How Risky Is it to be Choked During Sex?

This story appears in the March issue of VICE magazine. Click HERE to subscribe. 

Ah, friends. They're like family but cooler. Fully customizable. Fall and one of them will be right there to pick you back up. But as great as friends can be, they also do a lot of really stupid stuff. Stuff that blows your mind. Like, sometimes it seems crazy that you even hang out with people who make such crappy decisions. Stuff that, were it to get out, would be mortifying for anyone with even a shred of self-respect. Lucky for your friends, they've got you to ask their deepest, darkest questions for them. And lucky for you, we started this column to answer those most embarrassing of queries.

The scenario: Your friend is into BDSM stuff and likes to have his mouth and nose covered during sex. He's alluded to a curiosity about choking too. What? It gets him off.

What you're afraid of: That your buddy will die happy, but way too early, in the throes of kinky sex. A little background: Choking and breath play are "are possibly the single largest causes of permanent harm and death within the BDSM scene," says Barak*, co-owner of adventuresinsexuality.org, and an ER Nurse. (*We've omitted Barak's last name at the request of the medical institution he works for.)

What's likely to happen: There aren't solid statistics for how many people partake in this type of BDSM, or suffer the consequences of it. The main takeaway here is that anyone who tries it can have an experience that goes awry.

Research shows that healthy adults are unlikely to sustain permanent damage if the person being choked is released quickly and before losing consciousness, but Barak cautions that "this is not to say there will not be side effects and possible long term damage" from such a thing. Frequently, the stress that choking places on the body can cause "difficulty breathing, hoarse voice or cough, difficulty swallowing, headaches, and lightheadedness," Barak says. Other injuries your friend could potentially expect to sustain are small red dots mainly on the face, and broken blood vessels in the eye.

The worst that could happen: Death. That's especially a risk if things devolve into violent strangulation, aka squeezing or constricting of the neck. Also if they have certain pre-existing medical conditions—including high blood pressure, high cholesterol, cerebral aneurysms, and carotid fatty deposits—they're particularly vulnerable to dangerous, even fatal, results.

What to do: In his seminal sadism and masochism book, SM 101, sex educator and activist David Wiseman writes, "I know of no way whatsoever that suffocation or strangulation can be done that does not intrinsically put the recipient at risk of cardiac arrest… I know of no reliable way to determine when such a cardiac arrest becomes imminent. If the recipient does arrest, the probability of resuscitating them, even with optimal CPR, is small." Read that aloud to your friend and hope they lose their boner.