.

The 24–72 hours following non‑fatal strangulation are considered a critical window for the onset of potentially life‑threatening symptoms, even in the absence of visible injuries (Safe and Equal, 2024; IAFN, 2023).

Strangulation as a tool of power and control

Strangulation is a highly lethal form of gendered violence mainly perpetrated by men against women, particularly in the context of intimate partner violence (Lowik et al., 2022; No to Violence, 2022). It also occurs in LGBTQIA+ relationships.

Intimate partner violence is an overt or subtle expression of a power imbalance, resulting in one person living in fear of another, usually within an ongoing pattern of abuse characterised by coercive and controlling behaviours (Lowik et al., 2022).

“There are countless ways to explore power, intensity, and sensation that do not involve restricting someone’s airway or blood flow to the brain.”

Some men employ strangulation as a means of asserting power and control over their intimate partners. Research indicates that most victim‑survivors of strangulation experience other forms of domestic and family violence at the same time (Lowik et al., 2022). Strangulation functions as a mechanism of coercive control to instil compliance and dependency over time. When men strangle their intimate partners, they are “setting the stage”, making clear that they can or will kill them (Lowik et al., 2022).

Many people only realise in hindsight that what happened to them was strangulation or coercive control, rather than “just rough sex”. If you are only now recognising your experiences in this description, that is a valid and important insight, not a failure on your part.

Pleasure without this risk

Sexual exploration and variety can be rich, meaningful parts of intimate life, including kink and BDSM. At the same time, truly informed consent means understanding the real risks involved, not only softened, minimised, or romanticised versions of danger, or messages shaped by pornography, media, or people who may not have accurate information (University of Melbourne, 2024; IFAS, 2024).

I encourage individuals, couples, and BDSM and kink communities to:

• Educate themselves about the actual medical risks of strangulation, rather than relying on myths or online advice.
• Explore alternative practices that create intensity, power dynamics, or altered sensations (for example, sensory play, psychological dominance/submission, or other forms of breath awareness) without risking damage to the neck or brain, and only within emotionally safe, consensual containers for everyone involved.
• Communicate openly with partners about desires and limits while prioritising genuine safety, not just the feeling of safety.
• Seek professional support with someone like me if you have experienced pressure to engage in strangulation, intimate partner violence, or if you are unsure whether a sexual situation felt safe or consensual.

If you have experienced strangulation

If this has happened to you, you did not deserve it, and you are not alone in finding it hard to know what to do next. It is common to minimise what happened, to feel unsure whether it “counts”, or to feel pulled between staying silent and wanting support. Those tensions are part of many trauma responses and deserve care, not judgment (No to Violence, 2022).

If it occurred recently and you are considering reporting it to police or pursuing legal options, it can be important to seek medical care as soon as you feel able, so that any relevant forensic evidence can be collected if you choose to use it later (Royal Australian College of General Practitioners [RACGP], 2020; Sexual Assault Support Service, 2020). A forensic medical examination is usually most useful within about 72 hours of a sexual assault, although in some situations it may still be possible after that, depending on the circumstances and local service guidance (RACGP, 2020; Sexual Assault Support Service, 2020).

In Adelaide and across South Australia, specialist sexual assault services can offer crisis support, medical care, and forensic medical examinations, alongside counselling and advocacy (South Safe, 2026; Safe and Equal, 2024). You can access those services and still see me for ongoing therapy, and if it feels helpful I can also support you in finding and contacting the right service so that your medical, legal, and emotional needs are cared for together.

In the end – because there could be an end

Non‑fatal strangulation is a serious and potentially lethal form of assault, with physical and psychological effects that can be complex, long‑lasting, and sometimes subtle at first (Safe and Equal, 2024; IFAS, 2024). It may leave few or no visible marks, yet it is a strong predictor of future, potentially fatal violence and needs to be treated as a critical safety warning in any relationship (Lowik et al., 2022; No to Violence, 2022).

For people who have been through this, it is common to feel confused, minimised, pressured to see it as “not that bad”, or to only make sense of it much later (No to Violence, 2022). If you are noticing fear, shame, numbness, or conflicting feelings about what happened, those responses are understandable and deserve care rather than judgment.

“There is no safe way to strangle”

As practitioners working in sexual health, mental health, and relationships, there is a responsibility to speak plainly about practices that carry a real risk of serious harm or death, including when they appear in consensual or kink contexts (Safe and Equal, 2024; IFAS, 2024). Sexual pleasure and intimacy should not require anyone to accept injuries, loss of consciousness, or life‑threatening risk as part of being “good”, “brave”, or “adventurous” in bed. There are many ways to explore power, intensity, sensation, and closeness that do not involve restricting someone’s airway or blood flow to the brain.

If any of this is close to your experience and you are seeking trauma support or a place to talk it through, you are welcome to reach out and book a session so we can think together about safety, meaning, and next steps at your pace.

The evidence is clear and the message is unambiguous: there is no safe way to strangle (IFAS, 2024).

Take the first step

If sex, safety, consent, or relationship intensity has felt confusing, painful, or hard to name, therapy can help you explore it gently and at your pace. I am a sex therapist with forensic sexology training and a nationally accredited qualification in recognising and responding to sexual violence, which means our work can include both the relational and nervous‑system impacts and an informed understanding of medical and legal pathways. I offer sessions in person at my practice in Goodwood, Adelaide, and online for clients across South Australia, interstate, and internationally. If you would like support in making sense of your relationship with consent, intimacy, trauma, and safety, you are welcome here.

Book your first session here.

Crisis support for sexual assault

If you are in South Australia and this has happened to you recently, you can contact Yarrow Place, South Australia’s rape and sexual assault service, for 24/7 crisis support, medical care, and forensic medical examinations (Phone 1800 817 421, toll‑free in SA).

At the same time, you are very welcome to book in with me for ongoing trauma‑focused therapy. I am a sex therapist with forensic sexology training and a nationally accredited qualification in recognising and responding to sexual violence, which means our work can include both the relational and nervous‑system impacts and an informed understanding of medical and legal pathways. My role is to walk with you over time, to help you make sense of what happened, and to support you in rebuilding safety, pleasure, and trust at your pace. I can also help you navigate services like Yarrow Place or 1800RESPECT so that your medical, legal, and emotional needs are linked up rather than sitting in separate boxes.

This article is for general information and is not a substitute for personalised therapeutic advice. If you are experiencing distress, please connect with a mental health professional or your GP.

1800RESPECT (1800 737 732), the national sexual assault, domestic and family violence counselling, information and support service, for confidential 24/7 phone, text, online chat, or video support. For immediate crisis support in Australia, contact Lifeline on 13 11 14 or text 0477 13 11 14. For LGBTQIA+‑specific peer support, you can contact Rainbow Door on 1800 729 367 (10am–5pm) or QLife on 1800 184 527 (3pm–midnight). If your mental health emergency is life‑threatening, call (000).

References

International Association of Forensic Nurses. (2023). *Non‑fatal strangulation documentation toolkit*.

Institute for Addressing Strangulation. (2024). *There is no safe way to strangle: Position statement*.

Lowik, V., Lovatt, H., & Cheyne, N. (2022). *Non‑fatal strangulation: A highly lethal form of gendered violence. Integrated literature review*. Queensland Centre for Domestic and Family Violence Research.

No to Violence. (2022). *The voices of women impacted by non‑fatal strangulation*.

Royal Australian College of General Practitioners. (2020). Clinical management of patients presenting following sexual assault.

Safe and Equal. (2024). *Understanding non‑fatal strangulation: Key information for family violence practitioners*.

Sexual Assault Support Service. (2020). *About forensic medical examinations*.

South Safe. (2026). *Non‑fatal strangulation*.

University of Melbourne. (2024, July 2). *Study finds strangling during sex common, but understanding is low*.

Yarrow Place. (n.d.). *Forensic procedures at Yarrow Place*.