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Forensic and research experts warn that sexual strangulation, or consensual choking, has become generationally normalised and may leave young women with higher stroke risk and mild-to-severe brain injury.
Forensic and research experts have warned that women in their early 20s risk becoming a generation with higher stroke risk at a younger age because of what they describe as the epidemic of sexual strangulation, also known as the consensual practice of choking.
Dr Amelia McLean, of the Victorian Institute of Forensic Medicine, said the increase in patients who had been sexually strangled is so striking that clinicians are worried. McLean works in the clinical forensic medical unit at VIFM. McLean said sexual strangulation is now so common a feature of sexual assault, some cases of which begin as consensual encounters, that some young patients she examines believe the choking element is unremarkable.
Generational Rise in Sexual Strangulation Cases
We examine patients after sexual assault, and we have noticed it seems to be quite generational, she said. If I see someone in their mid-30s, it is uncommon to hear there has been strangulation, but when it is someone in their early to mid-20s or younger, it is very, very common. To the extent where we will not be aware strangulation has taken place, and when we do ask them they say, Oh, yeah, of course that happened, she said.
As opposed to it being unusual, they do not seem particularly alarmed about that part of it. McLean has also been alarmed by TikTok and YouTube tutorials outside of pornography that offer advice on how to slow blood supply in the neck's main vessels safely. There are some TikTok clips, also on YouTube, including one that has gone viral which basically is a young woman explaining how to strangle yourself or someone else safely, McLean said.
She points to the carotid arteries and how to compress them to cut off blood supply to the brain to be someone's hand necklace, she said. That the comments under the YouTube version were mostly positive reflects a lack of knowledge that even minor pressure could cause damage, including small tears to the lining of blood vessels.
Such damage can lead to hypoxic and anoxic brain injury, causing brain cells to die, cognitive defects such as amnesia, short-term memory gaps, disorientation, and heavily impaired decision-making or executive function, incontinence, cardiac arrest, miscarriage, convulsions and seizures. Frequent exposure to sexual strangulation also correlates with higher rates of mood disorders including depression, anxiety, loneliness and emotional distress.
Health Risks And Cognitive Impairment Dangers
McLean and non-fatal strangulation research experts such as University of Melbourne Professor Heather Douglas say it is essential that young people are informed about the serious and cumulative harms to brain function risked by even mild blood-flow restriction, but in a way that does not alienate them. Douglas last year studied the understanding of risk among young people, the primary demographic using sexual strangulation outside longstanding niche-sex communities, and concluded one reason strangulation has become so accepted is because of its normalisation.
She surveyed use of sexual strangulation among 4702 people aged 18-35 and found 57 per cent had been strangled at least once and 51 per cent had strangled someone at least once. Young women, 61 per cent, were more likely than young men, 43 per cent, to report ever having been strangled by a partner, and young men, 59 per cent, were more likely to have done it to a partner than young women, 40 per cent.
Douglas said clinicians such as McLean are right to be alarmed. Yes, you might have a generation at risk of stroke, or a generation who might have mild-to-severe brain injury as a result of this behaviour, she said. But the prohibition narrative can be something young people do not respond to, when older adults are saying, never do this, she said. Douglas is a longtime violence-against-women academic.
Consent for sexual activities was often assumed to be carried over from one event to the next, with no ongoing negotiation, placing those being strangled regularly at higher risk of longer-term cognitive issues, she said. There is really clear evidence coming out of the US comparing young women who have never been strangled with those strangled three or four times in the previous month, Douglas said.
Cumulative Brain Injury Effects And Stroke Risk
There are clear changes to how the brain looks, the time it takes to problem-solve, and clear changes to the memories of those strangled. These studies demonstrated that as well as increasing stroke risk, the practice may cause a generation of young women who might have mild-to-severe brain injury as a result of this. Dr Neil Goldie, service director for emergency medicine at Monash Health, compared the cumulative effects of non-fatal strangulation with the incremental harm caused by multiple concussions.
A bit like with concussions in football players, people may not notice it at the time, but 10 to 15 years down the track, there might be significant sequelae, he said. He described sequelae as chronic conditions or complications resulting from a prior trauma. It can have catastrophic effects of death, or repeated minor hypoxic brain injury causing cognitive decline or memory losses that would not necessarily be picked up at the time and may become evident later, Goldie said.
It is going to be really hard to measure. In New South Wales, women's health services have recently reported a huge surge in the number of people concerned they have been affected. The practice is considered so mainstream that a wide range of heavy pet-style slip chains for women's necks remain on sale on popular mainstream shopping platforms such as Etsy, and articles promoting erotic asphyxiation as an advanced kink appear in Women's Health.
New Criminal Laws Addressing Non-Fatal Strangulation
In Victoria, more than 1000 people were charged in the first year after laws criminalising non-fatal strangulation as a standalone family violence offence came into force in late 2024. The prevalence of choking in domestic violence situations is probably underreported, as the Australian Institute of Health and Welfare states only about a fraction of cases are formally recorded. Dr Amy Webster, manager of policy, advocacy and research at Sexual Assault Services Victoria, described sexual strangulation as a manuf
smh 
theage:This once fringe sex act is now ‘normal’ – and women are ending up with permanent brain damage 
brisbanetimes:This once fringe sex act is now ‘normal’ – and women are ending up with permanent brain damageThis story was compiled and edited by the HeadTopics newsroom and HT AI from the reports above.
Choking Brain Injury Stroke Risk Young Women Non-Fatal Strangulation Domestic Violence
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