Worrying sexual strangulation rates among rangatahi and the long-term health consequences

At Sexual Wellbeing Aotearoa, we share the concerns outlined in the Spinoff’s article about ‘worrying’ strangulation rates in under-25s, particularly in the context of rough sex.

We worry about young people’s access to accurate information, and the narrative they’re seeing about rough sex and sexual strangulation being “normal”, despite the significant dangers it poses.

Strangulation is when pressure is applied on or around the neck with enough force to reduce or stop breathing, or block the flow of oxygen to the brain. When this is done during sex, it’s called sexual strangulation, non-fatal strangulation or non-fatal strangulation and suffocation (NFSS).

Young people call it:

• Choking (though this isn’t technically correct)

• Breath play

• Being choked out

• Blood choking

• Air play

• Erotic asphyxiation. 

Rough sex has been mainstreamed in pornography and through social media. In fact, to combat this, the UK recently banned depictions of sexual choking in pornography.

With rough sex and sexual strangulation becoming increasingly common and expected as part of sex, young people also experience pressure to do it. For many young people, if consent is even discussed, consent for specific sexual acts, like “choking” are often missing from the conversation.

This is compounded by the lack of quality relationships and sexuality education (RSE) within the curriculum, which doesn’t address consent, pornography or the critical thinking needed to identify misinformation and disinformation around sexuality-related content.  

Since many young people don’t perceive sexual strangulation as sexual violence, approaching it in this may prevent some young people from having this kōrero and from accessing services. 

Sexual strangulation is never safe.

Any time that blood or oxygen is prevented from flowing to the head is dangerous. Being strangled can lead to serious health problems including headaches, memory loss, anxiety, and PTSD, and even brain injury. And the more this happens, the greater the risk of long-term damage.

Health professionals are concerned the long-term effects of strangulation could become a major health crisis in the future.

There’s a link between “choking” and sexual violence.

Many rangatahi don’t see “choking” as sexual violence or may not perceive it as sexual violence until later. But, worryingly, sexual assault services are seeing increasing rates of sexual assault happening at the same time as NFSS.

Consent in the context of rough sex – including sexual strangulation – is complex, dynamic, and highly contextual.

Young people don’t always understand that consent is ongoing and is for each specific act. Just because someone says yes to sex at the start, doesn’t mean yes for everything. Everyone has the right to change their mind at any point, or to say “no” to sexual acts they don’t want to do, and sex should stop. When you’re having sex, it’s important to ask and keep asking if the other person is comfortable and wants to continue.

Nobody should be pressured into doing something they don’t want to do, and if they aren’t sure about it, take it as a ‘no’ and find something else you’re both comfortable doing instead.

The Sexual Harm Helpline is free, confidential, and available 24 hours, 7 days a week. You can contact trained specialists by:

Free call: 0800 044 334 
Text: 4334 

We can all make a difference – health services, youth services, schools, parents and whānau, the wider community, and the government all have an important role to play to help young people navigate what could become a health crisis later down the track. 

This is why Sexual Wellbeing Aotearoa and The Light Project are developing guidance for professionals working with rangatahi on recognising, responding to, and reducing the risks associated with harmful rough sex, which includes sexual strangulation. This is due to be published later this year. 

We have a range of resources and training designed to help professionals and parents have conversations about difficult topics like this. 

• Supporting Young People with Sexual Wellbeing – full day training

• Tips for Talking for Kaimahi

• Talking to Young People Video series: We need to talk about consent 

• Tips for Talking for Parents and Whānau 

• Talking to Young People Video Series: We need to talk about porn 

• The Light Project (for professionals)

• In the Know (for young people)