For health care providers

Asking teens and young adults about choking.

Sexual strangulation has become common among young people, and they call it “choking.” Many adults don’t know what young people mean by that word, so they may not ask the right questions or look for the injuries strangulation causes, especially because it often doesn’t leave any marks or visible indications of harm. Students have shared that being asked about “strangulation” instead of “choking” can feel stigmatizing, so it’s important to learn the words young people use and how to talk with them about it.

Why ask

It starts before most patients reach college.

1 in 4

college students who had been choked were first choked between ages 10 and 17.

82%

of students said they’d want to learn about choking one-on-one from a health care provider.

18%

of women students said they had been choked without consent.

1 in 2

strangulations leave no visible injury.

Herbenick et al., Archives of Sexual Behavior (2022); Herbenick, ISSWSH webinar slides (January 2026), including students finding “strangulation” stigmatizing; It Left No Marks, Women’s Health NSW.

In the exam room

Ask, advise, act.

1

Ask

Add one question to your intake or confidential portion of the visit.

Intake · Relationships and safety

During sex, has anyone ever choked you, put pressure on your neck, or done something rough you didn’t want?

2

Advise

Say it to every adolescent and young adult patient, whatever their answer.

You

“A lot of people your age have heard that choking during sex is safe if you do it right. It isn’t. It cuts off blood to the brain and can cause a stroke without leaving a mark. If it ever happens to you, come see me.”

3

Act

If the answer is yes, follow up before the visit ends.

  • “Did you pass out, even for a moment?”
  • “Were you asked first? Did you want it?”
  • “Do you feel safe with this person?”
  • Check the neck for bruising, and the eyes and face for small red spots.

Anticipatory guidance and an intake question about rough or unwanted acts during sex: Herbenick, ISSWSH webinar slides (January 2026); Herbenick et al., Sexuality Research and Social Policy (2025).

If the answer is yes

Where to send them.

Call 911

If the patient is unconscious, having trouble breathing, has a swelling neck, seems confused, is weak or numb on one side, is having a seizure, or shows signs of a stroke.

Send to an ER today if

  • They passed out or can’t remember it
  • Breathing feels different
  • It hurts to swallow, or swallowing is hard
  • The voice is hoarse, raspy or deeper
  • The neck hurts or is tender
  • Vision or hearing has changed
  • Headache, dizziness or lightheadedness
  • Small red spots on the eyes or face
  • Loss of bladder or bowel control
If symptoms start or get worse later

Tell the patient to come back even if they were already seen. Swelling can develop hours and even days later, and a stroke from a torn artery can follow after days or weeks.

Document it

  • Write down what the patient says happened, in their words, including “strangled” or “choked.”
  • Record neck findings, red spots and voice changes, even if they are minor.

Ask about safety

  • Strangulation in an abusive relationship can signal that violence is escalating.
  • For patients under 18, follow your state’s reporting requirements.

Escalation: It Left No Marks, Women’s Health NSW.

For your office

Hand them out, put them up.

Warning-signs card

For patients: when to go to an ER, when to call 911, and what to do if symptoms start later.
No Safe Way poster

For exam rooms and waiting rooms.
Seconds poster

A person can pass out 5 to 10 seconds after the arteries in the neck close.