Choking During Sex: Strangulation Risks, Consent and What to Do

You may have seen choking during sex in pornography, on social media, or heard people talk about it.

In some kink communities, people use the term "breath play" for activities involving breathing or restricting airflow.

"Breath play" is a broad term. It can describe different activities. This article focuses only on pressure applied to the outside of the neck.

People often call this "choking". Medically, choking usually means an airway blockage, such as food stuck in the throat. Pressure applied to the outside of the neck is generally called strangulation.

Something can look common without being safe.

There is no reliable way to make neck compression during sex safe.

Pressure on the neck can interfere with breathing and blood flow. It can cause serious injury or death. It may also cause injury without leaving visible marks.

Why is pressure on the neck dangerous?

The neck contains important blood vessels, the airway, nerves, and other structures.

Pressure on the neck can:

• reduce blood flow to the brain

• affect breathing

• cause loss of consciousness

• injure the airway

• injure blood vessels

• cause brain or other neurological injury

• cause other serious complications

• result in death.

The amount of pressure that causes harm is not predictable.

People can also respond differently to the same type of pressure.

No bruising does not mean there is no injury.

Some injuries may not be obvious straight away. Symptoms can also develop later.

Alcohol and drugs can increase the risk

Alcohol and other drugs can affect:

• judgement

• awareness

• coordination

• communication

• reaction time

• the ability to recognise danger.

Some substances can also affect breathing, consciousness, or the cardiovascular system.

The effects vary between substances and people.

Mixing substances can make the situation harder to predict.

If someone is so affected by alcohol or another drug that they cannot consent to sexual activity or refuse it, they cannot legally consent to that sexual activity under New Zealand law. Section 128A of the Crimes Act 1961 covers circumstances where a person is unable to consent or refuse consent because of the effects of alcohol or another drug.

Consent does not remove the physical risk

Consent is required for sexual activity.

But agreeing to an activity does not make that activity medically safe.

Someone can agree to an activity and still experience an unexpected medical emergency.

Consent must also remain meaningful during sexual activity.

A person can change their mind at any time.

Communication can fail

A person whose neck is being compressed may have difficulty speaking or communicating.

They may also become confused or lose consciousness.

A safe word or hand signal cannot guarantee that a person will always be able to use it.

What if someone loses consciousness?

A person who is unconscious cannot consent to sexual activity.

New Zealand law specifically states that a person does not consent to sexual activity if it occurs while they are asleep or unconscious.

If someone loses consciousness, stop sexual activity and seek urgent medical help.

What does New Zealand law say?

New Zealand has a specific criminal offence for strangulation or suffocation.

Section 189A of the Crimes Act 1961

Section 189A makes it an offence to intentionally or recklessly impede another person's normal breathing, blood circulation, or both by:

• blocking their nose or mouth, or

• applying pressure to their throat or neck.

The offence carries a maximum penalty of seven years' imprisonment.

The law applies to the conduct described in the section. Whether a particular situation amounts to an offence depends on the circumstances.

Consensual sexual activity does not automatically make every act carried out during sex lawful.

If you are concerned about a specific incident, consider speaking with a qualified lawyer or an appropriate support service.

Consent and alcohol or drugs

New Zealand law also sets out circumstances where allowing sexual activity does not amount to consent.

This includes situations where a person is so affected by alcohol or another drug that they cannot consent or refuse consent.

The law also states that a person does not consent to sexual activity while unconscious or asleep.

For specific legal questions, seek legal advice rather than relying on a general information article.

What should you do if neck compression has happened?

If someone is unconscious or having trouble breathing, call 111 now.

Do not wait for bruising or other visible injuries before seeking help. Medical guidance in New Zealand notes that serious internal injuries can occur without visible external signs and that some symptoms can be delayed.

🚨 Call 111 in an emergency

Call 111 immediately if the person:

• has difficulty breathing

• has difficulty swallowing or speaking

• has lost consciousness, even briefly

• is confused or unusually difficult to wake

• has a seizure

• has severe or worsening headache

• has significant neck pain or swelling

• has weakness or numbness

• has slurred speech

• has blurred or double vision

• has repeated vomiting

• has a sudden change in behaviour or alertness

• or develops another serious or worrying symptom.

If you think it may be an emergency, call 111. Do not let embarrassment stop you from seeking medical help.

Even if you feel okay

Seek medical assessment after experiencing strangulation or suffocation, even if you feel physically well.

Medical guidance recommends assessment because injuries may not be visible and symptoms can be delayed.

Not sure what to do?

You can call Healthline on 0800 611 116 for free health advice in New Zealand.

If you are worried about an injury, tell the health professional that pressure was applied to the person's neck.

This information can help them decide what assessment and treatment may be needed.

You can explore intensity without neck pressure

People may be interested in breath play because they enjoy:

• intensity

• anticipation

• vulnerability

• control

• surrender

• power exchange.

You can explore some of these experiences without putting pressure on someone's neck.

Edging

Edging means bringing sexual stimulation close to orgasm, then reducing or stopping stimulation before starting again.

Some people enjoy the anticipation and sense of control this creates.

Verbal power dynamics

Commands, roles, and agreed rules can create a strong power dynamic without putting pressure on the neck.

Sensory play

Blindfolds, touch, and other forms of sensory play can change how someone experiences anticipation and sensation.

Restraint

Some people enjoy consensual restraint.

If restraints are used, choose equipment designed for that purpose, agree boundaries beforehand, and keep restraints away from the neck.

The goal is not to make sex less exciting.

The goal is to find ways to explore intensity without creating the specific risks associated with neck compression.

If you are a sex worker

You have the right to set boundaries around the sexual services you provide.

You do not have to provide choking or strangulation.

You do not have to provide an activity because:

• a client offers more money

• a client says another worker does it

• a client says it is safe

• you have seen it in pornography

• you agreed to other sexual activities.

You can say no.

If a client ignores your boundaries or continues to pressure you, prioritise your safety.

"No" is enough.

If you are a client

A sex worker's boundaries matter.

Do not assume that a sexual activity shown in pornography is safe or offered by a sex worker.

If a worker says they do not provide choking or strangulation, respect that boundary.

Do not:

• keep asking

• offer extra money

• argue

• compare them with another worker

• use pornography as an example of what they "should" provide.

Paying for a sexual service does not mean you are entitled to every activity. Consent can be removed at anytime.

Pornography is not a safety guide

Pornography is entertainment.

A video does not show everything that happened before, during, or after filming.

A production may involve:

• discussions about boundaries

• preparation

• pauses

• retakes

• editing

• other safety measures.

These practices vary between performers and productions.

What looks simple on screen may carry serious risks in real life.

Do not use pornography as a guide to medical safety or consent.

The bottom line

You can enjoy intense and adventurous sex without putting pressure on someone's neck.

Neck compression is unpredictable.

It can cause serious injury or death, including without visible marks.

New Zealand law also contains a specific offence covering intentional or reckless strangulation or suffocation in certain circumstances.

Consent is important, but consent does not remove the physical risks.

If you want intensity, control, or power exchange, there are other ways to explore those experiences.

And if neck compression has already happened and someone develops worrying symptoms: Get medical help.

Disclaimers

• Medical information: This article provides general health information. It is not a substitute for medical assessment or personalised medical advice. In an emergency in New Zealand, call 111. For free health advice, call Healthline on 0800 611 116.

• Legal information: This article provides general information about New Zealand law. It is not legal advice. Laws can change, and the law may apply differently depending on the circumstances. If you need advice about a specific situation, speak with a qualified legal professional or an appropriate support service.