This sex act has been linked to signs of brain damage in young women
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“The brain is the most powerful sexual organ a person possesses. For there to be injury to the brain as a result of play is a concern.” — Lexx Brown-James, PhD, LMFT, CSE, CSES, certified sexuality educator and director of the sexual health certificate program at the University of Michigan
“Being kink aware is really important for any practitioner. We don't have to condone activities but we should be aware of what patients are doing and avoid stigma at all costs to build therapeutic relationships.” — Tami Rowen, MD, an OB/GYN and sexual health expert at UCSF
It’s a sexual behavior that has been linked to signs of brain damage in young women.[]
So why are people engaging in choking during sexual activity?
“I think that there is an allure with choking, especially as seeing it and hearing of it has become more mainstream in erotica, sexually explicit media, and media in general. Choking is not safe on its own. It needs to be a practice that is studied, understood, practiced, and deployed in a safe manner with consent and boundaries,” Lexx Brown-James, PhD, LMFT, CSE, CSES, a certified sexuality educator and director of the sexual health certificate program at the University of Michigan, tells MDLinx.
When sex leads to brain damage...
Research published in May studied outcomes among young adult women with a history of recent and frequent experiences being strangled by a sexual partner.[]
Findings showed that these women had high serum levels of S100B in their blood, a marker for brain damage.
"The brain is the most powerful sexual organ a person possesses. For there to be injury to the brain as a result of play is a concern," Dr. Brown-James says. “This does not mean that the behavior or frequency of behavior is of concern, but it does call into question the technique that is being used, the consent, and prior negotiations of this type of sexual play."
Research into non-fatal strangulation in the context of sexual violence and domestic violence found choking has also been associated with a range of neurological and psychological problems including loss of consciousness, stroke, paralysis, seizures, motor and speech disorders, PTSD, depression, dissociation, and suicidality.[]
Keeping an open mind in the clinic
Experts say one thing is especially crucial when counseling their patients about sexual behaviors.
“[I] encourage people to have an open mind," says Tami Rowen, MD, an OB/GYN and sexual health expert at UCSF. "Many things people enjoy sexually are dangerous. Most of what we learn as physicians is harm reduction. People won’t listen if we tell them not to engage in what gives them pleasure, so one just has to support their patients while giving them the information they need to make informed decisions.”
“This is a very challenging topic,” Dr. Rowen continues. “It’s quite risky, so it really depends on how people engage in it. There are safe ways, not to actually cut off oxygen, to do this for very short periods of time (no true way to define but I would recommend less than 15 seconds at a time). If someone orgasms or is stimulated from oxygen deprivation, they can also hold their own breath but not actually be choked.”
When working with patients, Dr. Brown-James says physicians can consider referring them to a sexuality educator for further advice.
“The important part is that no one is condemned based on these behaviors. A doctor can say, ‘I'm really concerned about the effects this is having on you,’ and explain, with empathy, how there could be lasting harm. With that, in using the PLISSIT model, the doctor can then give some limited information and specific suggestions—like a referral to a sexuality educator—who can support the patient's behavior and enhance safety,” she says.
Both experts say it is important for physicians to be aware of various sexual behaviors patients may be engaging in.
“Being kink aware is really important for any practitioner,” Dr. Rowen says. “We don't have to condone activities but we should be aware of what patients are doing and avoid stigma at all costs to build therapeutic relationships.”
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