In short:
An Australian-first study into the prevalence of strangulation during sex among young people has prompted concerns over the serious health risks.
Researchers found women were more likely to have been strangled than men during sex.
What's next:
Experts say more conversations need to be happening in schools and at home to raise awareness around the risks, and the factors contributing to its normalisation.
Susie Dodds has had several sexual partners who wanted to choke her during sex.
While the 25-year-old had been able to rebuff their attempts, she says the experiences left her feeling panicked.
"That's definitely not something I am into," Ms Dodds told 7.30.
"If there's someone that you don't know that well, or it's the first experience you have with somebody, that's quite shocking to experience.
"I've had, you know, a few men ask if they can choke me. A couple of them, their hands kind of [wandered] up that way, but I know a lot of people have experienced much worse."
Ms Dodds said she did not want to shame the men who asked her if they could choke her, nor does she think they are bad people — but she was surprised by how frequently the question came up.
Susie isn't alone — a study by the University of Melbourne and the University of Queensland which surveyed 5,000 people aged between 18 and 35 found 59 per cent of men and 40 per cent of women admitted to having choked a sexual partner.
The figure was even higher among trans and gender-diverse people, at 74 per cent.
More women (61 per cent) than men (43 per cent) reported ever being strangled, while the numbers were higher again for trans and gender-diverse people (78 per cent).
"This group of people that we're looking at now is a context where the people engaging in sexual strangulation are largely saying that they're consenting to the practice," said Heather Douglas, a professor at Melbourne University Law School and co-author of the study.
The numbers don't surprise violence prevention educator Maree Crabbe.
"About three years ago, I started to hear much more frequently that strangulation was part of what was happening in young people's sexual lives," Ms Crabbe told 7.30.
"It had come up only marginally every now and then in the years before that.
"Young women have talked about [how] they have felt like they're genuinely being murdered ... they're really uncomfortable and feeling very, very unsafe."
The study, published in the academic journal Archives in Sexual Behaviour, defined strangulation or choking as placing pressure on the neck by using hands or other body parts or ligatures to hinder, restrict or obstruct breathing.
On average, those surveyed had been strangled six times by three partners – and the first time someone experienced strangulation was usually between the ages of 19 and 21.
Ms Crabbe said representations of strangulation in pornography and popular culture were influencing sexual practice, adding that sometimes, consent to sex was also seen as consent to choking.
The study found pornography is the most common way young people are finding out about strangulation (61 per cent), then movies (41 per cent), friends (32 per cent), social media (31 per cent), and current or potential partners (29 per cent).
"A lot of the people in our study said that they'd seen pornography in their teens, some quite young. So obviously this is an issue for parents as well in terms of engaging with the effects of pornography, the dangers of strangulation, how to broach those kinds of topics with their kids," Ms Douglas said.
Some young men Ms Crabbe has interviewed also describe feeling pressured to strangle their partners.
"Some of them talk about not really being into it, there being an expectation, sometimes being asked by their partners to do it," Ms Crabbe said.
"But I think also it can be really difficult for young men to reject that as a sexual practice when it's become normalised."
Potential for brain injuries 'concerning'
Medical professionals warn compression of the neck can cause miscarriage of pregnancy, stroke, and within minutes, death.
"[Death] is rare, but it can occur. But perhaps most concerning is the issue that we're very aware of, which is brain injury," said Heather Douglas, a professor at Melbourne University Law School and co-author of the study.
Ms Douglas said studies had found people could be injured quickly with about 10 seconds to being rendered unconscious, 17 seconds to having a fit from a lack of oxygen, 30 seconds to loss of bowel control and 150 seconds to death.
Jo Ann Parkin from the Victorian Institute of Forensic Medicine says choking during sex can cause brain injuries like concussion, even if it's not apparent, and signs of non-fatal strangulation can also evolve.
"Absence of oxygen being supplied to the brain will affect things such as concentration, memory, decision-making, and we're waiting for more research in that particular area," Dr Parkin said.
"The issue with non-fatal strangulation is the fact that it has very serious outcomes that can arise from instances of short to long-term compression, so repeated episodes as well are an issue that we get quite concerned about."
Dr Parkin said other symptoms of injury could include a hoarse voice, and difficulty breathing and swallowing.
"The thing I would like to convey to the community is there is a perception that they can have a safe word, there is a perception that they can tap out effectively that they can give a signal," she said.
"And what we are hearing from our victims when they present in these settings is they were unable to indicate that in that situation.
"There is a very large misconception that this can be operated as an act very safely and it just is not a safe act, at any time."
'We need to be having conversations as a society'
In response to what she had heard from young people, Ms Crabbe is launching a campaign called Breathless to raise awareness about the prevalence of health risks of non-fatal strangulation and to encourage critical thinking about the kinds of influences that are contributing to its normalisation.
"I think we need to be having conversations as a society, but also, in schools and homes. Parents need to be speaking with their children about this practice," Ms Crabbe said.
"Unless there is stronger awareness of the risks, and also, some critical thinking about the gendered nature of it … it's going to be something that continues."
Ms Dodds shared her own experience with the campaign and said young people, particularly women, often felt pressured to conform with so-called rough or kinky sex, including strangulation.
"If someone says they're not interested in doing that, in a sexual context, now that's labelled as boring, or vanilla," she said.
"If you're going to do that, you do need to know the risk and you need to know that there is no way you can really do it safely.
"If you're comfortable with that, I guess, you know, it's your life, but it is your life."
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