Choking Hazard: The Real Risks Of Erotic Asphyxiation

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Erotic asphyxiation is a dangerous, little discussed sexual practice. It is important to understand the associated risks.

Choking Hazard

Photo: run_dorcas_run Flickr

Erotic asphyxiation games can be fatal.

Small toys and plastic bags will often come with a “choking hazard” warning to prevent small children from accidentally suffocating. However, adults may need to take choking hazards into consideration as well, when playing in the bedroom.

It is not unusual to read news reports of individuals who have died from asphyxiation accidents, either solo, or while engaging in sexual activity with with a partner. In the cases when more the one person is involved, the surviving partner may face manslaughter charges, even if the act was consensual. Erotic asphyxiation is a type of sexuality that is not frequently discussed openly outside of these reports, due to the stigma, discomfort and fear it provokes. Little research data is available about practitioners of erotic asphyxiation activities due to this stigma. Reports of death and injury may not be a sufficient deterrent for those who find the riskiness to be part of the erotic thrill of this type of play. However, from a public health perspective it is necessary to examine this subject in greater depth to understand why erotic asphyxiation can lead to death and injury, and what can be done to reduce harm and potential deaths related to these practices.

The Choking Game

Not all accidental deaths related to asphyxiation are erotic in nature. Teenagers may engage in “choking games” where they deliberately cut off the flow of oxygen to the brain to induce a euphoric high. A recent CDC study indicated that at least 82 children and teens have died from recreational “choking games” since 1995, but it is difficult to know the true statistics as some deaths may be inaccurately classified as suicides. It is believed that the recent death of a fifteen year old boy in Bloomington, Indiana was due to the “choking game.” It is important that parents discuss the potentially fatal risks associated with these games with their children, just as they would discuss the risks related to drugs, alcohol, and sex. The GASP website offers useful educational resources for better understanding the risks associated with the “choking game.”

Understanding erotic asphyxiation

Teenagers aren’t the only ones at risk from death by asphyxiation, as adults may engage in grown-up, erotic “choking games.” Activities that suppress the flow of blood or oxygen to the brain to promote arousal and orgasm is known as erotic asphyxiation (also called “breath play,” “asphyxiophilia,” or “hypoxyphilia“). These activities may include constricting the throat or chest with nooses, hands, or ligatures; smothering or otherwise covering the nose or mouth with a plastic bag, mask, hand, pillow or other object, or deliberately inhaling gases or chemicals that reduce oxygen flow to the brain. These activities may be performed solo (autoerotic asphyxiation), or with a partner. The source of arousal may be linked to the “high” feeling and intensified orgasms that accompany oxygen deprivation (known as cerebral hypoxia), or enjoyment of the sensation of helplessness that accompanies restricted breathing. Erotic asphyxiation may be linked to bondage or other BD/SM activities, or cross-dressing.

The American Psychiatric Association classifies asphyxiophilia as a paraphilia in the 5th edition of the Diagnostic and Statistical Manual, as a sub-category of sexual masochism (though not all individuals who engage in asphyxiophilia consider themselves masochists). It is important to understand that there is no harm in fantasizing about asphyxiation during masturbation and sex. However, it is when these fantasies become realities that a very real potential for death and injury emerges. Most people who engage in these practices do not wish to harm or kill themselves or their partners. They may even use safeguards that give them a false sense of security.

All types of breath play are dangerous to one extent or another. Even holding your breath can be inadvisable if you have a contraindication such as pregnancy. However, it is interesting to consider that in martial arts such as Brazilian Jiu Jitsu, Judo, and Submission Wrestling, choke holds that restrict blood flow to the brain are commonplace maneuvers that seldom lead to death or injury.  That is not because these chokes are not dangerous, but because they are performed by supervised, carefully trained athletes in good health, in a controlled manner that minimizes danger. Therefore it is important for anyone who engages in these behaviors to have a realistic sense of the risks involved and how to minimize potential harm.

Risk factors to consider

The following are factors that dramatically increase the risk of death or injury when engaging in erotic asphyxiation:

  • Pre-existing health conditions can greatly increase the risks related to erotic asphyxiation. The risks related to erotic asphyxiation are not limited to suffocation. The physiological effects of oxygen deprivation can lead to strokes, heart attacks, brain damage, and other potentially lethal outcomes, even in healthy people. The  elderly, people with heart conditions, epilepsy, and other health conditions are at even greater risk.
  • Solo play is extremely dangerous, and can lead to death. “Safeguards” such as slipknots or padding are ineffective if you lose consciousness.
  • Any activity that puts pressure on the throat itself should be avoided. Constricting the throat using a hand, rope, or other implement can crush the trachea and other delicate structures of the throat, leading to serious medical emergencies.
  • Engaging in erotic asphyxiation while under the influence of drugs or alcohol is extremely dangerous, as judgement may be impaired, and intoxication may affect the physiological response to asphyxiation.

In summary, there is really no “safe” or even “safer” way to engage in erotic asphyxiation, but the risk factors listed above can dramatically increase the risk of injury or death. Former ambulance medic and BD/SM educator Jay Wiseman has a series of essays on his website that outline the medical risks associated with erotic asphyxiation in laymen’s terms for those who are interested in learning more.

Bianca Jarvis

Bianca Jarvis is an MPH student at Indiana University, and the executive editor at MsBehaved.com: "a sex-positive, body-positive, queer-friendly, gender-inclusive lifestyle site with a fierce femme sensibility." Her research interests include health disparities in gender-variant populations, body-diverse wellness, and sexual health and pleasure.
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