DR Zak discusses the alarming trend of 'consensual choking' and warns of its dangers.

There is perhaps no greater fear than being unable to breathe.

Talk to a person who has had a near death drowning experience or observe an individual with end stage Chronic Obstructive Airways Disease, who literally fights for every gasp of air.

So it is staggering that “choking” to use its colloquial term, also known as “autoerotic asphyxiation” medically, has emerged as a mainstream act for many young couples to engage in as a part of sexual intercourse.

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Studies show that up to half of females between 16-30 have experienced this on more than one occasion, often without the other party gaining consent.

The behaviour has become so normalised in the minds of some younger adults that certain women are too scared to object to the practice, and a group of men say that they think it is what their partner wants.

I say men because the majority of victims (and I do not think this is too strong a word) are women.

There is a preconception that choking only happens during casual hook ups, yet again this is not the case. Girlfriends and wives have been choked by their male partners, sometimes with fatal consequences.

In the UK, a woman dies every two weeks due to being strangled by a male partner.

Choking as a sexual practice is less reported in those aged 40 and over. It would be easy to blame pornography entirely for the rise in this practice in the so-called “Gen Z,” but it certainly does have a role.

These days, behaviours such as choking, slapping, hairpulling and spitting on an individual are not even considered abnormal by many directors and viewers of adult pornography.

Yet there is also an increase in discussion of choking in women’s magazines, internet forums and the like.

Indeed, many comments are light-hearted or seek to reduce the seriousness of the act.

Any act against a partner that seeks to degrade or hurt them physically or mentally, is a form of abuse.

Choking is essentially strangulation. It is frequently seen in rapes and robberies involving female victims.

It is a red flag for intimate partner violence (IPV) and a strong predictor of increased risk of death at the hands of the perpetrator.

It is essentially saying “I do not care about the consequences of my actions as long as I get my kicks”.

While I expect this statement will be robustly questioned, most young women interviewed in several studies admitted that they did not enjoy being choked and that they went along with it for fear of being seen as prudish.

This is deeply worrying. For some, being choked made them feel very frightened.

Choking is most often performed with the hands but can involve ligatures such as belts, scarves, and towels.

In theory the act temporarily reduces the blood flow to the brain, causing a “fight or flight” reaction, thus heightening sensations.

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However, loss of consciousness can occur literally within seconds. This can result in acquired brain injury and even stroke.

Pressure on the blood vessels taking blood to and from the brain can damage them and compression of the windpipe puts it under forces it is not designed to take.

It is easy to see how cardiac arrest can be an unexpected consequence of the above.

A group of young women who had been choked at least once during sex in the last month were compared with a similar group who had not. Though numbers were small, the results showed that those choked reported worse mental health and increased levels of anxiety.

Their ability to perform simple tasks, was reduced compared to the control subjects. This adds to the growing body of evidence that even a minor temporary reduction to blood flow to the brain can cause damage.

Choking at the hands of an intimate partner can result in Post-Traumatic Stress Disorder.

Although online forums and articles may discuss “safe ways of choking,” there is not a single medical article that would ever endorse the act as remotely safe.

It is perhaps what choking represents as much as the act itself, that should cause the most concern. It is a physical expression of anger and a violent, harmful gesture with potentially devastating consequences. This should never be normalised.