Experiences and Perceptions of Risk Among Australian Men Who Have Sex with Men Who Engage in Sexual Strangulation

Sexual strangulation-commonly referred to as "choking"-is a prevalent sexual practice among young people and individuals within the LGBTQ+ community, most prevalent in men who have sex with men. The practice of sexual strangulation is a potentially hazardous behavior that can have numerous deleterious health consequences. In some circumstances, strangulation can result in loss of consciousness, neurological injury, and death. While the health consequences of external pressure on the neck, which restricts blood flow and respiration, are self-evident to medical communities, the same level of knowledge is less common in the broader community. The lack of knowledge around the risks of incorporating strangulation into sexual practices is a public health and sexual health concern. Therefore, it is important to understand the current trends surrounding the perception of risk and the experience of risk in communities where the activity is prevalent, such as men who have sex with men.Through 23 semi-structured interviews, we identified four key themes surrounding the experiences and perceptions of risk among Australian men who have sex with men who engage in sexual strangulation. These include the influences on experience and perception of risk, erroneous estimations surrounding an individual's and partner's competence, a disregard for risk, and the prioritization of enjoyment, harm reduction, and minimization strategies. This article lends valuable insight into the experiences and perceptions of risk in men who have sex with men and engage in strangulation during sexual activity. The article provides suggestions and future implications for medicine and education.