Australian Survey: 57% of 18-35 Year Olds Report Sexual Strangulation

More than half of young adults surveyed in Australia recently reported experiencing sexual strangulation, a startling statistic that highlights how common the practice has become despite its severe medical dangers. Medscape reported on these findings alongside a separate 2025 US university study, bringing fresh clinical attention to an intimate practice that emergency departments must evaluate.

The numbers reveal a wide demographic footprint across different populations. A 2024 Australian survey tracking 4,702 individuals aged 18 to 35 found that 57% had been sexually strangled at least once. That figure broke down to 61% of women, 43% of men, and 79% of transgender and gender-diverse individuals. Meanwhile, a 2025 study of 3,780 students at a US university showed that 18.3% had been choked by a partner, and 16% had choked a partner during their most recent sexual encounter. These widespread occurrences present a distinct diagnostic challenge for emergency departments, where patients are frequently reluctant to disclose the true nature of their injuries.

Beyond Acute Asphyxia: The Vascular and Neurological Toll

The physical consequences of neck compression extend far beyond immediate breathing difficulties. Rosa Pérez, an emergency and dispatch center nurse and spokesperson for the Spanish Society of Urgent and Emergency Medicine, emphasized that the human body has no safe mechanism for enduring neck constriction. Compression forces blood vessels and airways into dangerous territory, triggering a cascade of potential failures across the cardiovascular and nervous systems.

Compression of the neck can compress the carotid arteries and jugular veins, causing what is known as cerebral ischemia, which means that blood flow to the brain is reduced. Compression of the larynx and trachea can also cause asphyxia by preventing oxygen from reaching the lungs. This can damage the entire body. In addition, neck stimulation can compress the carotid sinus and trigger changes in heart rate. The result can be serious damage to the organs, brain, and heart.

A 2022 systematic review published in Neuropsychological Rehabilitation detailed the severe neuropsychological consequences linked to nonfatal strangulation in domestic and sexual violence settings. Researchers identified potential complications including arterial dissection, stroke, seizures, motor and speech disorders, paralysis, and severe psychological trauma such as posttraumatic stress disorder, depression, suicidal ideation, and dissociation. However, those authors noted that existing literature often lacks formal neuropsychological assessments.

Pérez outlined the acute symptoms emergency medical teams look for during an evaluation, noting that patients may present with loss of consciousness, amnesia for the episode, visual disturbances like vision loss or flashing lights, and paresthesia or loss of sensation in parts of the body.

Clinical Assessment and the Barrier of Silence

Identifying these injuries requires a careful and targeted physical examination. According to guidance addressed in a review published in the Journal of the American College of Emergency Physicians Open, clinicians must understand the underlying pathophysiology to properly assess strangulation cases. Healthcare providers look for ecchymosis, bruising, ligature marks, petechiae on the face, oral mucosa, or conjunctiva caused by ruptured small blood vessels, voice changes due to airway injury, and tenderness over the trachea or larynx.

When injuries appear severe, standard carotid Dopplers often reveal very little. Medical teams may instead consider CT angiography and laryngoscopy to closely examine the trachea and larynx. Yet, if a patient feels well and exhibits no signs of vascular injury, physicians generally forgo additional testing.

The primary hurdle remains interpersonal rather than technical. Patients seeking care in emergency departments frequently conceal the context of their injuries, especially when the compression involves nonconsensual activity, coercion, or sexual violence. Clinicians must handle these sensitive conversations carefully to distinguish whether neck compression occurred during consensual activity, involved violence, or stemmed from self-harm and suicide attempts.