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Prevalence and characteristics of choking/strangulation during sex: Findings from a probability survey of undergraduate students
Journal of American College Health
Abstract
Objective:
In a random sample of undergraduate students, we aimed to: (1) establish the prevalence of choking and being choked; (2) examine demographic and situational predictors of being choked, and (3) examine demographic and situational predictors of choking someone. Participants: 4168 randomly sampled undergraduates at a large public U.S. university. Methods: A cross-sectional, confidential online survey. Results: We found that 26.5% of women, 6.6% of men, and 22.3% of transgender and gender non-binary participants reported having been choked during their most recent sexual event. Additionally, 5.7% of women, 24.8% of men, and 25.9% of transgender and non-binary participants reported that they choked their partner at their most recent event. Choking was more prevalent among sexual minority students. Conclusions: Choking is prevalent among undergraduate students; implications for college sexual health education are discussed.
... The term "rough sex" has been used to refer to sexual practices such as biting, spanking, slapping, choking, and other behaviors that may involve impact to the body and/or psychological risk, as with name-calling (Döring et al., 2024;Herbenick et al., 2020Herbenick et al., , 2021aKim, 2022;Lee et al. 2015;Svetina Valdivia et al., 2022). Recently, such sexual practices have become prevalent among young adults in the United States (U.S.), Belgium, Germany, Iceland, Italy, the United Kingdom, Australia, and New Zealand (Coker & Domett, 2022;Daminato et al., 2024;Döring et al., 2024;Herbenick et al., 2023bHolvoet et al., 2017;Savanta Com Res, 2019;Sharman et al., 2024a;Vilhjálmsdóttir & Forberg, 2023). Further, what young people mean by "rough sex" appears to have changed over time, with behaviors that were once more connected with sexual aggression moving into mainstream understandings of consensual (though not always wanted) rough sex (Burch & Salmon, 2019;Chikh Sulaiman, 2023;Herbenick et al., 2021a;Tholander et al., 2022). ...
... Despite the high prevalence of rough sex, studies that focus on specific rough sex practices are still emerging ). Yet, the growing body of research on rough sex practices suggests a pattern: that lifetime experiences of rough sex are: (1) more prevalent among younger adults than older adults (demonstrating an age cohort effect), (2) more often enacted on women and gender non-conforming people as compared with men, (3) more often performed by men and gender non-conforming people as compared with women, and (4) more often reported by sexual orientation minorities than by people who describe themselves as heterosexual (Coker & Domett, 2022;Daminato et al., 2024;Döring et al., 2024;Herbenick et al., 2023bHolvoet et al., 2017;Savanta Com Res, 2019;Sharman et al., 2024a;Vilhjálmsdóttir & Forberg, 2023). Further, many people who engage in rough sex do not identify as kinky nor do they necessarily have any connection with kink communities (Herbenick et al., 2022c(Herbenick et al., , 2022d. ...
... In that same study, 10% of men ages 18 to 24 and 14% of men ages 25 to 29 reported having choked their partner during their most recent sexual event. Consistent with the demographic correlates of rough sex more generally, studies in the U.S. and internationally show that being choked/strangled during sex disproportionately affects women and gender minorities more so than men and that sexual orientation minorities more often than heterosexual-identified people reported having engaged in choking (Daminato et al., 2024;Herbenick et al., 2020Herbenick et al., , 2022aHerbenick et al., , 2023aHerbenick et al., , 2023bSharman et al., 2024aSharman et al., , 2024bVilhjálmsdóttir & Forberg, 2023). ...
... Research into human sexuality indicates that people engage in a diverse range of sexual behavior as part of sexual expression (Herbenick et al., 2017(Herbenick et al., , 2020, and that patterns of sexual behavior change over time alongside changes in social attitudes (Herbenick et al., 2022a(Herbenick et al., , 2022b(Herbenick et al., , 2022c. Sexual activities that were once considered "taboo" are becoming more prevalent, and men and women are increasingly engaging in sexual acts such as anal sex, sexual choking (as a form of asphyxiation or strangulation), and rough sex as part of their sexual repertoire (Herbenick et al., 2017(Herbenick et al., , 2022a(Herbenick et al., , 2022b(Herbenick et al., , 2022c(Herbenick et al., , 2023McBride & Fortenberry, 2010;Rissel et al., 2014;Sharman et al., 2024). While not always wanted or desirable, people may engage in sexual acts (and endure associated discomfort) due to coercion or to please their partner (Carter et al., 2019;Fahs & Gonzalez, 2014;Jozkowski & Peterson, 2013;Marston & Lewis, 2014;Reynolds et al., 2015). ...
... Rough sex acts are considered gendered, where women are predominantly the target of rough sex acts and men take a dominant role. For example, in a nationally representative US sample (N = 2,227, 51.73% female), one-fifth of women reported having been choked during sexual activity (Herbenick et al., 2023). Some research has linked the prevalence of rough sex to exposure to violent or aggressive sexual acts in pornography (Herbenick et al., , 2023Vogels & O'Sullivan, 2019;Wright et al., 2022). ...
... For example, in a nationally representative US sample (N = 2,227, 51.73% female), one-fifth of women reported having been choked during sexual activity (Herbenick et al., 2023). Some research has linked the prevalence of rough sex to exposure to violent or aggressive sexual acts in pornography (Herbenick et al., , 2023Vogels & O'Sullivan, 2019;Wright et al., 2022). ...
Sexual health, including sexual pleasure, is fundamental to holistic health and well-being, and is considered an area of priority health in Australia. Despite the importance of sexual functioning, women experience significant gaps in sexual well-being compared to men and often do not seek medical care or treatment. Health practitioners are central to the identification and treatment of sexual dysfunction, including fostering sexual well-being for patients. Despite this, minimal research has explored health practitioners’ experiences in treating reports of unpleasant sex. This study aimed to explore health practitioners’ experiences, responses, and confidence in treating patients presenting for unpleasant sexual experiences. An online, mixed-methods survey was completed by 96 participants. Thematic analysis identified 11 core themes. These themes included five patient centred themes (health risks, diverse sex acts, painful vaginal intercourse, relationship breakdown and violence, unwanted sex) and six health practitioner centred themes (communication and counselling, what is normal, ongoing care and follow up, emotional response, limited practical training, and highly prevalent). Participants described a complex sexual health landscape, with social contexts impacting women’s sexual experiences and engagement in treatment. Additionally, health practitioners reported the need for a biopsychosocial approach to understanding and responding to unpleasant sexual experiences for patients, while simultaneously reporting limited education in this area. Findings reflect the need for health practitioners to be cognisant of matters related to sexual function, consent, coercion, client engagement, and treatment pathways, identifying a need for greater education and holistic approaches to sexual healthcare across medical settings.
... Recognition of the dangers of strangulation as part of domestic violence has led to the introduction of offences in all states and territories in Australia (Douglas, 2023) and in several other countries (Edwards & Douglas, 2021). However, research from the US (Herbenick et al., 2020(Herbenick et al., , 2021(Herbenick et al., , 2022a, and preliminary investigations in New Zealand (Beres et al., 2020) and Australia (Sharman et al., 2024) show that strangulation also occurs beyond the context of domestic violence as part of sexual activity, and particularly among adults younger than 40 Pavanello et al., 2024;Vilhjálmsdóttir & Forberg, 2023). ...
... Although strangulation is typically gendered, with women more often strangled and men more likely to be the strangler (Herbenick et al., 2021(Herbenick et al., , 2022a(Herbenick et al., , 2022b(Herbenick et al., , 2022cVilhjálmsdóttir & Forberg, 2023), there is still similarity across men and women in their rates of ever engaging in either activity that are only partially explained by sexual orientation (Herbenick et al., 2021(Herbenick et al., , 2022a. Research suggests that pornography and other media, including memes and magazine articles that can be accessed online, are helping to drive increased awareness and willingness to engage in strangulation, as well as young people's belief that it is a safe practice (Herbenick et al., 2020(Herbenick et al., , 2022c(Herbenick et al., , 2023b(Herbenick et al., , 2023cWright et al., 2023a). ...
... Although strangulation is typically gendered, with women more often strangled and men more likely to be the strangler (Herbenick et al., 2021(Herbenick et al., , 2022a(Herbenick et al., , 2022b(Herbenick et al., , 2022cVilhjálmsdóttir & Forberg, 2023), there is still similarity across men and women in their rates of ever engaging in either activity that are only partially explained by sexual orientation (Herbenick et al., 2021(Herbenick et al., , 2022a. Research suggests that pornography and other media, including memes and magazine articles that can be accessed online, are helping to drive increased awareness and willingness to engage in strangulation, as well as young people's belief that it is a safe practice (Herbenick et al., 2020(Herbenick et al., , 2022c(Herbenick et al., , 2023b(Herbenick et al., , 2023cWright et al., 2023a). ...
In Australia, strangulation has been explicitly criminalized in all states and territories. However, it continues to be a “normalized” sexual practice despite its potentially fatal consequences and associated short and long-term sequelae. This research aimed to establish the prevalence of strangulation during sex and examine predictors of positive perceptions toward sexual strangulation in Australia. Confidential, cross-sectional online surveys were conducted with 4702 Australians aged 18–35 years. Participants were 47% cis-men, 48% cis-women, and 4% trans or gender diverse. A total of 57% reported ever being sexually strangled (61% women, 43% men, 79% trans or gender diverse) and 51% reported ever strangling a partner (40% women, 59% men, 74% trans or gender diverse). Differences were found across genders on all variables of sexual strangulation, including frequency of engagement, level of pressure on the neck, consequences, wanting and enjoyment, and how consent was given/received. However, when split by gender, sexual orientation of men and women revealed further differences in behaviors, consequences, and wanting, particularly among straight and bisexual women. After accounting for exposure to strangulation in pornography and previous experience of sexual strangulation, positive perceptions of being strangled (R² = .51) and strangling a partner (R² = .53) were predicted by ratings that it could be done safely and social normative factors. These findings suggest strangulation is common during sex among young Australians. Non-stigmatizing education strategies are needed to engage with young people so they have a better understanding of the risks involved and how to negotiate consent and safety regarding sexual strangulation.
... In this way, rough sex may be defined as a set of several sexual behaviors that could have an impact on the psychophysical health of the person practicing these behaviors. For example, choking or sexual asphyxiation, is performed by restricting oxygen to the brain to improve sexual pleasure [2]. Although this behavior may lead to greater sexual pleasure, the risk of death by asphyxiation remains. ...
... Although this behavior may lead to greater sexual pleasure, the risk of death by asphyxiation remains. However, partnered sexual asphyxiation is considered less risky because asphyxiation tends to be induced by the hands and not by ropes, and the presence of a partner mitigates potential risks [2]. The prevalence of this behavior cannot be estimated precisely, since all rough sexual behaviors have not been investigated on a large scale. ...
... The prevalence of this behavior cannot be estimated precisely, since all rough sexual behaviors have not been investigated on a large scale. However, in the study by Herbenick et al. [2], 26.5% of women, 6.6% of men and 22.3% of transgender and nonbinary (TGNB) participants reported having been choked. On the other hand, 5.7% of women, 24.8% of men and 25.9% of TGNB participants reported that they choked their partners [2]. ...
Surveys of the Italian population typically assess general sexual behaviors (e.g., oral, vaginal and anal intercourse). However, little is known about other sexual behavior such as rough sexual behaviors, choking and slapping. Thus, an online cross-sectional survey of 4618 Italian participants was conducted. In the past month, the most prevalent sexual behaviors were solo masturbation (93.6%), partner masturbation (80.0%), oral sex (71.4% received, 75.9% performed), penile–vaginal intercourse (75.7%) and anal intercourse (12.5% received, 7.1% performed). Regarding rough sexual behaviors, the most common behaviors performed were spanking (23.3% received, 55.5% performed), choking (13.2% receive, 60.0% performed), slapping (30.1% received, 20.9% performed) and name calling (44.5% received, 37.0% performed). Our results suggest a gender difference where men and transgender/non-binary individuals perform more rough sexual behaviors compared to women. Moreover, regarding the role of consent in behaviors such as choking and slapping, our results highlight the importance of sexual and affective education to implement sexual assertiveness. In conclusion, this study adds knowledge to the limited literature on this topic, especially with respect to the Italian population.
... Typically seen to be part of stigmatized and "kink" sexual experiences (Cowell, 2009;Rehor, 2015), this behavior can take many forms, such as smothering, chest compression, or the use of plastic bags to induce cerebral hypoxia (depriving oxygen from the brain). Although there are a range of methods for sexual asphyxiation, one is quickly gaining traction as a normalized and common sexual practice: strangulation (Herbenick et al., 2021;Herbenick et al., 2022a). ...
... Research directed only at the most extreme harms of strangulation during sex does not allow for nuanced understandings of the potential range of consequences, including those associations that may be positive (e.g., enhanced sexual pleasure, but see Edwards, 2016). 1 Research exploring sexual experiences of women from the kink community found that strangulation behaviors, described as including breath play, choking, strangling, or hanging, were engaged in by participants for their own sensual or erotic pleasure (Rehor, 2015). This experience of strangulation during sex as desirable or pleasurable has also been found across non-kink samples in Germany among women consuming pornography (Sun et al., 2017) and a large university student sample in the USA (US; Herbenick et al., 2021). In particular, Herbenick et al. (2021) found that 82% of 1537 respondents who reported ever being strangled during sex had felt pleasurable or euphoric feelings during at least one of their experiences, although the range of physical reactions that were experienced was wide-ranging, including, most commonly, a head rush, feeling unable to breathe, difficulty swallowing, watery eyes, inability to speak, gasping for air, coughing, neck pain, and neck bruising. ...
... This experience of strangulation during sex as desirable or pleasurable has also been found across non-kink samples in Germany among women consuming pornography (Sun et al., 2017) and a large university student sample in the USA (US; Herbenick et al., 2021). In particular, Herbenick et al. (2021) found that 82% of 1537 respondents who reported ever being strangled during sex had felt pleasurable or euphoric feelings during at least one of their experiences, although the range of physical reactions that were experienced was wide-ranging, including, most commonly, a head rush, feeling unable to breathe, difficulty swallowing, watery eyes, inability to speak, gasping for air, coughing, neck pain, and neck bruising. Across these lifetime experiences of strangulation during sex, 18.8% experienced some form of alteration of consciousness (e.g., dizziness), and 2.6% reported ever losing consciousness (Herbenick et al., 2021). ...
Background
Strangulation is becoming a more common sexual practice despite its potentially fatal consequences and associated short- and long-term sequelae. This research provides a preliminary examination of participation and perception toward strangulation during sex among Australian undergraduates.
Methods
This study utilized a confidential, cross-sectional online survey collected in 2022–2023. Analysis included 168 undergraduate students at an Australian University and explored their awareness of the harms of strangulation, understanding of criminalization, and the impact of education on these attitudes.
Results
In total, 56% reported ever being strangled during sex and 51% ever strangling a partner. Seventeen percent of participants reported being strangled and 13% strangling a partner during their last sexual experience. Higher frequency, wanting, and positive perceptions of strangulation were associated with more liberal sexual attitudes. However, there were differences depending on gender. Participants generally did not perceive strangulation to be harmful and had limited knowledge about its criminalization. Lastly, a brief education intervention on strangulation harms revealed reductions in positive perceptions of strangulation that were pronounced among women.
Conclusions
In this convenience survey, Australian university students commonly reported previously engaging in strangulation during sex but with limited awareness of the potential consequences. Our results indicate that education on these consequences could reduce positive perceptions of strangulation, particularly among women.
Policy Implications
Education on strangulation harms are likely more effective than criminalization alone in improving awareness of its consequences and changing perceptions of strangulation. These findings could help guide targeted policy and education on strangulation within sexual health contexts.
... Sexual choking is now prevalent among adolescents and young adults in the USA, UK, and New Zealand, disproportionately affects women and sexual minoritized individuals, and is consequential to health (Beres et al., 2020;Coker & Domett, 2022;Herbenick et al., 2020Herbenick et al., , 2021aHerbenick et al., , 2021cHerbenick et al., , 2022aHerbenick et al., , 2022bSavanta Com Res, 2019). Although commonly called "choking" (Beres et al., 2020;Cruz, 2022;Herbenick et al., 2022d, using one's hands, limb, or a ligature to squeeze or press against the neck to occlude blood flow and/ or airways is a form of strangulation (Sauvageau & Boghossian, 2010). ...
... In a series of 2006-2016 convenience surveys, Burch and Salmon (2019) found that about one-third of undergraduate students considered choking to be a form of rough sex. However, in a 2020 campus representative survey, 77% of US undergraduates indicated they considered choking to be a form of rough sex (Herbenick et al., 2021a), suggesting societal shifts in how young adults conceptualize choking and rough sex. A recent descriptive report from New Zealand also noted that youth tend to think of sexual choking as a mainstream, consensual sex act, and not connected to sexual violence (Beres et al., 2020). ...
... Even though many memes recognized choking as potentially dangerous or fatal, it was rare for memes to feature fact-based information related to harm reduction, or to challenge the mainstreaming of choking. Additionally, although survey data demonstrates that choking disproportionately affects women as well as sexual minorities (Herbenick et al., 2021a), the memes largely represented men choking women. ...
Recent research indicates that some young people initially learn about sexual choking through Internet memes. Thus, a qualitative content analysis was performed on 316 visual and textual memes collected from various social media websites and online searches to assess salient categories related to choking during sex. We identified nine main categories: communication, gendered dynamics, choking as dangerous, choking as sexy, sexualization of the nonsexual, shame and worry, romance/rough sex juxtaposition, choking and religious references, instructional/informational. Given that memes, through their humor, can make difficult topics more palatable and minimize potential harm in the phenomenon they depict, more concerted, synergistic effort that integrates media literacy into sexuality education programming on the potential risks that may ensue for those engaging in sexual choking is warranted.
... As one example, lifetime prevalence of anal sex nearly doubled between the 1992 National Health and Social Life Survey (NHSLS) and the 2009 National Survey of Sexual Health and Behavior (NSSHB). However, recent (past-year) experiences of anal sex have since decreased (Herbenick et al., 2010b(Herbenick et al., , 2021aLeichliter, 2008;Michael et al., 1994). As another example, whereas adults' sex toy use was uncommon in the 1990s (Laumann et al., 2000), broadening access to sexual enhancement products through the internet and women's in-home sex toy parties translated into increases in the 2000s, with some studies showing about half or more of U.S. adults reporting lifetime sex toy use (Foxman et al., 2006;Herbenick et al., 2009;Reece et al., 2009;Rosenberger et al., 2012). ...
... More recently, sexual choking-which is a form of (usually consensual) strangulation-has become prevalent among adolescents and young adults (Beres et al., 2020;Coker & Domett, 2022;Herbenick et al., 2020;Savanta Com Res, 2019). One-third of randomly sampled undergraduate women were choked at their most recent sexual event (Herbenick et al., 2021a). However, the field lacks event-level data on this consequential sexual practice beyond college students. ...
... Consistent with prior research , we found evidence of an age cohort effect with choking more prevalent among those younger than 40 as well as evidence of gender differences, with more women being choked than men. Our finding that 35% of women were choked/strangled at their most recent sexual event aligns with a 2020 campus-representative survey of college students which found that 1 in 3 women had been choked during their most recent vaginal intercourse event (Herbenick et al., 2021a). In the present research, about 3.5 times as many 18-24 year old women were choked at their most recent sexual event as compared to the percent that had used a vibrator or sex toy. ...
In a confidential U.S. nationally representative survey of 2,525 adults (1300 women, 1225 men), we examined participants’ event-level sexual behaviors, predictors of pleasure and orgasm, and perceived actual and ideal duration of sex, by gender and age. Event-level kissing, cuddling, vaginal intercourse, and oral sex were prevalent. Sexual choking was more prevalent among adults under 40. While women and men reported a similar actual duration of sex, men reported a longer ideal duration. Participants with same-sex partners reported a longer ideal duration than those with other-sex partners. Finally, findings show that gendered sexual inequities related to pleasure and orgasm persist.
... 2 Further, 1 in 3 undergraduate women reported having been strangled by a partner during their most recent sexual event. 3 Despite this popularity, the potential health effects of engaging in this partnered behavior remain largely unknown. ...
... Bichard and colleagues defined strangulation as when the airway, the blood vessels in the neck, or both are externally compressed. 4 In the context of partnered sexual behavior, frequently occurring during consensual sexual events with high emotional intimacy, 3 strangulation is thought to increase arousal and pleasure. However, it may also trigger transient hypoxic-ischemic stress through decreased oxygen and/or blood supply to the brain. ...
Background
“Choking” or partnered strangulation is an emerging and popular sexual behavior that is more often experienced by young women, yet the neurobiological consequences of partnered sexual strangulation remain unclear.
Aim
The aim of the present study was to assess differences in 5 brain-injury blood biomarkers in young adult women who frequently engaged in sexual strangulation.
Methods
Young adult women were recruited from a large Midwestern university and assigned to groups based on sexual strangulation experience: (1) at least 4 instances of being strangled by a partner during sexual activities in the past 30 days or (2) no prior experience being strangled by a sexual partner. Choking/strangulation history during partnered sexual activities was assessed using a self-report questionnaire. Blood samples were collected via venipuncture. Data from 32 female participants (median 21.5 years old [IQR 20-24]) were available for analysis: 15 with a history of recent, frequent partnered strangulation exposure and 17 without any history of partnered sexual strangulation.
Outcomes
Serum levels of 5 blood biomarkers for brain injury were measured using sandwich enzyme-linked immunosorbent assay (S100B) and single-molecule array digital immunoassay (neurofilament light, tau, ubiquitin C-terminal hydrolase L1, and glial fibrillary acidic protein).
Results
Group differences for the 5 biomarkers were examined using 1-way multivariate analysis of covariance, adjusting for age and alcohol use. We observed a significant multivariate effect of group, Pillai’s trace = 0.485, F(5, 24) = 4.235, P = .007, η2 = 0.47. Univariate results indicated that female college students who were recently, frequently strangled during partnered sexual activities exhibited elevated S100B levels compared to their peers who had never engaged in this partnered sexual behavior, F(1,28) = 11.165, P = .002, η2 = 0.29.
Clinical Implications
Engaging in this partnered sexual behavior may elicit neuroinflammation, with unknown long-term consequences for brain health.
Strengths and Limitations
Strengths include the recruitment of a novel population, as this investigation was the first of its kind to examine neurobiological correlates of repetitive exposure to partnered sexual strangulation. Another strength is the panel of 5 blood biomarkers that were assessed, providing information from multiple cell types and pathophysiological processes. Limitations were the relatively small sample size and the cross-sectional design, which prevents causal inference.
Conclusion
Young adult women with a history of recent, frequent experience being strangled by a sexual partner exhibited higher serum S100B, an astrocyte-enriched protein, compared to their biomarkers, meriting future work to determine a causal mechanism between partnered sexual strangulation and neuroinflammatory processes.
... Among young U.S. adults, sexual choking is now a frequent, normative part of consensual sex, with 1 in 3 college women having been choked the most recent time they had sex (Herbenick et al., 2021a). Given its prevalence and frequency, sexual choking may be the most common form of choking/strangulation in the U.S., and it disproportionately impacts women. ...
... Most people will have insufficient training to attend to someone should they lose consciousness, experience a seizure or cardiac arrest, or become unresponsive while being choked. Apart from occurrences in public sex locations, sexual choking likely occurs in private and not uncommonly by people who have just met and/or are using alcohol or other substances (Herbenick et al., 2021a). Some people may also point out that various forms of choking/ strangulation routinely occur in sports such as mixed martial arts (MMA); indeed, there is an emerging and controversial literature examining potential neurocognitive effects of having been choked/strangled as part of MMA (e.g., Lim et al., 2019;Stacey et al., 2021;Stellpflug, 2019). ...
Although sexual choking is now prevalent, little is known about how people engage in choking in terms of frequency, intensity, method, or potential health sequelae. In a campus-representative survey of undergraduate and graduate students, we aimed to: (1) describe the prevalence of ever having choked/been choked as part of sex; (2) examine the characteristics of choking one’s sexual partners (e.g., age at first experience, number of partners, frequency, intensity, method); (3) examine the characteristics of having been choked during sex; and (4) assess immediate responses of having been choked including the extent to which frequency and method (e.g., hand, ligature, limb) of having been choked predicts the range of responses endorsed by participants. A total of 4254 randomly sampled students (2668 undergraduate, 1576 graduate) completed a confidential online survey during Spring 2021. The mean age of first choking/being choked was about 19, with more undergraduates than graduate students reporting first choking/being choked in adolescence. Women and transgender/gender non-binary participants were significantly more likely to have been choked than men. Participants more often reported the use of hands compared to limbs or ligature. Common responses to being choked were pleasurable sensations/euphoria (81.7%), a head rush (43.8%), feeling like they could not breathe (43.0%), difficulty swallowing (38.9%), unable to speak (37.6%), and watery eyes (37.2%). About 15% had noticed neck bruising and 3% had lost consciousness from being choked. Greater frequency and intensity of being choked was associated with reports of more physical responses as was use of limb (arm, leg) or ligature.
... Men were more likely to report perpetrating such behaviors, while women more often reported being on the receiving end. This pattern is consistent with findings by Herbenick et al. (2023), which showed that men more often reported choking a partner, whereas women more often reported being choked. These dynamics suggest a dominant sexual script characterized by the subordination and domination of women. ...
Understanding the dynamics of sexually violent behavior is essential for developing effective interventions and policies that promote safe and respectful sexual relationships. An important area of research in this context is examining the influence of pornography on sexual behavior, which can inform these efforts. This study explores how sexually permissive attitudes and acceptance of the sexual double standard mediate the relationship between pornography consumption and engagement in violent sexual practices among a sample of the general population in Castilla-La Mancha, Spain (N = 1003; 50.7% men). The sexual double standard refers to the societal belief that men and women should be judged differently for the same sexual behaviors, with men often praised or excused for promiscuity, while women face stigma and shame. The findings reveal gender differences in engagement in sexually violent practices during sexual relationships. Men are more likely to perpetrate these behaviors, while women are more likely to experience them. Importantly, both lifetime and last year pornography consumption are associated with an increased involvement in such practices. This relationship is partially mediated by sexually permissive attitudes, with a stronger mediation effect observed in men. Practitioners can leverage these insights to develop comprehensive strategies that mitigate the risks associated with pornography consumption.
... Erotic asphyxiation refers to restricting oxygen to enhance sexual pleasure, arousal, or orgasm (Herbenick et al., 2021a). Strangulation is a common method of erotic asphyxiation, involving the external compression of the neck and consequent restriction of respiration and/or blood circulation (Foley, 2015;Sharman et al., 2023). ...
Despite its potentially fatal consequences, sexual choking/strangulation is an increasingly common sexual practice. Existing research suggests that its growing prevalence is partly a consequence of its popular construction as “risky yet safe.” Few studies have directly examined how people frame and engage in choking/strangulation in terms of “safety”—what people think it means for strangulation to be (or not be) “safe” and how people think safety during strangulation can be achieved. Drawing on qualitative text responses from a survey collected in 2023, this paper examined whether and how Australian adults aged between 18–35 perceived choking/strangulation in terms of “safety.” We identified and discussed four main themes arising from the data: choking/strangulation during sex can be safe; pressure/intensity is a safety mechanism; consent is a safety mechanism; and trust and communication are necessary. In consideration of these themes, we suggest that many Australian young people are not aware of the risks of choking/strangulation during sex and frequently equate pressure/intensity and consent, within a trusting relationship, with safety. Given the significant risks and harms associated with any sexual choking/strangulation and the resultant difficulty in achieving safe use, we concluded that appropriate education and information should be provided to young people.
... Consequently, the exact extent of NFS-related injuries remains unclear and may not be linked to their true cause. Additionally, NFS sometimes happens during consensual sexual activity, which can lead to consequences that are frequently overlooked or not investigated [49]; whenever NFS is associated with an assault, healthcare professionals must be able to recognize the signs and symptoms as soon as possible, both during hospital exams for initial treatment and during medico-legal consultations for forensic purposes. Signs of traumatic mechanical force from a non-fatal strangulation (NFS) attack typically fade within a few days. ...
Introduction: on-fatal strangulation (NFS) is a dangerous mechanism that can produce injuries with varying levels of severity. NFS-related injuries can range from low severity, such as simple contusions, to very severe, with convulsions and major forms of impairment. It is often difficult to gauge the severity of injuries from external and initial manifestations alone; it is therefore necessary to assess the possibility of misdiagnosed injuries or subsequent manifestations. Case report: In this study, we describe the case of a 71-year-old man with several injuries, mainly in the craniofacial region, following an assault by his flatmate. Not only did the subject suffer a concussive head injury and a fracture of the zygomatic bone, but he was also subjected to NFS. The patient was examined three times, and the third examination was carried out directly by us 40 days after the assault. Discussion: We concluded that NFS-related injuries are not always clearly visible and recognized after some time. It would therefore be necessary to standardize the clinical investigation procedure in suspected or confirmed cases of NFS. Conclusion: Clinical investigation should be done from the first hours after the injury event, with the help of forensic experts, with the use of dedicated instrumentation and the acquisition of photographic images, all carried out in a systematic manner for use in court, and a search performed for after-effects that cannot be identified by other methods. Psychological evaluation should also be considered as part of the broader assessment process as victims of NFS often experience significant psychological trauma.
... In terms of specific behaviours that are included, it would make sense to include non-fatal strangulation, which as Edwards and Douglas (Edwards and Douglas 2021) have outlined, is both a prevalent, gendered, and highly risky behaviour associated with domestic abuse and is common among students (Herbenick et al. 2021). It has also recently become a crime in England and Wales. ...
Domestic abuse and stalking in higher education (HE) have been overlooked in research in comparison to sexual harassment and sexual violence. This article reports on survey data from 725 students at an English university using measures of stalking and ‘dating violence’—physical and psychological violence from an intimate partner—from a US survey instrument (the Administrator Researcher Campus Climate Collaborative (ARC3) survey). According to this measure, 26% of respondents had been subjected to ‘dating violence’ and 16% to stalking behaviours. However, these findings need to be contextualised within a critical discussion about the use of the ARC3 survey tool in the English context. The ARC3 questions on ‘dating violence’ focus on physical and ‘psychological violence’; the questions therefore omit further types of domestic abuse under UK definitions. In relation to stalking, US definitions—as captured in the ARC3 survey instrument—define specific behaviours. By contrast, in England and Wales, stalking involves behaviours that engender fear or distress in a pattern of behaviour over time. These differences mean that the ARC3 modules on stalking and ‘dating violence’ would need to be significantly adapted to be suitable for use in England and Wales.
... For example, 35% of women ages 18-24 and 11% of women ages [25][26][27][28][29] had been choked at their most recent sexual event compared to < 3% of women in their 40s, 1% of women in their 50s, and < 1% of women ages 60+ [11•]. Being choked during a sexual encounter has been associated with greater emotional intimacy as well as event-level vaginal intercourse or anal intercourse [12]. While choking is more commonly reported as part of relational sex as compared to sex with new partners, campus-representative survey data from the USA show that choking still occurs in about 1 in 5 sexual encounters with partners who just met one another that day, perhaps reflecting how normative choking has become among young U.S. adults [1 •, 2•, 10, 11•, 12]. ...
Purpose of Review
Sexual choking/strangulation—usually done as part of consensual sex—has increased in prevalence among U.S. adolescents and young adults. Thus, it is critical for sexual health professionals to become aware of this emerging sexual behavior, how people engage in it, as well as short-term and potential long-term health consequences. The present review addresses these issues.
Recent Findings
Sexual choking refers to a sexual practice in which people apply external pressure to the neck in order to reduce blood flow and/or air flow. Although hands are most often used, people sometimes use a limb (e.g., forearm) or ligature. Young adults report learning about sexual choking from peers, partners, pornography, and social media, among other sources. Sexual choking/strangulation disproportionately affects women as well as sexual and gender minorities, and is more common between relationship partners. Emerging research indicates that a number of short-term health sequelae may occur from being choked (e.g., headaches, bruising, neck pain, neck swelling, loss of consciousness) and that there may be long-term health sequelae, including to neurological health.
Summary
Sexual choking/strangulation has become prevalent among young people in the USA, disproportionately impacts women as well as sexual and gender minorities, and is consequential to health. Future research that focuses on adolescents as well as sexual and gender minorities is warranted; also, prospective research is needed in order to examine potential health sequelae of having been choked/strangled during sex.
... One small audit of 48 patients referred for imaging after forensic examination due to non-fatal strangulation noted internal injury in five patients (including three patients with neck artery dissections). 19 Beyond the intimate partner violence context, we note that non-fatal strangulation is also used in consensual sexual practices, 20 including chemsex and group sex subcultures, and has been used in autoerotic contexts, violent pornography and dangerous adolescent 'choking games', 21 leading to accidental death. 22 Further discussion of non-fatal strangulation in these contexts, as well as injuries seen in near-hangings and hangings in a mental health or homicidal context (addressed in the forensic medical literature), 23 is beyond the scope of this article. ...
Background:
Awareness of the significance of non‑fatal strangulation is increasing in health and justice settings. While approximately half of patients strangled will sustain no immediate physical injury, strangulation has potential significant sequelae such as carotid dissection, hypoxic brain injury and laryngeal injury. Non-fatal strangulation by an intimate partner increases homicide risk by 7.48 times. General practitioners have a key role in identification, education and appropriate treatment. OBJECTIVE: The aim of this article is to provide an understanding of strangulation and its associated risks, to inform decision making regarding assessment, investigation and appropriate patient referral and safety netting. DISCUSSION: Informing patients of the increased risk of future homicide if strangled by an intimate partner may prevent death. Awareness of the red flag signs and symptoms, from subtle bruises or petechiae to significant oedema, focal neurological deficits and cognitive impairment, aids decision making regarding referrals and imaging as well as informing documentation for legal purposes.
... Strangulation/choking as a partnered sex behavior is disproportionately experienced by women. For instance, in a recent undergraduate probability survey study, nearly one-third of undergraduate women reported being choked by a partner during their most recent sexual event that included oral, vaginal, or anal sex, compared to only 8% of men (Herbenick et al., 2021b). Further, 58% of undergraduate women reported a lifetime history of at least one instance of being choked during partnered sexual activities, with 34% reporting more than five lifetime choking experiences (Herbenick et al., 2021a). ...
Being strangled, or “choked,” by a sexual partner has emerged as a prevalent, often wanted and consensual sexual behavior among adolescent and young adult women, yet the neurological consequences of repeated exposure to this behavior are unknown. The objective of the study was to examine the association between a history of repeated, recent choking/strangling episodes during sex and fMRI activation during working memory tasks in young adult women. This case-control study involved young adult women (18–30 years old) at a large, public university, and consisted of two study groups: a choking group consisting of participants who were recently and frequently choked/strangled during sex by a partner (≥4 times in the past 30 days) and a choking-naïve (control) group who had never been choked/strangled during sex. Participants completed two variations of the N-back (0-back, 1-back, and 2-back) working memory task during functional magnetic resonance imaging (fMRI): verbal and visual N-back tasks. Data from 20 participants per group were available for analysis. Between-group differences for accuracy and reaction time were not significant for either variation of the N-back task. Significant differences in fMRI activation patterns were detected between the choking and the choking-naïve groups for the three contrasts of interest (1-back > 0-back, 2-back > 0-back, and 2-back > 1-back). The choking group exhibited increased activation in multiple clusters relative to the choking-naïve group for the contrasts between the 1-back and 2-back conditions compared to the 0-back conditions (e.g., superior frontal gyrus, corpus callosum). However, the choking-naïve group exhibited increased activation relative to the choking group in several clusters for the 2-back > 1 back contrast (e.g., splenium, middle frontal gyrus). These data indicate that recent, frequent exposure to partnered sexual strangulation is associated with different neural activation patterns during verbal and visual working memory tasks compared to controls, suggesting that being choked/strangled during sex may modify the allocation of neural resources at increasing levels of cognitive load. Further investigation into the neurologic effects of this sexual behavior is warranted, given the prevalence of sexual choking among adolescent and young adult women.
... Our sequential surveys show the prevalence of this potentially harmful sexual behavior, since choking is a form of manual or ligature strangulation that results in obstructed airways and reduced blood flow to the brain. 1 For example, a recent U.S. nationally representative survey targeting adults ages 18-60 revealed that 21% of sexually active women reported having been previously choked as a part of partnered sexual experiences, as compared to 11% of men. 2 The prevalence of choking is higher among young adult women and adolescent girls, such that 58% of randomly sampled women college students reported having ever been choked during sex, and one-quarter of these students first experienced being choked between ages 12 and 17. 3 Further, one in three undergraduate women reported having been choked during their most recent sex. 4 There are several factors driving the increased prevalence of this sexual behavior, such as influences from pornography, magazines, media, and peers, 2, 5 which are further complicated by varying perspectives among those who engage in choking during sex. On one hand, choking during sex or erotic asphyxiation is thought to enhance sexual arousal and to be a pleasurable part of sex. ...
Being choked/strangled during a partnered sex is an emerging sexual behavior, particularly prevalent among adolescent and young adult women, but the neurobiological impact of choking remains unknown. This case-control study aimed to test whether frequent choking during sex influences neurological health in young adult women, as assessed by serum levels of S100B and neurofilament-light (NfL). Participants who reported being choking >4 times during sex in the past 30 days were enrolled into a choking group, whereas those without were assigned to a control group. Serum samples were collected and assessed for S100B and NfL levels. Demographic questionnaires as well as alcohol use, depression, and anxiety scales were also obtained. Fifty-seven participants were enrolled initially. Due to voluntary withdrawal, phlebotomy difficulties, and scheduling conflicts, the final sample size of 32 subjects (choking n=15; control n=17) was eligible for analysis. After adjusting for a significant covariate (race), the choking group exhibited significantly elevated levels of S100B relative to controls (B=13.96 pg/mL, SE=5.41, p=0.016) but no significant group differences in NfL levels. A follow-up receiver operating characteristic analysis revealed that serum levels of S100B had very good accuracy for distinguishing between the choking and control groups [AUC=0.811, 95%CI (0.651, 0.971), p=0.0033]. Our S100B provide evidence of recurring astrocyte activation due to frequent choking while the NfL data indicate that axonal microstructural integrity may be resilient to these transient hypoxic stressors. Further clinical investigation is needed to clarify the acute and chronic neurological consequences of being choked during sex using a multimodal neurologic assessment.
Purpose of Review
The aim of this narrative review is to retrieve, summarize, and synthesize qualitative and quantitative peer-reviewed research on bondage/discipline, dominance/submission, and sadism/masochism (BDSM) within technology-mediated sexual interactions (TMSI) published since 2007.
Recent Findings
Research findings suggest that TMSI, such as sexting, cybersex, and avatar sex, are relatively widespread experiences. Separate research indicates that BDSM has become more prevalent over time. People may use TMSI for BDSM, especially during an exploratory phase of sexual development. The online disinhibition effect posits that interactions via technology result in reduced inhibitions because of characteristics present in technology-mediated interactions that are not present in person-to-person interactions. As such, TMSI may provide a space for people to explore and express their sexual selves, including BDSM interests in ways they may not do in-person. We conducted a narrative review by systematically searching PsycINFO, Academic Search Complete, and Web of Science to find articles published between 2007–2024 related to BDSM and TMSI. We supplemented the findings with manual searches. We summarized study characteristics and provide a narrative overview of the extracted information.
Summary
The findings indicate that most research is focused on people who identify with BDSM, and avatar sex. There is little research on people who engage in BDSM but not the community. Some findings align with the online disinhibition effect, indicating that for those who are interested in BDSM, TMSI provides a reduction in inhibition present in in-person contexts. More research is needed to improve knowledge on the dynamics between BDSM and TMSI.
I analyse the way ‘rough sex’, including ‘choking’, was normalised during the 2019 trial of Jesse Kempson for the murder of Grace Millane – and portrayed as a modern form of mutual and egalitarian sexual exploration, particularly for young people. While the so-called ‘rough sex defence’ has been widely critiqued for the way it operates in the criminal justice system to minimise violence against women and blame victims for their own murder or assault, I focus here on the wider social implications of such legal arguments. I identify how the trial was infused with a ‘modern mythology of everyday kink’ discourse, which I critically deconstruct through the lens of three women's stories about unwanted or unenjoyed ‘rough sex’. I show that this discourse obscures and enables concerning new patterns of hurtful, exploitative and violent acts against women and girls that are becoming normalised and legitimated in the name of (rough) sex.
The term "rough sex" is widely used, but it is not always clear what it means. Through exploring people's working definitions of "rough sex," we asked what they revealed about the underlying phenomenon it is applied to, and whether it is actually a thing. Our online survey of 567 New Zealand respondents (73.7% women, 21% men, 5.3% gender diverse; mean age, 35.6 years, SD = 10.8) identified various behaviors that many considered to be part of "rough sex" - including hair pulling, holding down someone forcefully, slapping and "choking." While this behavioral profile was similar to previous U.S. studies, our survey was designed with novel features that allowed us to look more closely at the variation in how people make sense of "rough sex." Embedded within a critical psychology approach, our descriptive analysis highlighted areas of ambiguity and difference, including points of contradiction across people's working definitions. Critical qualitative analysis of open-ended textual data further examined categorical misalignments and the difficulties in interpreting behavioral indicators as defining of "rough sex" - especially without more contextual information. Overall, we found considerable variability and some contradictions in people's definitions of "rough sex" and the meanings they ascribed to it. Our findings led us to argue that the term "rough sex" does not map onto a coherent phenomenon, and that use of the term can be misleading, with potentially problematic implications.
Introduction
Consensual sexual choking has become prevalent among young United States (US) adults. In sex between women and men, women are overwhelmingly the ones choked, perhaps reproducing traditional heteronormative power dynamics. No research has examined the relationship between being choked during consensual sex and the use of external condoms and other contraceptives.
Methods
We administered a cross‐sectional campus‐representative survey to 4989 undergraduate students at a large public Midwestern US university.
Results
Half of respondents ( n = 1803) had ever been choked during sex. Having been choked was associated with a significantly lower likelihood of event‐level condom use (OR = 0.32 [0.19, 0.54] for >5 times lifetime choking among men and OR = 0.35 [0.27, 0.45] for >5 times lifetime choking among women compared to those with no choking experiences) and in the past 6 months (OR = 0.42 [0.24, 0.72] for >5 times lifetime choking among men and OR = 0.59 [0.43, 0.81] for >5 times lifetime choking among women compared to those with no choking experiences). Also, having ever been choked was associated with a significantly greater likelihood of having used an implant/intra‐uterine device in the past 6 months (OR = 1.85 [1.28, 2.68] for >5 times lifetime choking compared to those with no choking experiences).
Conclusion
Recognition that sexual choking is prevalent among young people has only recently emerged and educational programs are lacking. Study findings could be used to engage people in discussions about choking in relation to gender, power, and reproductive health agency.
Introduction
Sexual choking is a form of strangulation that involves using one’s hands, limb, or ligature to press or squeeze the neck, thus reducing blood and/or air flow, and has become prevalent among young adults in the United States. Yet, little is known about how sexual communication and consent occur in the context of choking, especially as some people may be unable to breathe or speak while being choked.
Methods
Qualitative interviews were conducted in January/February 2020 with 45 undergraduate and graduate students who had choked or been choked during sex.
Results
We identified two broad themes relating to (1) the nebulousness in the spectrum of consent and (2) the intersections of gender, power, and trust in relation to consent. Although most participants indicated that it was important for people to talk about choking before engaging in it, few described doing so in practice. Additionally, participants described placing a hand on the neck as a nonverbal form of seeking consent for choking or of asking a partner to choke them. Participants rarely described discussing preferences or boundaries related to choking pressure or duration.
Conclusions
We found that young adults rarely discuss sexual choking/strangulation with one another, even though choking/strangulation is a higher risk practice. Further, we found evidence of sexual compliance in which people choke, or accept being choked, to please their partner.
Policy Implications
Findings could help guide policy related to consent, sexuality education (including consent education), and clinical guidance related to sexual choking/strangulation.
Sexual assault remains an entrenched public health issue, with adolescent and emerging adult women at disproportionate risk for victimization. Identifying common typologies of sexual assault could be critical in developing effective prevention and intervention. However, prior work in this area has primarily utilized quantitative methodologies to classify sexual assaults into typologies, which may not capture important contextual factors and assault characteristics within typologies. The current study utilized a mixed methods approach, including analysis of survivors’ sexual assault narratives, to identify sexual assault typologies among a sample of college rape survivors (N = 106). Six typologies were identified, which were characterized by specific constellations of assault contexts, perpetration tactics, patterns of perpetrator and victim substance use, and type of relationship between survivor and perpetrator. Future research utilizing multiple methodologies (e.g., interviews, quantitative assessments) should attempt to characterize assault typologies more fully among survivors, as this work could lead to the identification of previously overlooked targets for comprehensive sexual assault prevention programs. Likewise, research focused on identifying risk and recovery-related factors among survivors of different types of assault could be used to tailor interventions to increase their uptake and effectiveness.
Sexual violence (SV) experienced by higher education students is a prevalent public health problem. Collecting data on SV through self-report surveys in higher education institutions (HEIs) is essential for estimating the scope of the problem, the first step to adequately resourcing and implementing prevention and response programming and policies. However, in the United Kingdom, data is limited. We used data from the cross-sectional Oxford Understanding Relationships, Sex, Power, Abuse and Consent Experiences survey, administered to all students at a university in the United Kingdom in May 2021 (n = 25,820), to estimate the past year prevalence of SV. We analyzed data from respondents who answered at least one question on SV (n = 1,318) and found that 20.5% of respondents experienced at least one act of attempted or forced sexual touching or rape, and 52.7% of respondents experienced at least one act of sexual harassment (SH). We found that women experienced the highest rates of SV. Attempted forced sexual touching was far more common than forced sexual touching, or rape. Sexist remarks or jokes were the most common act of SH. Most acts of SV took place at the university. These findings reveal that the prevalence of SV in HEIs in the United Kingdom could be far higher than what is experienced in the general population. While this study reflects the context in only one institution, it underlines the need for continued monitoring to develop rigorous, evidence-based, and targeted prevention and response strategies.
Why do people fall in love? Does passion fade with time? What makes for a happy, healthy relationship? This introduction to relationship science follows the lifecycle of a relationship – from attraction and initiation, to the hard work of relationship maintenance, to dissolution and ways to strengthen a relationship. Designed for advanced undergraduates studying psychology, communication or family studies, this textbook presents a fresh, diversity-infused approach to relationship science. It includes real-world examples and critical-thinking questions, callout boxes that challenge students to make connections, and researcher interviews that showcase the many career paths of relationship scientists. Article Spotlights reveal cutting-edge methods, while Diversity and Inclusion boxes celebrate the variety found in human love and connection. Throughout the book, students see the application of theory and come to recognize universal themes in relationships as well as the nuances of many findings. Instructors can access lecture slides, an instructor manual, and test banks.
This DOCA entry provides an overview of theories and key concepts used in pornography content research. It covers 1) general media effects theories, b) sexual media effects theories, c) gender role, feminist and queer theories, d) sexual fantasy and desire theories, e) mold versus mirror theories. Furthermore, eight dimensions of portrayals of sexuality in pornography are introduced (1. violence, 2. degradation, 3. sex acts, 4. performer demographics, 5. performer bodily appearance, 6. safer sex practices, 7. relational context of sex, and 8. consent communication).
Sexual choking/strangulation has become prevalent among young U.S. adults, yet little is known about media articles that teach readers about choking. We conducted a content analysis of 27 Internet articles, examining how choking is described, information related to health risks and healthcare, and article accuracy. Most articles described choking in positive terms and indicated choking can be done safely or properly, even while acknowledging potential dangers. Only two articles indicated having undergone expert/medical review. Few gave information about signs that would warrant seeking healthcare. Sexuality professionals need to be aware of choking-related information and misinformation in online media articles.
Sexual choking, which is a form of strangulation, can lead to various health consequences, including death. Recent surveys suggest that sexual choking is prevalent among young U.S. adults, a demographic also likely to view pornography. Pornography professionals, social commentators, and scholars have noted that mixed-gender choking is normative in contemporary pornography. Further, the pornographic portrayal of sexual choking is gendered; men choke women more often than women choke men. Guided by the sexual script acquisition, activation, application model (3AM) of mediated sexual socialization, the present campus-representative probability study explored associations between heterosexual-identified women's pornography exposure and sexual choking behavior. The more frequently women viewed pornography, the more often they were exposed to pornographic depictions of sexual choking. Exposure to sexual choking, in turn, was associated with being choked by men, but not choking men. The link between choking exposure and being choked was mediated by the eroticization of choking (rather than reduced agency to stop rough sex) and became stronger the more women perceived themselves as similar to actors in pornography. These results suggest that women's experience of sexual choking is influenced by their use of pornography, but in an active and willing, rather than a passive and unwilling, manner.
The purpose of this study was to investigate how various subgroups based on gender, sexual identity, and political ideology conceptualize rough sex. We used available data from a 2020 survey of randomly sampled undergraduate students at a large public university in the Midwestern U.S. (n = 4,989). The dichotomous responses to 13 items on the rough sex meaning scale were analyzed using a conditional covariance approach to better understand which behaviors commonly described as rough sex behaviors were prevalent. Our results showed that rough sex was conceptualized largely as a two-dimensional construct for vast majority of subgroups. Across all subgroups, nine of the 13 behaviors clustered along two dimensions in the same way. Specifically, four behaviors related to hair pulling, being pinned down, hard thrusting, and throwing someone onto a bed clustered together as one dimension (spanking and tearing clothes off being present along this dimension for vast majority of the subgroups). Being tied up, slapping, choking, punching, and making someone have sex behaviors formed a separate dimension of rough sex across all studied groups (with biting and scratching being associated with this dimension for vast majority of subgroups).
Choking/strangulation during sex has become prevalent in the United States. Yet, no qualitative research has addressed men’s choking experiences. Through interviews with 21 young adult men, we examined the language men use to refer to choking, how they first learned about it, their experiences with choking, and consent and safety practices. Men learned about choking during adolescence from pornography, partners, friends, and mainstream media. They engaged in choking to be kinky, adventurous, and to please partners. While many enjoyed or felt neutral about choking, others were reluctant to choke or be choked. Safety and verbal/non-verbal consent practices varied widely.
Many researchers interested In the socializing effects of pornography have found heuristic utility in the sexual script acquisition, activation, application model (3AM) of mediated sexual socialization. Studies have emphasized overall pornography/sexual behavior associations, however, rather than mediating sexual beliefs that a 3AM perspective suggests should underlie such associations. The present study used data from a campus-representative probability sample to examine whether linkages between pornography use and heterosexual-identified collegiate men’s choking of sexual partners is mediated by the belief that sexual choking is pleasurable, the belief that sexual choking is safe, and the disbelief that sexual choking requires consent from the person being choked. Sexual choking has been increasingly identified as a focal point of contemporary mixed-sex pornography as well as young men’s sexual behavior; it can also result in adverse health and legal consequences. Results were consistent with a sequential model positing that consuming pornography more frequently leads to more exposure to pornographic depictions of sexual choking, which in turn predicts a higher likelihood of choking sexual partners through the belief that sexual choking is pleasurable, the belief that sexual choking is safe, and the disbelief that sexual choking requires consent from the person being choked.
Choking/strangulation during sex is prevalent among young adults in the United States. We examined associations between having ever been choked and participants’ current mental health symptoms (e.g., feeling depressed, anxious, sad, lonely) in the prior 30 days and in the prior year. Participants were 4352 randomly sampled undergraduates who completed a confidential online survey and reported lifetime partnered sexual activity. 33.6% of women and 6.0% of men reported having been choked more than five times. After adjusting for demographic characteristics, having been choked remained significantly associated with all four mental health outcomes, except for overwhelming anxiety among men.
Background
Probability-based surveys of college students typically assess sexual behaviors such as oral, vaginal, and anal sex. Little is known about the broader range of sexual behaviors in which students engage.
Aims
In a random sample survey of undergraduate students, we aimed to: (1) describe how recently participants had engaged in solo and partnered sexual behaviors, (2) examine how frequently participants enacted certain rough sex sexual behaviors (e.g., light spanking, hard spanking, choking, slapping, and others), (3) assess participants’ frequency of experiencing certain rough sex behaviors, (4) describe participants’ frequency of threesome/group sex, (5) assess the characteristics of participants’ experiences with choking during sex; and (6) examine choking and face slapping in regard to consent.
Methods
A confidential, online cross-sectional survey of 4,989 randomly sampled undergraduate students at a large U.S. university.
Outcomes
Participants reported having engaged in a broad range of solo and partnered sexual activities, including rough sex behaviors.
Results
The most prevalent general sexual behaviors were solo masturbation (88.6%), oral sex (79.4% received, 78.4% performed), penile-vaginal intercourse (73.5%), and partnered masturbation (71.1%). Anal intercourse was the least prevalent of these behaviors (16.8% received, 25.3% performed). Among those with any partnered sexual experience, 43.0% had choked a partner, 47.3% had been choked, 59.1% had been lightly spanked and 12.1% had been slapped on the face during sex.
Clinical translation
College health clinicians and educators need to be aware of the diverse and evolving range of solo and partnered sexual behaviors reported by students. In addition to counseling students about pregnancy and sexually transmitted infection risk, clinicians might assess patients’ engagement in diverse sexual behaviors, such as choking/strangulation during sex, given the risk for serious outcomes including death.
Strengths and limitations
Strengths of our research include the large sample size, use of random sampling, high response rate for college populations, broad range of behaviors assessed, and novel data on choking during sex. Among our limitations, we did not assess to what extent the experiences were wanted, pleasurable, or appealing to participants. Except for in relation to choking and slapping, we also did not assess issues of consent.
Conclusion
Participants reported engaging in diverse sexual behaviors, some of which have important clinical implications, are understudied, and warrant further research.
Herbenick D, Patterson C, Beckmeyer J, et al. Diverse Sexual Behaviors in Undergraduate Students: Findings From a Campus Probability Survey. J Sex Med 2021;XXX:XXX–XXX.
Sexual aggression is now widely recognized as a public health crisis. Using the sexual script acquisition, activation, application model (3AM) as a guide, this paper reports findings on U.S. teenagers' exposure to pornography, motivation for viewing pornography, perceptions of pornography's realism, identification with pornographic actors, and sexual aggression risk from the National Survey of Porn Use, Relationships, and Sexual Socialization (NSPRSS), a U.S. population-based probability study. Sexual aggression was operationalized as pressuring another person into having sex despite their explicit declaration of nonconsent. Having been exposed to pornography and perceiving pornography as realistic were associated with increased sexual aggression risk. A stronger level of identification with pornographic actors was associated with an increased probability of sexual aggression for males, but not females. A motivation to learn about others' sexual expectations from pornography was unrelated to sexual aggression. Results interpretation and discussion focus on the need for additional theoretical nuance and measurement specificity in the media psychology literature on pornography and sexual aggression.
Using data from an undergraduate probability sample, we aimed to: (1) describe the prevalence and demographic characteristics of students who reported having engaged in rough sex with their current partner; (2) assess which sexual behaviors students consider to be rough sex; (3) describe the frequency with which participants report engaging in rough sex as well as their reports of initiating and liking rough sex, in relation to gender and sexual identity; and (4) examine predictors of rough sex frequency. Participants were 4998 students randomly sampled from a large Midwestern university who completed a confidential Internet-based survey (2453 women, 2445 men, 41 gender non-binary, 36 transgender or other gender non- conforming identities). Within these, 1795 individuals who reported a romantic/sexual partner of at least 3 months responded to questions about engaging, liking, and initiating rough sex. The most common behaviors participants considered to be rough sex were choking, hair pulling, and spanking. Transgender and gender non-binary students more often endorsed behaviors as rough sex. Also, rough sex was conceptualized as multidimensional, with one cluster being more consistent with earlier conceptualizations of rough sex (e.g., hair pulling, spanking) and the second cluster including behaviors such as choking, slapping, punching, and making someone have sex. About 80% of those with a current sexual or romantic partner engaged in rough sex with them and most who engaged it liked it. Bisexual women reported greater rough sex frequency and enjoyment (54.1% indicated enjoying it “very much”). Implications for sexuality research and education are discussed.
For decades, scholars and public health officials have been concerned with the depictions of sexual aggression in pornography, especially when acts of aggression are depicted with no consequences. Social cognitive theory suggests behaviors that are rewarded are more likely to be learned by consumers while those punished are less likely to be learned. To date, however, there has not been a large-scale content analysis to provide researchers with the baseline knowledge of the amount of sexual aggression in online pornography nor have previous content analyses examined the reactions of the targets of sexual aggression. This study of 4009 heterosexual scenes from two major free pornographic tube sites (Pornhub and Xvideos) sought to provide this baseline. Overall, 45% of Pornhub scenes included at least one act of physical aggression, while 35% of scenes from Xvideos contained aggression. Spanking, gagging, slapping, hair pulling, and choking were the five most common forms of physical aggression. Women were the target of the aggression in 97% of the scenes, and their response to aggression was either neutral or positive and rarely negative. Men were the perpetrators of aggression against women in 76% of scenes. Finally, examining the 10 most populous categories, the Amateur and Teen categories in Xvideos and the Amateur category in Pornhub had significantly less aggression, while the Xvideos Hardcore category had significantly more physical aggression against women. This study suggests aggression is common against women in online pornography, while repercussions to this aggression are rarely portrayed.
Sexual disgust is an emotion hypothesized to deter individuals from engaging in sexual activities that are probabilistically detrimental to fitness. Existing measures of sexual disgust are limited in treating sexual disgust as a unitary construct, potentially missing its multidimensional nature, and inadvertently ignoring important adaptive problems that this emotion evolved to solve. We conducted three studies to address these limitations. In Study 1, women and men (N = 225) nominated over 2,300 unique items that they considered sexually disgusting across a variety of different contexts. Study 2 (N = 331) identified a six-factor structure of the 50 most frequently nominated items: Taboo, Oral sex, Promiscuity, Hygiene, BDSM, and Same-sex attraction. Moreover, this study established construct validity with significant associations between sexual disgust and major dimensions of personality. Correlations between the Three Domains of Disgust Scale and our six-factor measure of sexual disgust established convergent validity. Study 3 (N = 318) confirmed the factor structure found in Study 2, established further convergent validity and examined sex differences and other individual differences in sexual disgust. Discussion focuses on the theoretical importance and psychometric validity of the Sexual Disgust Inventory-a new six-factor measure of sexual disgust.
Non‐fatal strangulation associated with sexual assault is a public health problem affecting female survivors, especially those assaulted by current/former partners or strangers.
Research on sexual behavior often characterizes rough sex as sexual aggression and as violent or abusive in nature. In a sample of 734 male and female undergraduates, we examined the extent of rough sexual acts in romantic relationships, the triggers for those acts, and how rough sex differs from “typical” sex. Participants were asked their definition of rough sex, questions regarding sexual aggression and behaviors during rough sex, and abusive behaviors in the relationship. Findings indicate that rough sex is triggered by curiosity and a need for novelty, and that both men and women often initiate rough sexual behaviors. Consensual rough sex typically results in little violence and only superficial injuries such as scratches, bruises, and welts. Rough sex does not correlate with violence in the relationship or abuse. However, rough sexual behaviors were increased in situations that involved male sexual jealousy. Being separated from a sexual partner was the second most common trigger for rough sex, particularly for men. Aspects of rough sex, such as increased semen displacement and decreased latency for female orgasm are discussed.
BDSM is an omnibus term covering a spectrum of activities within bondage/discipline, dominance/submission, and sadism/masochism relationships. To date, BDSM practitioners experience stigma due to a general unfamiliarity with the practice and marginalization of this type of sexual behavior. Destigmatization occurs partly through knowledge expansion and identification with the stigmatized group. In this study within the Belgian population, we aimed to characterize certain aspects of socioeconomic status and specific BDSM preferences of individuals with differing BDSM experience levels. We show that individuals who perform BDSM in a community setting (BDSM clubs, events. BDSM-CP) are generally higher educated, are significantly younger when first becoming aware of their inclination toward kink-oriented sex, and have a more strict BDSM role identity (Dom vs. Sub) than individuals who engage in BDSM-related activities in a private setting (BDSM-PP). This latter group in turn display a more pronounced Dom/Sub identification than individuals who only fantasize about the practice (BDSM-F). Our data indicate BDSM interest is a sexual preference already manifesting at early age, with role identification profiles becoming gradually more pronounced based on the practitioner’s contextual experience.
The broad accessibility of online sexually explicit material (SEM) exposes viewers to a wide scope of sexual behaviors. Social concern tends to be heightened over SEM that incorporates highly graphic, “rough” sex. This study assessed the associations among exposure to rough sex in SEM, desire for rough sex, and participation in rough sex while accounting for gender, sexual orientation, and perceived realism of SEM. Young adults (N = 327; ages 19–30; 50.8% men) were recruited through a crowdsourcing website. They completed an anonymous online survey that assessed viewing frequency for a range of sexual behaviors in SEM, the perceived realism of SEM, desire to participate in the behaviors viewed, and if they had ever participated in those behaviors. Hair pulling, spanking, scratching, biting, bondage, fisting, and double penetration were used to create the variable of rough sex. Rough sex desire and participation were common among individuals who have been exposed to rough sex in SEM, with 91.4% desiring to engage in 1 + behaviors at least to a small degree and 81.7% having engaged in 1 + behaviors. Exposure to rough sex in SEM was positively associated with desire for and participation in rough sex, emphasizing the need to ensure that individuals can distinguish between consensual rough sex and sexual violence. This study did not parse out causal effects or directionality, but did provide some insights into the interrelatedness of viewing, desiring, and participating in rough sex.
This article proposes new approaches to sexual violence prevention on college and university campuses in the United States. The author conducted four thought experiments about possible college sexual assault prevention strategies based on personal experience with campus administrators and sexual assault prevention specialists, review of existing research, and conversation with undergraduates and graduate students engaged in sexual assault prevention. Both advantages and drawbacks of each potential new strategy were contemplated. The four thought experiments were: (1) What if campuses stopped investing in sexual assault prevention and invested in fighting structural oppression instead?; (2) What if the mission to change social norms was not limited to campus, but aimed at the macro level?; (3) What if sexual assault prevention experts were trained in consent and pleasure related to kink, anal sex, and group sex?; and (4) What if colleges and universities provided on-campus education and counseling options for people who perpetrate sexual assault? First, encouraging a “root cause” perspective on sexual assault prevention would be strategic and socially responsible, but might be difficult to enact. Second, social norms change strategies that are global, not local, might be effective but might require an unrealistic level of cooperation between schools. Third, more information about consent as it pertains to kink, anal sex, and group sex may be useful components of sexual assault prevention education. Finally, there are too few evidence-based programs for people who have perpetrated sexual assault on campuses. Thought experiments are inexpensive to conduct and may invigorate the field. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
In most discussions of academic freedom, tenure-track employment figures either implicitly or explicitly as the normative model of academic work. When contingent faculty are taken into account, it is usually to discuss how the proliferation of adjuncts negatively affects academic freedom overall, or to lament the extraordinary lack of protections and vulnerability to pressures for conformity that result in adjuncts having considerably less academic freedom than their colleagues with tenure. In contrast, this essay affirms that today the adjunct reality is the new norm, 1 and that reframing conceptions of academic freedom to reflect this reality is key to any strategy to defend and expand this freedom. What we hope to offer here, however, goes beyond a litany of the fears and restrictions under which adjuncts labor, or an enumeration of the ways increasing reliance on adjuncts undermines the freedoms of the entire academy, for our contrapuntal analysis considers the various important strengths that adjuncts bring to the fight for academic freedom. In a world where contingent faculty now comprise the majority of college and university teachers, effectively defending academic freedom requires that we locate and amplify the strengths specific to this large group.
Introduction: Erotic asphyxiation is a sexual phenomenon in which one partner reduces the other person's brain oxygen level through strangulation. This study analyzes deaths caused by sexually-motivated strangulation to cases of homicidal choking — summarizing criminal penalties for defendants, depending on the presence of drugs, or alcohol intoxication.
Methods: The mode of analysis involves three sources of data. First, a retrospective chart review of our clinics' two recent cases. Second, a meta-analysis of these materials in relationship to forensic reports obtained from prosecutor's office. Third, we examine the prevalence of death due to strangulation in erotic and non-erotic cases using central court database. Lastly, we provide the summary of interviews involving the country's only forensic unit, which investigates criminal cases involving voluntary and involuntary strangulation.
Results: In total, we analyzed 15 cases of sexual asphyxiation — 2 of our own; 5 reported in prosecutor's archives; 8 control cases ruled as a non-sexual homicide. The two of our clinical cases describe two victims of voluntary erotic asphyxiation, involving complex sexual environment in which a sexual partner accidentally strangulated the other one during sex. The first case describes a 30 years-old female, who required all of her past sexual partners to choke her with hands in order to reach orgasm. The second case is that of a 41 years-old homosexual male, who was still a novice to kinky play and succumbed to death as a result of being tied with a set of ropes around his neck and body. By combining findings from the analysis of our clinic's cases with 5 files obtained from prosecutor's office — we are able to compare results of these cases to controls (involving homicidal suffocation using the plastic bag). In our cases, the defendants who avoid serving prison time for strangulating in course of erotic play typically exhibit these characteristics — at the time of the killing, they were not under influence of drugs; the deceased had documented (based on witness interview, review of personal items, or medical documentation) long-standing paraphilic disorder. In controls, the likelihood of being convicted of voluntary manslaughter was lower for people who acted under the influence of drugs but higher for those under the influence of alcohol.
Conclusions: These findings show that documented presence of paraphilic tendencies in the deceased might serve as grounds for not sentencing their sex partners for prison time if they acted to satisfy someone else's kinky needs.
In 2015, we conducted a cross-sectional, Internet-based, U.S. nationally representative probability survey of 2,021 adults (975 men, 1,046 women) focused on a broad range of sexual behaviors. Individuals invited to participate were from the GfK KnowledgePanel®. The survey was titled the 2015 Sexual Exploration in America Study and survey completion took about 12 to 15 minutes. The survey was confidential and the researchers never had access to respondents’ identifiers. Respondents reported on demographic items, lifetime and recent sexual behaviors, and the appeal of 50+ sexual behaviors. Most (>80%) reported lifetime masturbation, vaginal sex, and oral sex. Lifetime anal sex was reported by 43% of men (insertive) and 37% of women (receptive). Common lifetime sexual behaviors included wearing sexy lingerie/underwear (75% women, 26% men), sending/receiving digital nude/semi-nude photos (54% women, 65% men), reading erotic stories (57% of participants), public sex (≥43%), role-playing (≥22%), tying/being tied up (≥20%), spanking (≥30%), and watching sexually explicit videos/DVDs (60% women, 82% men). Having engaged in threesomes (10% women, 18% men) and playful whipping (≥13%) were less common. Lifetime group sex, sex parties, taking a sexuality class/workshop, and going to BDSM parties were uncommon (each <8%). More Americans identified behaviors as “appealing” than had engaged in them. Romantic/affectionate behaviors were among those most commonly identified as appealing for both men and women. The appeal of particular behaviors was associated with greater odds that the individual had ever engaged in the behavior. This study contributes to our understanding of more diverse adult sexual behaviors than has previously been captured in U.S. nationally representative probability surveys. Implications for sexuality educators, clinicians, and individuals in the general population are discussed.
Background:
Bondage and discipline, dominance and submission, and sadism and masochism (BDSM) is gaining popularity through the mainstream media. Nevertheless, very little is known about the prevalence of BDSM-related fantasies and activities in the general population.
Aim:
To determine the prevalence of BDSM fantasies and behavioral involvement in four different age groups of the general population in Belgium.
Methods:
By use of a cross-sectional survey questionnaire, the level of interest in several BDSM-related activities was investigated in a sample representative of the general Belgian population (N = 1,027). The questionnaire evaluated interest in 54 BDSM activities and 14 fetishes. Self-identification as BDSM practitioner, situational context of BDSM practice, age at awareness of these interests, and transparency to others were queried.
Outcomes:
Individual item scores and summary scores on four BDSM categories were included in the analyses.
Results:
A high interest in BDSM-related activities in the general population was found because 46.8% of the total sample had ever performed at least one BDSM-related activity and an additional 22% indicated having (had) fantasies about it. Interestingly, 12.5% of the total population indicated performing at least one BDSM-related activity on a regular basis. When asked whether they saw themselves as being interested in BDSM, 26% stated this to be the case and 7.6% self-identified as BDSM practitioners. Interests in dominant and submissive activities were comparable and, remarkably, were highly intercorrelated. BDSM and fetish interests were significantly higher in men than in women. The older group (48-65 years) had significantly lower BDSM scores compared with their younger peers. Of participants with a BDSM interest, 61.4% became aware of it before 25 years of age.
Clinical implications:
There is a high level of interest in BDSM in the general population, which strongly argues against stigmatization and pathologic characterization of these interests.
Strengths and limitations:
This is the first thorough study concerning prevalence of interest in and fantasies about a wide range of BDSM-related activities in the general population worldwide. Although our findings tend to argue against it, we cannot completely rule out participation bias introduced by non-interest in the non-completers. In addition, some topics might have been subject to interpretation by the respondents.
Conclusion:
Interest in BDSM is present in most of the general population. Further research is needed to destigmatize it by confirming BDSM as a leisurely preference rather than a psychiatric affliction. Holvoet L, Huys W, Coppens V, et al. Fifty Shades of Belgian Gray: The Prevalence of BDSM-Related Fantasies and Activities in the General Population. J Sex Med 2017;XX:XXX-XXX.
Sexual desires, behaviors and identities that focus on intense sensation, eroticized power exchange, or sensual experiences labeled fetishes, have important intersectionalities with bisexual or pansexual orientations, at least for some people. This raises some important considerations for therapy and counseling, and kink-aware therapists might bring a special set of skills and approaches to working with bisexual or pansexual clients. A qualitative analysis of 25 interviews with kink-identified, bisexual/pansexual/queer identified people highlighted the following patterns: the term queer, for some people, includes kink or BDSM sexualities; kink activities can be avenues for exploring gender identity and sexual orientation; and kink activities and community can be important elements in healing from shame, isolation, grief, and loss. Discussions of possible elements of competent care are reviewed in relation to kink sexuality and identity.
This study found that German heterosexual women’s personal and partnered consumption of pornography were positively correlated with their desire to engage in or having previously engaged in submissive (but not dominant) sexual behaviors such as having their hair pulled, having their face ejaculated on, being spanked, choked, called names, slapped, and gagged. The association between women’s partnered pornography consumption and submissive sexual behavior was strongest for women whose first exposure to pornography was at a young age. The findings also indicated that women’s personal and partnered pornography consumption were uniquely related to their engagement in submissive sexual behavior.
Public Health Significance Statement
This study suggests that greater exposure to pornography among heterosexual German women is associated with their desire to engage in or having previously engaged in submissive sexual behaviors but not dominant behaviors. This pattern of correlations aligns with sexual script theory and content analyses of dominance and submission and gender in pornography. It does not align with the perspective that measures of pornography consumption are simply proxies for factors such as a high sex drive or an adventurous approach to sex.
Various scientific disciplines devoted to the study of sexual behavior are concerned with the understanding of sadomasochistic (SM) practices. However, only a fragmented body of theories, opinions, and studies is available, which limits the systematic study of this field. Empirical studies and tools for the assessment of SM tendencies are particularly sparse. Our aim was to develop a comprehensive tool for the assessment of an individual’s engagement in SM practices. A comprehensive 24-item checklist of different types of SM play was generated with the assistance of members of the German SM community, covering both a dominance scale and a submission scale. The sadomasochism checklist was administered in an online study to a sample of 652 adults (345 female, 307 male), with 527 participants being active members in the SM community. Both the frequency of SM behavior and the attraction to the types of SM practices were assessed. Results revealed a one-factor structure for the dominance as well as the submission scale. The distinction between different types of practices (soft play, domination/submission, beating, toys, breath and bodily fluids) was confirmed using principal component analysis. Cronbach’s alpha was appropriate. The total scores for the dominance and the submission scale distinguish between participants with different preferences for dominant and submissive practices. The newly developed scale is a reliable and valid tool for the assessment of the frequency of and attraction to SM behavior. It aims to provide the basis for future systematic studies on sadomasochism.
Objective:
To describe the prevalence, risk factors, signs and symptoms of non-fatal strangulation (NFS) in women referred to a Sexual Assault Resource Centre (SARC) following recent sexual assault.
Methods:
A cross-sectional study using data routinely collected at time of forensic examination of women (age ≥ 13 years) referred to the Western Australian SARC between Jan-2009 and Mar-2015 alleging a recent sexual assault. Data on demographics, assault characteristics and forensic findings were available.
Results:
A total of 1064 women were included in the study; 79 (7.4%) alleged NFS during the sexual assault. The prevalence of NFS varied significantly by age-group and assailant type. Of women aged 30-39 years 15.1% gave a history of NFS compared to less than 8.2% in all other age groups. Of women assaulted by an intimate partner, 22.5% gave a history of NFS compared to less than 6% of women assaulted by other assailant types. Of all sexual assaults with NFS, intimate partners were the assailant in 58.2% of cases, whereas in sexual assault cases without NFS, intimate partners were the assailant in 15.9% of cases. Odds of NFS were 8.4 times higher in women sexually assaulted by an intimate partner compared to women assaulted by an acquaintance/friend and 4.9 times higher compared to women assaulted by a stranger. When considering both age and assailant type the highest proportion of NFS (33.9%) was in women aged 30-39 years sexually assaulted by an intimate partner. Other factors associated with NFS during sexual assault included deprivation of liberty, verbal threats, being assaulted in the woman's home and use of additional blunt force. External physical signs of NFS were absent in 49.4% of all NFS sexual assault cases.
Conclusions:
This study identifies and quantifies NFS risk factors in female sexual assault and highlights the strong association with intimate partner sexual assault. Greater awareness of NFS in sexual assault should lead to improvement in medical screening, forensic management and safety risk assessment by sexual assault and domestic violence services, emergency departments and police.
Interviewer-administered surveys are an important method of collecting population-level epidemiological data, but suffer from declining response rates and increasing costs. Web surveys offer more rapid data collection and lower costs. There are concerns, however, about data quality from web surveys. Previous research has largely focused on selection biases, and few have explored measurement differences. This paper aims to assess the extent to which mode affects the responses given by the same respondents at two points in time, providing information on potential measurement error if web surveys are used in the future.
527 participants from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3), which uses computer assisted personal interview (CAPI) and self-interview (CASI) modes, subsequently responded to identically-worded questions in a web survey. McNemar tests assessed whether within-person differences in responses were at random or indicated a mode effect, i.e. higher reporting of more sensitive responses in one mode. An analysis of pooled responses by generalized estimating equations addressed the impact of gender and question type on change.
Only 10% of responses changed between surveys. However mode effects were found for about a third of variables, with higher reporting of sensitive responses more commonly found on the web compared with Natsal-3.
The web appears a promising mode for surveys of sensitive behaviours, most likely as part of a mixed-mode design. Our findings suggest that mode effects may vary by question type and content, and by the particular mix of modes used. Mixed-mode surveys need careful development to understand mode effects and how to account for them.
This study surveyed German heterosexual men's interest and engagement in a variety of dominant behaviors observed in recent analyses of pornography. Interest in watching popular pornographic movies or more frequent consumption of pornography was associated with men's desire to engage in or having already engaged in behaviors such as hair pulling, spanking a partner hard enough to leave a mark, facial ejaculation, confinement, double-penetration (i.e. penetrating a partner's anus or vagina simultaneously with another man), ass-to-mouth (i.e. anally penetrating a partner and then inserting the penis directly into her mouth), penile gagging, facial slapping, choking, and name-calling (e.g. “slut” or “whore”). Consistent with past experimental research on the effect of alcohol and pornography exposure on men's likelihood of sexual coercion, men who had engaged in the most dominant behaviors were those who frequently consumed pornography and regularly consumed alcohol before or during sex.
Unconventional sensual, erotic, and sexual behaviors (herein referred to as kink behaviors) investigated by academia are based largely on clinical and criminal cases, and most published, peer-reviewed, quantitative research on these behaviors is based almost exclusively on male participants. For this study, information was collected and analyzed from 1580 female participants recruited from the kink community, using a non-clinical and non-criminal sample. We explored and described the preferences and diversity of more than 126 sensual, erotic, and sexual behaviors found among these participants, along with recommendations for continued research. Gaining a better understanding of the breadth and depth of activities engaged in by female kink practitioners could benefit educators, counselors, therapists, medical doctors, and other professionals when interacting with members of the kink community.
Background
This study describes the prevalence of (solo) masturbation, paying for sex and a range of other sexual practices among Australians. Methods: A representative sample of 20 094 men and women aged 16–69 years (participation rate among eligible people, 66.2%) were recruited by landline and mobile phone random-digit dialling and computer-assisted telephone interviews in 2012–13. Results: Many respondents (men, 72%; women, 42%) had masturbated in the past year. Half (51%) of the men and 24% of women had masturbated in the past 4 weeks. In the past year, more than two-fifths of respondents (men, 63%; women, 20%) had looked at pornography in any medium. Approximately 15% of men and 21% of women had used a sex toy. Digital-anal stimulation with a partner was practised by 19% of men and 15% of women, and oral-anal stimulation by 7% of men and 4% of women. Sexual role playing or dressing up were engaged in by 7–8%. Online sex, swinging, group sex, BDSM (bondage and discipline, ‘sadomasochism’ or dominance and submission) and fisting (rectal or vaginal) were each engaged in by less than 3% of the sample. Seventeen per cent of men said they had ever paid for sex; 2% had done so in the past year. Conclusion: Most of the solo practices studied were engaged in by more men than women, but women were more likely to have used a sex toy. Autoerotic activities are both substitutes for partnered sex and additional sources of pleasure for people with sexual partners.
We describe a case of shibari, a double hanging sexual asphyxia practice, which ended fatally for one of the two women involved. We present the autopsy findings and a psychiatric and psychometric evaluation of the surviving participant. The survivor had a borderline personality disorder, had suffered sexual abuse as a child, and had a history of illicit substance consumption, self-harm behavior, and sexual dysregulation. This case study raises doubts regarding the safety measures adopted by participants in masochistic practices and the engagement of people with psychiatric disorders in these extremely dangerous games. Further case studies of living participants in such games are likely to shed light on this practice and facilitate treatment.
The current study explored gender differences in college students' definitions and enjoyment of playful force and aggression.
Ninety-six female and 55 male college students who were predominantly White (96%) and heterosexual (97%) answered questions
about playful force during sex and playful aggression at other times. A content analysis showed that the current definitions
were very similar to those for children's rough-and-tumble play. However, a qualitative analysis found several potential gender
differences. Physically aggressive men appeared to give aggressive definitions of playful force during sex. In addition, there
was some disagreement among participants as to the acceptability of playful force during sex. Finally, there may be gender
differences in the assumed agency of playful force and aggression.
Despite a demonstrated relationship between sexual behaviors and health, including clinical risks, little is known about contemporary sexual behavior.
To assess the rates of sexual behavior among adolescents and adults in the United States.
We report the recent (past month, past year) and lifetime prevalence of sexual behaviors in a nationally representative probability sample of 5,865 men and women ages 14 to 94 in the United States (2,936 men, 2,929 women).
Behaviors assessed included solo masturbation, partnered masturbation, giving and receiving oral sex, vaginal intercourse, and anal intercourse.
Masturbation was common throughout the lifespan and more common than partnered sexual activities during adolescence and older age (70+). Although uncommon among 14- to 15-year olds, in the past year 18.3% of 16- to 17-year-old males and 22.4% of 16- to 17-year-old females performed oral sex with an other-sex partner. Also in the past year, more than half of women and men ages 18 to 49 engaged in oral sex. The proportion of adults who reported vaginal sex in the past year was highest among men ages 25-39 and for women ages 20-29, then progressively declined among older age groups. More than 20% of men ages 25-49 and women ages 20-39 reported anal sex in the past year. Same-sex sexual behaviors occurring in the past year were uncommonly reported.
Men and women engage in a diverse range of solo and partnered sexual behaviors throughout the life course. The rates of contemporary sexual behavior provided in this report will be valuable to those who develop, implement, and evaluate programs that seek to improve societal knowledge related to the prevalence of sexual behaviors and to sexual health clinicians whose work to improve sexual health among the population often requires such rates of behavior.
Purpose: To study postings of partial asphyxiation by adolescents on YouTube and to increase awareness of this dangerous activity as well as the value of YouTube as a research tool. Methods: Videos were searched on YouTube using many terms for recreational partial asphyxiation. Data were gathered on the participants and on the occurrence of hypoxic seizure. Results: Sixty-five videos of the asphyxiation game were identified. Most (90%) participants were male. A variety of techniques were used. Hypoxic seizures were witnessed in 55% of videos, but occurred in 88% of videos that employed the “sleeper hold” technique. The videos were collectively viewed 173550 times on YouTube. Conclusions: YouTube has enabled millions of young people to watch videos of the “choking game” and other dangerous activities. Seeing videos may normalize the behavior among adolescents. Increased awareness of this activity may prevent some youths from participating and potentially harming themselves or others.
Although vibrators are commonly recommended by clinicians as adjunct to treatment for female sexual dysfunction, and for sexual enhancement, little is known about their prevalence or correlates of use.
The aim of this study was to determine the lifetime and recent prevalence of women's vibrator use during masturbation and partnered sex, and the correlates of use related to sociodemographic variables, health behaviors, and sexual function.
A nationally representative sample of 3,800 women aged 18-60 years were invited to participate in a cross-sectional Internet-based survey; 2,056 (54.1%) participated.
The prevalence of vibrator use, the relationship between vibrator use and physical and psychological well-being (as assessed by the Centers for Disease Control and Prevention [CDC] Healthy Days measure) and health-promoting behaviors, the relationship between vibrator use and women's scores on the Female Sexual Function Index, and an assessment of the frequency and severity of side effects potentially associated with vibrator use.
The prevalence of women's vibrator use was found to be 52.5% (95% CI 50.3-54.7%). Vibrator users were significantly more likely to have had a gynecologic exam during the past year (P < 0.001) and to have performed genital self-examination during the previous month (P < 0.001). Vibrator use was significantly related to several aspects of sexual function (i.e., desire, arousal, lubrication, orgasm, pain, overall function) with recent vibrator users scoring higher on most sexual function domains, indicating more positive sexual function. Most women (71.5%) reported having never experienced genital symptoms associated with vibrator use. There were no significant associations between vibrator use and participants' scores on the CDC Healthy Days Measures.
Vibrator use among women is common, associated with health-promoting behaviors and positive sexual function, and rarely associated with side effects. Clinicians may find these data useful in responding to patients' sexual issues and recommending vibrator use to improve sexual function. Further research on the relationships between vibrator use and sexual health is warranted.
Much of our understanding of the association between the Sexual Compulsivity Scale (SCS) and sexual risk behavior among men who have sex with men (MSM) has been limited to samples of HIV positive MSM only. Using data from a community-based survey of gay and bisexual men (n = 1214), this analysis sought to further evaluate the association between the SCS and sexual risk behavior. The SCS was significantly associated with a variety of sexual risk behaviors, including having sex under the influence of club drugs, engaging in unprotected anal sex (receptive or insertive) with partners of the same and/or different HIV serostatus, identity as a barebacker, intentions to have bareback sex, number of recent sex partners, and temptation for unsafe sex. The SCS was also significantly associated with having engaged in a variety of specialized sexual behaviors (i.e., fetishes), many of which can increase HIV transmission risks. Finally, in multivariate analyses, the SCS significantly predicted unprotected sex with a non-main partner even when controlling for race, HIV serostatus, age, identity as a barebacker, and club drug use. These data indicate that the SCS may be able to serve as an indicator to detect HIV-associated sexual risk behavior in community-based samples of gay and bisexual men.
This study of 347 urban, self-identified lesbian (n = 289) and bisexual (n = 58) women examined women's engaging in 4 kinky sexual behaviors: bondage/domination, sadomasochism, photo/video exhibitionism, and asphyxiation/breath play. A cross-sectional, brief-intercept survey was administered at 2 New York City gay, lesbian, and bisexual community events. Over 40% reported engaging in at least 1 of these behaviors, and 25% reported engaging in multiple behaviors. Bisexual women were more likely to have engaged in any kinky sexual behavior and photo/video exhibitionism. White women were more likely than women of color to have engaged in bondage/domination. Compared to older women, younger women were more likely to have engaged in photo/video exhibitionism and asphyxiation/breath play. Participants who were younger when they came out to others, and younger at their same-sex sexual debut, were more likely to have engaged in any and each of the behaviors compared to women who were older at those developmental events.
This research investigated cases of femicide in Great Britain where perpetrators claimed that victims died in "sex games gone wrong." Forty-three femicides that resulted in a conviction for murder, manslaughter, or culpable homicide were examined in relation to victim-perpetrator sociodemographic characteristics, victim-perpetrator relationship, homicide details, and criminal justice outcomes. Key patterns within the data were identified. The research highlights that the "sex game gone wrong" narrative has gained traction against a cultural backdrop of normalized bondage, domination, and sadomasochism (BDSM) within neoliberal political economy.
Background:
Convenience sample data indicate that substantial portions of adults have engaged in sexual behaviors sometimes described as rough; little is known about these behaviors at the population level.
Aim:
To describe, in a U.S. probability sample of Americans aged 18 to 60 years, (i) the prevalence of diverse sexual behaviors, described here as dominant and target behaviors; (ii) the age at first pornography exposure as well as prevalence, range, and frequency of pornography use; (iii) the association between past year pornography use frequency and dominant/target sexual behaviors; and (iv) associations between lifetime range of pornography use and dominant/target sexual behaviors.
Methods:
A confidential cross-sectional online survey was used in this study.
Outcomes:
Lifetime engagement in dominant behaviors (eg, spanking, choking, name calling, performing aggressive fellatio, facial ejaculation, penile-anal penetration without first asking/discussing) and lifetime engagement in target behaviors (eg, being spanked, being choked, being called names during sex, having their face ejaculated on, receiving aggressive fellatio, or receiving penile-anal penetration without having discussed) were assessed; lifetime pornography use, age at first porn exposure, past-year frequency of porn viewing, and lifetime range of pornography were also assessed.
Results:
Women as well as men who have sex with men were more likely to report target sexual behaviors: having been choked (21.4% women), having one's face ejaculated on (32.3% women, 52.7% men who have sex with men), and aggressive fellatio (34.0% women). Lifetime pornography use was reported by most respondents. After adjusting for age, age at first porn exposure, and current relationship status, the associations between pornography use and sexual behaviors was statistically significant.
Clinical implications:
Clinicians need to be aware of recent potential shifts in sexual behaviors, particularly those such as choking that may lead to harm.
Strengths & limitations:
Strengths include U.S. probability sampling to provide population level estimates and the use of Internet-based data collection on sensitive topics. We were limited by a lack of detail and context related to understanding the diverse sexual behaviors assessed.
Conclusion:
Clinicians, educators, and researchers have unique and important roles to play in continued understanding of these sexual behaviors in the contemporary United States. Herbenick D, Fu T-C, Wright P, et al. Diverse Sexual Behaviors and Pornography Use: Findings From a Nationally Representative Probability Survey of Americans Aged 14 to 60 Years. J Sex Med 2020;XX:XXX-XXX.
Using data from the 2014 National Survey of Sexual Health & Behavior, a probability survey of Americans aged 14+, we assessed the prevalence and correlates of kissing, cuddling, and massage during 1493 individuals’ most recent sexual event from the past year. Most respondents reported kissing (87%) and cuddling (70%); fewer (23%) reported massage. Each was significantly associated with age, education, and relationship structure. Respondents younger than 30 were significantly more likely to indicate they did not kiss because kissing would have been too intimate with their partner. Only cuddling was significantly associated with event-level emotional intimacy and sexual pleasure.
What is misogyny? And (why) is it still occurring? This book explores the logic of misogyny, conceived in terms of the hostilities women face because they are living in a man’s world, or one that has been until recently. It shows how misogyny may persist in cultures in which its existence is routinely denied-including the United States, Australia, and the United Kingdom, which are often alleged to be post-patriarchal. Not so, Down Girl argues. Misogyny has rather taken particular forms following the advent of legal equality, obligating women to be moral “givers,” and validating a sense of entitlement among her privileged male counterparts. Many of rape culture’s manifestations are canvassed-from the ubiquitous entreaty “Smile, sweetheart!” to Donald Trump’s boasts of grabbing women by the “pussy,” which came to light during his successful 2016 presidential campaign; from the Isla Vista killings in California to the police officer in Oklahoma who preyed on African American women with criminal records, sexually assaulting them in the knowledge they would have little legal recourse; from the conservative anti-abortion movement to online mobbings of women in public life, deterring the participation therein of all but the most privileged and well-protected. It is argued on this basis that misogyny often takes the form of taking from her what she is (falsely) held to owe him, and preventing her from competing for positions of masculine-coded power and authority. And he, in turn, may be held to owe her little.
Objective: To examine, in a probability sample of undergraduate students, characteristics of students’ most recent sexual experiences (including alcohol use) as well as their experiences with non-consensual sex.
Participants: In January and February 2015, 22,046 students were invited to participate in an anonymous, cross-sectional, Internet-based survey; 7,032 surveys were completed (31.9%).
Methods: Measures included background characteristics (age, gender, sexual orientation), most recent sexual event items (sexual pleasure, wantedness, alcohol use), and experiences with nonconsensual sex (since college and lifetime).
Results: Respondents reporting sober consensual sex were more likely to report higher levels of sexual pleasure and wantedness. Nonconsensual oral, vaginal, or anal penetration occurring during college were reported by 15.8% of women and 7.7% of men. Students more often told friends, partners, or family members and rarely disclosed to university faculty or police.
Conclusions: Implications for campus policy and health education are addressed.
Death during autoerotic activities is of special concern to law enforcement officials, medical examiners, the family of the decedent, and society in general. As in the probing of any violent demise, accurate identification, management, and preservation of all physical evidence; complete photographic documentation of the scene and the body; reconstruction of the scene; and interviews with the family and acquaintances (psychological autopsy) are mandatory for proper study, evaluation, and interpretation of the case. Because of a lack of knowledge on the part of many people, including professionals, about these activities and the fact that many autoerotic fatalities share common characteristics with suicide and homicide, these cases are often misinterpreted. The authors present a case of autoerotic accidental asphyxial death which was initially misinterpreted as suicide. Language: en
Using data collected from 1,880 heterosexual men and women residing in the United States, this study investigated the associations among gender, pornography consumption, and 20 sexual behaviors observed in popular pornography. Acts were grouped according to whether participants reported engaging or being interested in trying specific sexual behaviors as the (a) aggressor (e.g., hairpulling, spanking, or choking), (b) target (e.g., being spanked or choked), or (c) uncommon and/or degrading sexual activity (e.g., male ejaculation in female partner’s mouth, anal sex, double penetration, and ass-to-mouth). Using sexual script theory, we hypothesized greater use of pornography would be associated with greater likelihood of both having engaged in and interest in engaging in these sexual behaviors. We further hypothesized gender differences consistent with pornographic sexual scripts that frequently portray men as aggressors and women as targets of aggression. Hierarchical multiple regressions revealed significant main effects for gender and pornography use on the three categories of sexual behavior but no significant interactions. Higher pornography use was associated with greater likelihood of both engaging and being interested in trying all categories of sexual behavior. Men were more likely than women to have engaged in aggressive and degrading/uncommon behaviors, and women were more likely than men to have engaged in target behaviors. However, men were more interested than women in trying all three categories of sexual behavior. Results provide partial support for sexual script theory; while higher pornography use increased interest and prior engagement in pornography-like sexual behavior, the increases in types of sexual behavior (aggressor, target, or uncommon/degrading) were not moderated by gender.
Autoerotic deaths are accidental deaths that occur during individual, solitary sexual activity in which a type of apparatus which was used to enhance the sexual stimulation of the deceased caused unintentional death. By definition these deaths are always accidental. Their annual incidence in the West is approximately 0.2–1 death per million inhabitants, with an average of around 0.5. At the scene, the most common features are exposure of genitals, pornography, nudity, cross-dressing and bondage. Other less common elements are: protective padding, evidence of masturbatory activity, foreign body insertion, mirrors, video recording, covering of the face, other masochistic behaviour and evidence of repetitive behaviour. Deaths are most commonly by hanging (70–80% of cases), followed by asphyxia by plastic bag and/or chemical substances (10–30% of cases). In 5–10% of cases, atypical methods are encountered: electrocution, overdressing/body wrapping, foreign body insertion and atypical asphyxia (including ligature strangulation, chest compression, inverted or abdominal suspension, immersion and drowning, and smothering). The typical victim is a white adult male in his early thirties (average age 33 years ± 15 years).
Objectives:
Both sexual assault (SA) survivors and domestic violence (DV) survivors are populations at risk of strangulation injury. Our goal was to identify the prevalence of strangulation in patients who are survivors of SA and DV, identify presence of lethality risk factors in intimate partner violence, and assess differences in strangulation between SA and DV populations.
Methods:
We reviewed all patient encounters from our health system's SA/DV forensic nurse examiner program from 2004 to 2008. Medical records were reviewed for documented physical signs of strangulation or documentation of strangulation. Risk factors for lethality included presence of firearm, threats of suicide/homicide by the perpetrator, significant bodily injury, loss of consciousness, loss of bladder or bowel control, voice changes, or difficulty swallowing. Data were analyzed with Pearson χ(2) and 95% confidence intervals (CIs).
Results:
A total of 1542 encounters were reviewed. The mean patient age was 30 (range, 13-98) years and 97% were female. Six hundred forty-nine encounters were for DV assaults and 893 were SA. An intimate partner was the assailant 46% of the time; 84% DV vs 16% SA (P<.001). Patients reported strangulation in 23% (351/1542; 95% CI, 21%-25%) of their assaults. The prevalence of strangulation was 38% with DV and 12% with SA (P<.001). Most of the intimate partner encounters with strangulation had significant risk for lethality (97%, 261/269; 95% CI, 94%-99%).
Conclusions:
Patients presenting to our forensic nurse examiner program who were survivors of DV were more likely than SA patients to sustain strangulation. Lethality risk factors were common.
As asphyxial episodes during autoerotic activity are rarely reported in women, a review of eight fatal cases and one near-fatal case was conducted to delineate more clearly the characteristics of this syndrome in women. Six cases involved characteristic fatal autoerotic asphyxial activity. The remaining two fatal cases were atypical in that the apparatus that was used for sexual purposes was not intended to cause asphyxia in one case and did not directly cause asphyxial death in the second case. The final case was not fatal. Significantly, the majority of women did not use unusual clothing, props, or devices to augment their activity, for example, five were completely naked and only one was found with elaborate clothing and extra ligatures. Six of the fatal cases had objective evidence of sexual activity, three had used neck padding to prevent chafing, and eight had failed self-rescue mechanisms. Of note, the initial impression in four cases (44%) was homicide (two), attempted suicide (one), and accidental death during sexual activity with a partner (one). These results support the assertion that the manifestations of female autoerotic asphyxial activity reported to date may be initially misleading to investigators. Our purpose in presenting these findings, therefore, is to increase awareness of the more subtle features of this syndrome in women in an attempt to reduce the potential for underdiagnosis or confusion with nonaccidental death in future cases.
Men who have sex with men (MSM) continue to be disproportionately impacted by STIs and HIV. In addition to traditional risk factors, increasing attention has been given to the potential role of affective components of a sexual encounter, including mood state. To date, no study has described sexual behaviors engaged in by those who report being in love (or not) during a given sexual event. Internet-based survey data were collected from 24,787 gay and bisexual men who were members of online websites facilitating social or sexual interactions with other men. Measures included sociodemographics, recent sexual behavior history, sexual event characteristics, and perceptions of "love" with men's most recent male sexual partner. Participants' mean age was 39.2 years; ethnicities included white (84.6 %), Latino (6.4 %), and African American (3.6 %). Nearly all men (91 %) were matched by presence (I love him/he loves me), absence (I don't love him/he doesn't love me), or uncertainty (I don't know if I do/I don't know if he does) of love with their most recent sexual partner. Men who reported love for their partner and believed their partner loved them were significantly more likely to have engaged in behaviors, such as cuddling and kissing on the mouth. Differences were also seen in regard to love and men's reports of anal intercourse and oral sex. Findings highlight differences in sexual behaviors based on perceptions of love and suggest the need to further explore how these differences influence sexual health.
Pornography is a lucrative business. Increasingly, women have participated in both its production, direction, and consumption. This study investigated how the content in popular pornographic videos created by female directors differs from that of their male counterparts. We conducted a quantitative analysis of 122 randomly selected scenes from 44 top-renting adult videos in 2005 (half male- and half female-directed). Findings revealed that all films shared similar depictions: Verbal and physical aggression was common, women were the primary targets of aggression, and negative responses to aggression were extremely rare. Compared to male-directed films, female-directed films were significantly more likely to portray women-only scenes and sexual acts. Even when controlling for main characters' gender, female-directed films showed significantly more female perpetrators aggressing against female targets and significantly more depictions of women as perpetrators of aggression. We highlight the importance of economic forces, rather than director gender, in dictating the content of popular pornography.
Does consent excuse violence against another? Generally, it does not. Recently, however, criminal defendants charged with violence against their sexual partners have asked courts to treat violent sex or sadomasochism (S/M) as a sport, like prize fighting and hockey. While most courts have refused to do so, a recent New York case, People v. Jovanovic, let stand a ruling that effectively permits a defendant to argue consent as a defense. This Article argues that the liberal argument treating S/M as a matter of sexual autonomy fails to account adequately for the history and practical application of the doctrine of violent consent. It concludes that by recognizing consent in the S/M context, the law is evolving in a direction that could lead to the glorification of sexual violence, rather than the sexual liberation of consenting adults.
It is written in almost all articles on autoerotic deaths that these fatalities account for about 500 to 1000 deaths per year in the United States and Canada. However, contrary to the general belief, this incidence rate was not obtained through a study, but it is an estimation based on 30-year unpublished data from Canada and England. In the present retrospective study from 1985 to 2009, 38 cases of autoerotic deaths were identified in the province of Alberta (Canada). This number corresponds to an incidence of 0.56 autoerotic deaths per million inhabitants per year. The vast majority of these deaths are related to typical, predominantly asphyxial methods, such as hanging. The bodies were most commonly found in basements, bedrooms, and bathrooms. There is no clear evidence of a preferential time of day for these deaths, but there appear to be slightly more autoerotic deaths during summer. The incidence of autoerotic deaths is higher in big cities compared with rural areas. The previously published estimate of 500 to 1000 'autoerotic deaths per year should not be used for Canada. An incidence of 0.2 to 0.5 cases per million inhabitants per year is a better estimate of the incidence of autoerotic deaths. The incidence in United States should be reassessed using epidemiological studies.
Although studies of specific groups of individuals (e.g., adolescents, "high risk" samples) have examined sexual repertoire, little is known, at the population level, about the sexual behaviors that comprise a given sexual encounter.
To assess the sexual behaviors that men and women report during their most recent sexual event; the age, partner and situational characteristics related to that event; and their association with participants' evaluation of the sexual event.
During March-May 2009, data from a United States probability sample related to the most recent partnered sexual event reported by 3990 adults (ages 18-59) were analyzed.
Measures included sexual behaviors during the most recent partnered sexual event, event characteristics (i.e., event location, alcohol use, marijuana use, and for men, erection medication use), and evaluations of the sexual experience (pleasure, arousal, erection/lubrication difficulty, orgasm).
Great diversity exists in the behaviors that occur during a single sexual event by adults, with a total of 41 combinations of sexual behaviors represented across this sample. Orgasm was positively related to the number of behaviors that occurred and age was related to greater difficulty with erections and lubrication. Men whose most recent event was with a relationship partner indicated greater arousal, greater pleasure, fewer problems with erectile function, orgasm, and less pain during the event compared with men whose last event was with a nonrelationship partner.
Findings demonstrate that adults ages 18 to 59 engage in a diverse range of behaviors during a sexual event and that greater behavior diversity is related to ease of orgasm for both women and men. Although both men and women experience sexual difficulties related to erectile function and lubrication with age, men's orgasm is facilitated by sex with a relationship partner whereas the likelihood of women's orgasm is related to varied sexual behaviors.
This current study analyzes the content of popular pornographic videos, with the objectives of updating depictions of aggression, degradation, and sexual practices and comparing the study's results to previous content analysis studies. Findings indicate high levels of aggression in pornography in both verbal and physical forms. Of the 304 scenes analyzed, 88.2% contained physical aggression, principally spanking, gagging, and slapping, while 48.7% of scenes contained verbal aggression, primarily name-calling. Perpetrators of aggression were usually male, whereas targets of aggression were overwhelmingly female. Targets most often showed pleasure or responded neutrally to the aggression.
How individuals who engage in autoerotic asphyxial activities first become aware of its purported erotic potential is debated. The case of an adult male who died from autoerotic asphyxiation shortly after watching a television show that discussed sexual asphyxiation is reported. A request is made that medical examiners and coroners report other accidental autoerotic deaths that are temporally associated with this television broadcast.
Accidental death by manual strangulation among homosexuals during the act of sodomy is an uncommon event. In our recent case, the pattern of injuries indicates that strangulation resulted from the forearm application on the neck in a manner better known as "choke holding."
The purpose of this article is to define autoerotic asphyxia and present the enigma as a preventable problem. Articles published between 1856 and 1994 are identified through medline, referenced citations, and expert opinion. The literature selected were those most often cited and for which the methodological assumptions could be identified. Interventional strategies determined included legislation/regulation, technology, and education. Injury and death from autoerotic asphyxia can be controlled by pre-event, event, and post-event phase control. However, there are formidable barriers in the way.