Choking During Sex for Brain Function

Overseen By Keisuke Kawata, PhD

Age: 18 - 65

Sex: Female

Trial Phase: Academic

Sponsor: Indiana University

Must not be taking: Antipsychotics

Disqualifiers: Pregnancy, TBI, Concussion, Neurological, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 5

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to study how choking during sex affects the brain. Researchers seek to understand changes in brain function and structure by examining specific markers in blood and brain scans. Participants will engage in sex with choking first, then without, or vice versa. Women who have experienced choking during sex at least twice in the last month and also have non-choking sexual experiences may be suitable for this study. As an unphased trial, this study offers participants a unique opportunity to contribute to groundbreaking research on sexual health and brain function.

Do I have to stop taking my current medications for the trial?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are currently taking antipsychotic medication.

What prior data suggests that choking during partnered sex is safe?

Research shows that choking during sex is common among young adults, but it carries serious risks. Studies have found that sexual choking, or strangulation, can be dangerous and even life-threatening. Although specific safety data from studies on treating choking during sex is lacking, it's crucial to recognize that this practice can lead to severe consequences, such as brain injury or death. Those considering joining a trial involving this should be aware of these risks. Always prioritize safety and consent in any sexual activity. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are intrigued by this trial because it explores how different sexual activities, specifically choking during partnered sex, might affect brain function. Unlike traditional methods that rely on medication or therapy to study brain health, this trial focuses on a behavioral aspect of sex, potentially uncovering new insights into how physical experiences can influence cognitive processes. By comparing brain function following both choking-involved and non-choking-involved sex, the trial could reveal unique interactions between sexual practices and mental performance, opening doors to novel approaches in cognitive health research.

What evidence suggests that this trial's treatments could be effective for brain function?

Research shows that choking during sex is becoming more common, especially among young adults. Some studies suggest that this often occurs with consent and is desired by those involved. However, concerns exist about its potential impact on brain health. For example, one study found possible links between frequent sexual choking and changes in brain structure. This trial will explore these potential effects by comparing two paths: Path 1, where participants engage in choking-involved sex before non-choking-involved sex, and Path 2, where participants engage in non-choking-involved sex before choking-involved sex. Concrete data remains insufficient, and more research is needed to fully understand these effects. ^{1 2 3 6 7}

Are You a Good Fit for This Trial?

This trial is for individuals who engage in partnered sexual activity, both with and without the practice of choking. Participants must be healthy enough to undergo MRI scans and blood tests. Those with conditions affecting brain function or injury risk, such as a history of brain hypoxia or respiratory issues, may not qualify.

Inclusion Criteria

I am female.

Proficient in English

Reports engaging in sex involving being choked at least 2 times in the past month

Exclusion Criteria

I have only engaged in sexual activities involving choking in the past month.

Traumatic brain injury within past year

I have a neurological condition like epilepsy or a brain tumor.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Baseline Data Collection

Baseline data collection including blood biomarkers, MRI, and ocular-motor function assessments

2 hours

1 visit (in-person)

Post Choking-Involved Sex Data Collection

Data collection including blood biomarkers, MRI, and ocular-motor function assessments within 24 hours after engaging in choking-involved sex

2 hours

1 visit (in-person)

Post Non-Choking-Involved Sex Data Collection

Data collection including blood biomarkers, MRI, and ocular-motor function assessments within 24 hours after engaging in non-choking-involved sex

2 hours

1 visit (in-person)

Follow-up

Participants are monitored for any delayed effects or safety concerns after the main data collection phases

4 weeks

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Choking during Partnered Sex

Trial Overview

The study investigates how being choked during sex affects the brain by comparing it to non-choking sexual activity. It measures changes in blood biomarkers for neural injury, brain imaging results from MRIs, and eye movement functions before and after each type of sexual encounter.

How Is the Trial Designed?

Group I: Path 2 (non-choking involved sex prior to choking involved sex) Experimental Treatment 2 Interventions

Path 2 will involve 3 data collection time points including baseline data collection, post non-choking involved sex time point, and post choking involved sex time point, in that order. After enrollment, subjects will be sent a brief Qualtrics survey link once a day to determine when they are eligible for data collection based on their sexual activity within the last 24 hours. Subjects placed in the group following Path 2 will first come in for a baseline data collection which will occur after a 48 hour washout period of not engaging in partnered sex. Next, subjects will be asked to come in for an experimental data collection visit within the 24 hours after engaging in sex that did not involve any choking. Last, subjects will be asked to come in for an experimental data collection visit within 24 hours of engaging in choking involved sex.

Group II: Path 1 (choking involved sex prior to non-choking involved sex) Experimental Treatment 2 Interventions

Path 1 will involve 3 data collection time points including baseline data collection, post choking involved sex data collection time point, and post non-choking involved sex time point, in that order. After enrollment, subjects will be sent a brief Qualtrics survey link once a day to determine when they are eligible for data collection based on their sexual activity within the last 24 hours. Subjects placed in the group following Path 1 will first come in for a baseline data collection which will occur after a 48 hour washout period of not engaging in partnered sex. Next, subjects will be asked to come in for an experimental data collection visit within the 24 hours post engaging in choking involved sex. Last, subjects will be asked to come in for an experimental data collection visit within 24 hours of engaging in sex that did not involve any choking.

Who Is Running the Clinical Trial?

Indiana University

Lead Sponsor

Trials

1,063

Recruited

1,182,000+

Published Research Related to This Trial

A survey of 4254 students revealed that choking during sex is common, with a mean age of first experience around 19, and women and transgender/gender non-binary individuals reporting higher rates of being choked than men.

Responses to being choked varied widely, with 81.7% reporting pleasurable sensations, but also significant risks such as neck bruising (15%) and loss of consciousness (3%), indicating potential health risks associated with this practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Frequency, Method, Intensity, and Health Sequelae of Sexual Choking Among U.S. Undergraduate and Graduate Students. Herbenick, D., Fu, TC., Eastman-Mueller, H., et al.[2023]

A study involving 40 young adult women (20 who experienced frequent choking during sex and 20 who had never experienced it) found that those who were choked showed different brain activation patterns during working memory tasks, indicating potential neurological changes due to this behavior.

Despite no significant differences in task performance between the two groups, the choking group exhibited increased brain activation in areas associated with cognitive load, suggesting that repeated exposure to choking may alter how the brain allocates resources during complex tasks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Frequent and Recent Non-fatal Strangulation/Choking During Sex and Its Association With fMRI Activation During Working Memory Tasks. Huibregtse, ME., Alexander, IL., Klemsz, LM., et al.[2022]

Women who experienced choking during sex showed significant differences in brain activity compared to those who had not, with lower activation in certain left cortical regions and higher activation in right cortical regions, indicating an inter-hemispheric imbalance in neural functioning.

The choking group exhibited hyperconnectivity between the angular gyrus and motor control areas of the brain, suggesting that frequent experiences of sexual choking may impact emotional and motor processing, warranting further longitudinal studies to explore the long-term effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association of Frequent Sexual Choking/Strangulation With Neurophysiological Responses: A Pilot Resting-State fMRI Study. Hou, J., Huibregtse, ME., Alexander, IL., et al.[2023]

The study analyzed 15 cases of erotic asphyxiation, revealing that defendants in these cases often avoided prison time if the victim had a documented history of paraphilic tendencies and the defendant was not under the influence of drugs during the incident.

In contrast, in non-sexual homicide cases, defendants under the influence of alcohol were more likely to face severe penalties, highlighting the legal complexities surrounding strangulation in both erotic and non-erotic contexts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Lethal asphyxiation due to sadomasochistic sex training - How some sex partners avoid criminal responsibility even though their actions lead to someone's death. Sendler, DJ.[2018]

In a study of 41 young adult women, those who experienced frequent sexual choking showed significant increases in cortical thickness in several brain regions compared to those who had not experienced choking.

The choking group also exhibited widespread reductions in gyrification, suggesting that sexual choking may be linked to neuroanatomical changes, warranting further longitudinal research to explore these effects over time.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Structural brain morphology in young adult women who have been choked/strangled during sex: A whole-brain surface morphometry study. Hou, J., Huibregtse, ME., Alexander, IL., et al.[2023]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10294564/

Association of Frequent Sexual Choking/Strangulation With ...

Being choked or strangled during partnered sex is an emerging sexual behavior, prevalent among young adult women. The goal of this study was to test whether ...

2.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC9201570/

Frequent and Recent Non-fatal Strangulation/Choking ...

Being strangled, or “choked,” by a sexual partner has emerged as a prevalent, often wanted and consensual sexual behavior among adolescent ...

3.

link.springer.com

link.springer.com/article/10.1007/s10508-025-03097-3

Choking/Strangulation During Sex: Understanding and ...

Despite its potentially fatal consequences, sexual choking/strangulation is an increasingly common sexual practice.

4.

medrxiv.org

medrxiv.org/content/10.1101/2021.11.01.21265760.full

Chronic elevation of serum S100B but not neurofilament- ...

This case-control study aimed to test whether frequent choking during sex influences neurological health in young adult women.

5.

scholarworks.indianapolis.iu.edu

scholarworks.indianapolis.iu.edu/server/api/core/bitstreams/018e9340-2d3c-4931-8dd4-b4e2f4bb1b70/content

brain surface mo - IU Indianapolis ScholarWorks

Conclusion: These data in cortical morphology suggest that sexual choking events may be associated with neuroanatomical alteration. A ...

6.

webmd.com

webmd.com/sex/what-is-sexual-asphyxiation

What Is Sexual Choking?

What are other names for choking during sex? Other names include sexual asphyxiation and erotic asphyxiation (EA). Autoerotic asphyxiation is ...

7.

onlinelibrary.wiley.com

onlinelibrary.wiley.com/doi/full/10.1111/psrh.12285

Sexual choking/strangulation and its association with ...

No research has examined the relationship between being choked during consensual sex and the use of external condoms and other contraceptives.