We’re Talking About Non-Fatal Strangulation

Written By Caddyshack Project

November 2025

Content Warning: This blog post outlines details of and references to sexual assault including sexual strangulation (sexual choking).

If this doesn’t feel like the right time to access this information, you can always revisit it later. Please take good care as you read this blog post and do what you need to do look after yourself and reach out to support services if you need to.

 

We recently met with Sexual Assault clinicians and Women’s Health NSW and received some insight into the key issues they are seeing young people presenting with; A common one being non-fatal strangulation.

We are also hearing from young people that it’s common to have chats with friends about experiences of sexual choking (a form of non-fatal strangulation).

We have been reflecting on this sexual practice, the risks and the discourse around the action and decided to write this blog post to provide the information and tools to guide conversations with friends, peers and clients.  

Would you know what to say if a friend told you that their partner regularly strangled them during sex? 

What if you were chatting with your group of friends about Shibari, or rope play, and one friend mentions that something had gone wrong, and the knots were really tight, and they couldn’t breathe? 

Where would you take someone who disclosed to you that they had been strangled and passed out, but it was just supposed to be fun?  

Conversations about non-fatal sexual strangulation (or sexual choking) can be uncomfortable. But it’s important to understand what it is, what the risks are and where to go for support. So that if you or someone in your life is ever in this position, you are empowered to know what to do. 

Sexual Choking is a form of Non-Fatal Strangulation 

Let’s start with some definitions for sexual choking, and non-fatal strangulation. 

Sexual choking and non-fatal strangulation is when pressure is applied to a person’s neck by one or both hands, other body parts or an object, making it difficult for them to breathe and restricting blood flow to their brain. 

Sexual choking is a more common term used to describe rough sex and involves the activity of pressure applied to a person’s neck to partially restrict blood flow which, in theory, can increase endorphins.

It’s important to know that medical professionals use the word strangulation to describe pressure applied to the outside of the neck, which can block blood flow to and from the brain and sometimes block airflow into and out of the lungs.

In medical terms, the word choking describes an obstruction affecting airflow related to a blockage inside of the airway (e.g. when a piece of food is accidentally inhaled instead of swallowed).   

There is no safe way to restrict a person’s airway and blood vessels. 

Strangulation experts agree that even with informed consent, there is no safe way to engage in sexual choking.  

It’s easy to get the idea that everyone is practicing sexual choking, but not everyone likes rough or kinky sex and you are not boring if you don’t wish to engage in it. Sex should be consensual, safe and pleasurable for everyone.  

Affirmative and Informed Consent 

Informed consent is a person’s decision, given voluntarily, to agree to an activity after they have been provided with accurate and relevant information about the activity.  

Affirmative consent means everyone participating in a sexual activity enthusiastically agrees to take part in that specific sexual activity. 

To be able to provide informed and affirmative consent to sexual choking, it is important that both parties recognise and understand the risks and have a plan to take action (medical care) if things go wrong. This forward planning is used by people in the kink and BDSM communities carrying out practices such as Shibari (Rope Bondage), where a safety plan is in place.  

Some people may talk about using safe words or safe gestures (like tapping an arm) to indicate when sexual activities move from consent to non-consent. Using safe words or gestures doesn’t work for sexual choking, as being choked can stop a person from being able to speak, move or think clearly very quickly. You can quickly become unconscious before you are able to signal for your partner to stop.  

Understanding the continuum of risk is important when exploring these sexual activities. You can experience sexual pleasure by redirecting to lower risk ways that don’t involve putting pressure on the neck, for example, role-play and fantasy play that don’t cross boundaries.  

A consent educator spoke with Women’s Health NSW and said

“We are honest about risks to the person being choked and the person doing the choking. Even if there is fully informed consent, boundaries and safety things, it could still go wrong … and realistically no one wants to accidentally kill someone during sex.” 

Learn more about consent in podcasts, blog posts, and social media content on the Teach Us Consent website and check the Understanding Consent and Sexual Strangulation/Choking blog post from Learning Consent

Health Care Workers are Worried about Sexual Strangulation

Experiencing a strangulation is a scary situation. The feeling of not being able to breathe creates a cascade of events that can result in your brain not receiving the oxygen it needs and can make you not feel yourself, or feeling like you are going to die.  

Doctors and nurses are genuinely concerned about a person's physical health, as a non-fatal strangulation can damage internal structures of the neck, including your spinal cord and column, as well as nerves, arteries and veins. This damage can result in strokes, seizures, and long-term brain damage. 

Significant internal damage can occur with no visible external damage to a person’s neck, so doctors and nurses should never assume that everything is just ok.  

These effects from strangulation happen quickly and with minimal pressure.  

The pressure of a person's handshake can make a person unconscious in as little as 6.8 seconds 

After 15 seconds a person can lose control of their bladder

After a minute a person may die

When we think about these time frames and that 15 seconds is about the length of an Instagram reel, this really shows how quickly the physical consequences of strangulation can occur.  

Strangulation: A Serious Form of Violence

Non-fatal strangulation is considered a potentially life-threatening injury and will be always be taken seriously.  

If the strangulation has occurred in the context of Domestic and Family Violence or Sexual Assault, you may be eligible for an AVO, with specifically trained police called Domestic Violence Liaison Officers allocated to your case. Strangulation is a crime in NSW and will be taken seriously by the police.

When to go to an Emergency Department 

If you are worried, and/or have symptoms after a non-fatal strangulation/sexual choking, the recommendation is to attend a NSW Health Emergency Department (ED) where you will be medically assessed.

Medical staff talk in terms of red flags which indicate signs or symptoms that make them a little more concerned regarding a person’s health. If you notice, see or feel any of these, you should immediately seek medical assistance. You may need to call an ambulance, especially if you have lost consciousness.  

  • Difficulty breathing 

  • Unable to swallow or pain on swallowing 

  • Changes to the sound of your voice 

  • Difficulty speaking 

  • Headaches, memory problems or dizziness 

  • Double vision or blurry vision or loss of vision 

  • Ringing in your ears 

  • Seizures or fits 

  • Loss of balance 

  • Red or bruised eyes - especially in the whites of your eyes 

  • Neck bruising or swelling 

  • Losing control of your bladder or bowel 

The It Left No Marks website have a graphic and brochure which shows the visible signs of strangulation.

Western NSW Local Health District also show a graphic with visible signs in their info card Seeking Help Could Save Your Life.

What to Expect when going to an Emergency Department  

When you arrive tell the staff exactly what has happened, as you will be treated with dignity and respect. No information is too much or too embarrassing for the staff, and they will triage you according to how you are doing at that point. If any of your symptoms get worse in the waiting room, make sure you let them know that something has changed.  

After a strangulation, you may be referred to a hospital social worker or the Domestic and Family Violence and Sexual Assault Service for support.

How do you Help Yourself or your Friends 

If you find yourself having a chat about sexual choking or strangulation, or if you yourself are in a situation that feels unsafe or out of control, we encourage you to get support. 

It Left No Marks is an amazing and clear online resource for more information for both sexual choking and strangulation. 

If you need help immediately, dial 000 and ask for an ambulance or police, or both if you need to! 

If you would like to be speak to a counsellor about what has happened, 1800Respect or your local sexual assault crisis phone number is a great place to start. 1800Respect also provides some online and text support options on their website.  

Support is available to you!

Key points to remember 

Sexual choking may appear normal in porn but porn is not reality and sexual choking can be dangerous and even fatal. 

There is no safe way to strangle. During sexual choking, the ability to withdraw consent often evaporates. 

Even when there are no visible marks, the damage can be real and lasting. 

Your experience is valid, full consent must be informed and ongoing. Learn more about how to practice consent over at Teach Us Consent.  

 

As always,

Peace, Love & Protection

x


Caddyshack Project
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