Non-fatal strangulation (NFS)

What is choking or non-fatal strangulation in sex?

Non-fatal strangulation (NFS) is often called choking or breath play. It involves putting pressure on someone’s neck in a way that restricts breathing or blood flow to the brain without resulting in immediate death. Pressure can be applied using hands, other body parts such as arms, legs, or with an object.

There is no safe way to do it. Sexual choking is never without risk and even minor pressure can cause long-term health problems.

Research shows that non-fatal strangulation is not only extremely dangerous, but it’s becoming more common among younger people.

In the UK, surveys found that experiences of choking during sex have risen sharply, with more than half of under 35s having experienced it, and nearly a third of those people wrongly believing there is a safe way to strangle someone.

What happens to the body and what are the risks?

Strangulation can cause harm without looking serious at all. There is no safe way to choke someone. The risks are unpredictable and life threatening each time it happens.

• It can cut off oxygen and blood flow to the brain, even if it only lasts a short amount of time and leaves no visible marks.
• The neck contains major blood vessels, nerves and the airway. All of these can be damaged with little force.
• A small amount of pressure – similar to the force used to open a can of drink – can block blood flow and can cause someone to lose consciousness within seconds.

Evidence now also suggests that strangulation is the second most common cause of stroke in young women.

Injuries such as breathing difficulties, brain damage and stroke can develop hours or days later. Someone might feel fine at first but become unwell later.

There is no safe way to choke someone. The risks are unpredictable and potentially life threatening. 

Find out more about the risks during and after non-fatal strangulation in the Institute for Addressing Strangulation factsheet (PDF).

Why has it become more common?

Multiple sources and research show a significant rise in choking shown in pornography, presenting it as a normal part of sex.

Brook.org.uk describes this as a serious problem, as porn does not show the potential harm involved. The truth is many people do not realise that it can cause serious injury or death.

Pornography showing strangulation is to become a criminal offence in the UK. 

It’s also important to understand that it is often used as a form of control, intimidation and violence in intimate relationships.

Strangulation or suffocation is recognised as a distinct and serious form of harm. In many cases, it is an indicator of escalating violence and increased homicide risk.

Find out more: NHS guidance on understanding non-fatal strangulation.

What is the law?

Non-fatal strangulation and suffocation became a criminal offence in England and Wales on 7 June 2022. It covers intentionally strangling another person or acts that affect a person's ability to breathe. The offence can lead to up to five years in prison and it cannot be used as a defence in court.

It’s a criminal offence to strangle or suffocate another person, even if they have given consent in a sexual context. Read about the non-fatal strangulation offence on GOV.UK.

Myth busting

• If there are no marks, nothing serious happened.
  Truth – research shows that more than half of people who experience NFS have little to no bruising. Internal damage can happen even without visible injury and serious brain or nerve injuries can happen even if the neck looks fine.
• Strangulation can be safe
  Truth – there is no medically safe way to strangle someone. Even minor pressure for a short amount of time can cause serious long-term health problems or death.
• If you don’t do it, you’re boring or vanilla.
  Truth – this is a peer-pressure tactic, not a reflection of personality. People use peer pressure to push others into doing something they’re unsure about, make risky actions seem normal and avoid being judged on their own behaviour.
• If everyone else is doing it, it must be safe
  Truth – risk doesn’t decrease just because others participate. In reality, group normalisation often hides how dangerous the behaviour is.
• It’s common in porn so it must be normal
  Truth - pornography showing strangulation is about to become a criminal offence in the UK. Porn does not show the harm involved or the negotiations that happen before filming and is not recognised as sex education. 
• If someone consents to it, it’s fine and can’t be classed as abuse or violence
  Truth – UK law recognises that whilst someone can consent to being choked if they are aware of the risks, they cannot legally consent to being harmed or killed by strangulation. This means if someone is seriously injured during, consent cannot be used as a defence.
• It’s just sex, not a violent act
  Truth – non-fatal strangulation is one of the strongest predictors of future serious violence in intimate partner abuse cases and potentially harmful sexual practices. 
• If they seem ok afterward, there’s no risk
  Truth – symptoms can be delayed and warning signs can include difficulty swallowing, change in voice, neck and head pain, dizziness, vision problems and more. Seek medical attention as soon as possible.
• You must be strong to strangle someone and cause damage
  Truth – very little pressure is needed to cause someone serious harm, less pressure than opening a can of drink.