Police in Sydney, Australia, are investigating the recent death of a 16-year-old girl who reportedly lost consciousness after being strangled during consensual sex with her boyfriend. The practice, colloquially known as “choking,” has become alarmingly prevalent, and not just in Australia. A nationally representative survey found that one in three American women ages 18 to 24 were choked during their most recent sexual encounter. Among female undergraduates at one large university, 58 percent reported being choked during sex at least once, and one-quarter were first choked by age 17. More than a third of U.S. college students first learned about the act through pornography.
Strangulation can cause unconsciousness within seconds. Serious vascular and neurological injuries, including stroke, may not become apparent until hours or even days later. Studies of sexual strangulation have found acute neurological effects, biomarkers of brain injury, and structural and functional changes in the brains of women repeatedly choked during sex. It takes far less force to cause serious injury than is widely appreciated: only four pounds of pressure can block the jugular veins, while about 11 pounds can block the carotid arteries. By comparison, opening a soda can requires roughly 20 pounds of pressure.
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The liberal defense of pornography is rooted in John Stuart Mill’s harm principle, which would prohibit government or society from interfering with “self-regarding” conduct—actions that affect only the person engaging in them—regardless of whether others consider this behavior harmful to the individual. But if pornography is teaching young people that their sexual partners want to be strangled, then its consequences extend beyond those who consume it.
Pornography does not merely cater to sexual desire; it shapes it. In a crowded attention market, producers introduce increasingly extreme practices, ratcheting up the spectacle required to capture an audience. These practices do not stay confined to screens. As heterosexual anal intercourse became common in pornography in the mid-1980s, its prevalence in real life also rose. In 1992, 16 percent of American women ages 18 to 24 reported ever having anal sex; by 2009, that figure had risen to 40 percent of women ages 20 to 24. Today, “rosebudding”—a dangerous practice of deliberately inducing rectal prolapse through extreme anal penetration—has become a recognizable feature of mainstream pornography. Its popularity has inspired ordinary people to embrace “prolapse play” as a “kink,” and beginner’s guides to achieving the “perfect prolapse” now circulate online. As porn performer and “extreme anal queen” Sheena Shaw notes, “Culture teaches us what to like and what not to like.”
Pornography writes sexual scripts that influence our behavior, though few of us will admit it. The same is true of advertising: as Americans, we prize our autonomy and chafe at the idea that our preferences can be manipulated by advertisers armed with market research and focus groups. Yet we readily assume that advertising works on everyone else—a phenomenon psychologists call “third-person perception.”
The denial of media’s influence is highly selective. Pornography has consumers across the political aisle, but liberals have long been among its most vocal defenders. Even as they discount its ability to reshape sexual norms, they concede that media can condition social expectations in other contexts—the premise behind the argument for greater “representation” in film and television. If casting racial minorities as corporate executives can affect our perceptions of what kinds of people belong in the boardroom, then masturbating to depictions of strangulation can surely affect our perceptions of what kinds of behaviors belong in the bedroom.
The impact of pornography is especially consequential for young people. Today, the average age of first exposure to pornography is around 12, when most children have little sexual experience and their preferences are still taking shape. In a 2022 national survey of more than 1,300 U.S. teenagers, about half reported seeing pornographic content depicting rape, choking, or other violence. These sexual scripts are formative: they guide later sexual encounters—and, because sex is relational, affect partners who may never have watched pornography themselves.
Research bears this out. Adolescent pornography use is linked to sexually dominant behaviors, including strangulation. Men who use pornography more frequently are likelier to believe that women find choking pleasurable and more likely to have choked a partner. Observational studies cannot prove that porn plays a causal role, but the evidence points in that direction. Since its rise to pornographic prominence, choking has become so normalized that, for many young women, it is a routine sexual act—and often initiated without prior discussion or consent. Even when consensual, the motivations behind sexual strangulation often have little to do with pleasure: many young women consent to being choked primarily to please their partners, while many young men report choking their partners because they believe it arouses them.
The teenager’s death in Sydney has prompted calls for greater porn literacy. Young people, according to Australian Social Services Minister Tanya Plibersek, need to understand that “pornography is not real life.” This refrain is familiar but misleading. What is unreal in pornography is women’s apparent pleasure in sexual violence. The acts themselves are all too real, and performers have the injuries to prove it. The physical toll of pornography is such that adult actors are often likened to professional athletes, minus the multimillion-dollar endorsements and comprehensive health-care coverage. Most women leave the industry in two years or less, sometimes with medical bills that dwarf what they earned.
Others in Australia have called for a “harm reduction” approach to sexual strangulation. Kelly Jaunzems, a public-health lecturer at Edith Cowan University, argues that instead of “focusing on criminalisation or blaming porn,” we should provide young people with better “guidance on consent [and] safety information.” But strangulation cannot be made safe through consent or instruction. Moreover, expanding sex education to cover practices “outside mainstream” sexuality, as Jaunzems suggests, risks doing precisely what pornography already does: presenting dangerous practices as quirky features of normal human sexuality.
A more effective response is to reduce young people’s exposure to pornography. Age-verification laws, which have met fierce resistance from the pornography industry and free speech advocates, should be expanded and enforced. The U.S. should follow Britain, which has passed legislation banning pornography depicting strangulation and suffocation, though the prohibition has not yet taken effect. Australia is considering a similar ban. Because children and teens also encounter pornography through social media, lawmakers should consider measures that require those platforms to let users opt out of algorithmically generated feeds, giving minors—and their parents—greater control over the content pushed at them.
These are commonsense safeguards. A broader reckoning with pornography is also overdue. The industry has long been permitted to flout legal constraints that would apply in almost any other context. In most U.S. states, a person cannot legally consent to serious bodily harm, even during consensual sex, and, under the First Amendment, otherwise illegal conduct is not made legal by being filmed. Physical harm is not just an accidental byproduct of pornography; it is often the point. One need only glance at Pornhub, one of the world’s most trafficked websites, to see as much. Despite efforts to rehabilitate the company’s image, its landing page remains dominated by videos with titles advertising acts that would likely constitute criminal offenses were they to occur outside of pornography. Lawmakers should go further than restricting access for minors; they should scrutinize the content we permit pornographers to produce and disseminate in the first place.
Mill’s harm principle protects self-regarding conduct from coercive interference by government or society when it affects only the person engaging in it. But it’s not likely that Mill envisioned a world in which sexual violence is mass entertainment and a primary source of sex education. It is long past time that we stop treating pornography as a matter of private choice and begin to recognize it for what it is: a threat to public safety.