{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:47:58Z","timestamp":1787068078954,"version":"build-2736575974"},"reference-count":54,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Indiana University School of Public Health"},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01HD119019"],"award-info":[{"award-number":["R01HD119019"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sexual strangulation, widely referred to as \u201cchoking,\u201d has become a prevalent sexual practice among young adults, disproportionately affecting females. Despite this high prevalence, little is known about its acute neurobehavioral effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the short-term impact of sexual strangulation on physical, psychological, and oculomotor functioning, and to explore participants\u2019 subjective experiences and perceptions of study participation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This randomized crossover study included 31 young adult females (18-30\u00a0years) who had engaged in both choking-involved and non-choking partnered sex in the past month. Participants completed 3 visits: baseline, post-choking sex, and post-non-choking sex. Mental health assessments (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Perceived Stress Scale) and near point of convergence (NPC) testing were administered at each visit. Mixed-effects regression models assessed outcome changes across conditions. Additionally, participants completed a post-study experience survey to express their thoughts and feelings regarding study participation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>Primary outcomes were NPC distance (in centimeters) and mental health scores. Secondary outcomes included symptom self-reports following sexual choking and participants' feedback on study acceptability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>NPC distance increased significantly following both choking and non-choking sex, with a greater increase post-choking (19.9% vs 8.1%, P\u2009=\u2009.007). Depression scores declined significantly only following non-choking sex (P\u00a0=\u2009.038), whereas perceived stress levels decreased after both types of sex (Ps\u2009&amp;lt;\u20090.05). Anxiety scores declined only after choking-involved sex (P\u2009= .048). Notably, approximately one-third of participants reported neurological symptoms, such as head rush and blurred vision, following choking-involved sex. Most participants rated the study as acceptable and appropriate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Implications<\/jats:title>\n                    <jats:p>Sexual strangulation\/choking may acutely disrupt oculomotor control and attenuate typical mood-related benefits of sex. These findings support the need to assess strangulation\/choking-involved sex distinctly from other sexual behaviors in clinical and research settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Strengths and Limitations<\/jats:title>\n                    <jats:p>This is the first randomized crossover study to examine the acute effects of sexual strangulation\/choking. Strengths include a within-subject design, assessment acutely after exposure, and multimodal assessment. Limitations include a small sample size, short follow-up, and reliance on self-report data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sexual strangulation\/choking may acutely impair NPC more than non-choking sex, attenuate the typical mood-enhancing effects of sexual activity (depression), and produce unique affective outcomes (anxiety reduction). As this practice becomes increasingly mainstream, further research is urgently needed to inform health education, clinical screening, and public health responses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdaf356","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T13:08:13Z","timestamp":1764940093000},"source":"Crossref","is-referenced-by-count":2,"title":["Clinical characteristics of acute sexual strangulation\/choking: a randomized cross-over study"],"prefix":"10.1093","volume":"23","author":[{"given":"Sage H","family":"Sweeney","sequence":"first","affiliation":[{"name":"Department of Kinesiology, Indiana University School of Public Health\u2014Bloomington , Bloomington, IN 47405 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6311-8872","authenticated-orcid":false,"given":"Megan E","family":"Huibregtse","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine , Atlanta, GA 30322 ,","place":["United States"]},{"name":"Department of Health and Kinesiology, University of Illinois Urbana-Champaign , Urbana, IL 61801 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harper","family":"Day","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, Indiana University School of Public Health\u2014Bloomington , Bloomington, IN 47405 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire V","family":"Buddenbaum","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, Indiana University School of Public Health\u2014Bloomington , Bloomington, IN 47405 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace O","family":"Recht","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, Indiana University School of Public Health\u2014Bloomington , Bloomington, IN 47405 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bella","family":"Buehler","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, Indiana University School of Public Health\u2014Bloomington , Bloomington, IN 47405 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debby","family":"Herbenick","sequence":"additional","affiliation":[{"name":"Department of Applied Health Science, Indiana University School of Public Health-Bloomington , Bloomington, IN 47405 ,","place":["United States"]},{"name":"The Center for Sexual Health Promotion, Indiana University School of Public Health-Bloomington , Bloomington, IN 47405 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Kawata","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, Indiana University School of Public Health\u2014Bloomington , Bloomington, IN 47405 ,","place":["United States"]},{"name":"Program in Neuroscience, College of Arts and Sciences, Indiana University , Bloomington, IN 47405 ,","place":["United States"]},{"name":"Department of Pediatrics, Indiana University School of Medicine , Indianapolis, IN 46202 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"2026010506162683600_ref1","doi-asserted-by":"publisher","first-page":"3435","DOI":"10.1007\/s10508-025-03245-9","article-title":"Prevalence and demographic correlates of \u201crough sex\u201d behaviors: findings from a U.S. nationally representative survey of adults ages 18 to 94","volume":"54","author":"Herbenick","year":"2025","journal-title":"Arch Sex Behav"},{"key":"2026010506162683600_ref2","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1080\/0092623X.2021.1985025","article-title":"Non-fatal strangulation\/choking during sex and its associations with mental health: findings from an undergraduate probability survey","volume":"48","author":"Herbenick","year":"2022","journal-title":"J Sex Marital Ther"},{"key":"2026010506162683600_ref3","volume-title":"Youth Healthy and Safe Relationships: A Literature Review","author":"Beres","year":"2020"},{"issue":"2","key":"2026010506162683600_ref4","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1007\/s10508-024-02937-y","article-title":"Prevalence of sexual strangulation\/choking among Australian 18\u201335 year-olds","volume":"54","author":"Sharman","year":"2025","journal-title":"Arch Sex Behav"},{"key":"2026010506162683600_ref5","volume-title":"Res. 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