Acute and Cumulative Effects of Risky Sexual Behaviors

Sexual strangulation (often called “sexual choking” by those who engage in it, even though it is technically a form of neck compression or strangulation) has become highly prevalent among young adults, is usually described as consensual, and disproportionately impacts females. Our survey of randomly sampled college students showed that 58% of females had ever been choked/strangled during sex. A series of pilot studies have begun unraveling the effects of this emerging and risky sexual behavior, where females with frequent exposure to sexual choking/strangulation showed elevations in brain injury blood biomarkers, increases in mental health symptoms such as feeling depressed and anxious, alterations in brain morphology, and changes in neuronal connectivity. While relentless efforts through epidemiological, qualitative, and experimental studies have greatly advanced the scientific knowledge of this sexual behavior, the current understanding of neurological consequences has been limited by cross-sectional designs and small sample sizes. Therefore, the proposed prospective cohort study moves the field forward by examining acute and chronic neurological effects of sexual choking/strangulation while a structured interview aim will help us to better understand why people engage in this risky sexual behavior, despite its risks. The proposed study is guided by the following 3 specific aims. (1) To identify the acute neurological effects of sexual choking/strangulation through the response profile of multimodal neuroimaging, blood biomarkers, and cognitive assessments. (2) To determine the associations between cumulative exposure to sexual strangulation and neural cellular, physiological, and functional integrities. (3) To characterize young adults’ experiences with sexual choking/strangulation. The longitudinal design will allow us to examine acute effects of this sexual practice (Aim 1), observe the cumulative impacts of multiple choking/strangulation events (Aim 2), and establish temporality between sexual choking/strangulation and neurological outcomes. Our rigorous interview will help characterize this sexual behavior (Aim 3), which is vital for developing guidelines and educational intervention. The proposed study will not only characterize the impact of sexual choking/strangulation on brain health but also lay the foundation for the development of empirically supported sexual health educational guidelines to mitigate neurodegenerative conditions. Project Number: 1R01HD119019-01 | Fiscal Year: 2025 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: Keisuke Kawata (+1 co-PI) | Institution: TRUSTEES OF INDIANA UNIVERSITY, BLOOMINGTON, IN | Award Amount: $677,535 | Activity Code: R01 | Study Section: Neural Basis of Psychopathology, Addictions and Sleep Disorders Study Section[NPAS] View on NIH RePORTER: https://reporter.nih.gov/project-details/1R01HD11901901