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No Safe Word: How Strangulation Crosses the Line in Intimate Encounters

Mar 7, 2025 | Battered Women's Support Services

Intimate Partner Violence (IPV) often manifests through visible injuries—bruises, broken bones, or black eyes. However, some of the most severe injuries leave no obvious mark, lingering silently in the bodies and minds of survivors. Strangulation, an extreme and alarmingly common form of IPV, often occurs in intimate spaces, wielded as a tool of control and dominance. While the act itself is violent and terrifying, its aftermath—a cascade of physical, emotional, and cognitive impacts—remains poorly understood and rarely addressed in healthcare or support systems.  

This article delves into the chilling reality of strangulation as a weapon of power and control, its physiological and psychological consequences, the blurred lines of consent in sexual contexts, and the urgent need to centre survivor voices in healthcare, advocacy, and policy responses. 

The Weapon of Silence: Why Strangulation is a Unique Form of Violence 

Strangulation is not simply a physical act; it is a calculated attempt to dominate and instill terror. Survivors frequently describe the moment of strangulation as one of profound fear—a chilling awareness that their life hangs in the balance. Unlike other physical assaults, strangulation often leaves little external evidence. A survivor may walk away from an incident with no visible bruising, only to suffer devastating internal injuries and long-term neurological effects.

Power and Control

Strangulation is deeply tied to coercion and control. Perpetrators often use it to send an unspoken message: “I control whether you live or die.” This tactic not only creates physical harm but also leaves psychological scars that make survivors more compliant, isolated, and afraid to seek help.

Survivors of strangulation are 750% more likely to be killed by their abuser in subsequent attacks.
68% of IPV survivors report being strangled by their partner at least once.

The act transcends physical assault; it becomes an assertion of ultimate power over another human being.

The Hidden Epidemic: Physiological Impacts of Strangulation Deprivation of Oxygen: An Unseen Crisis 

Strangulation restricts blood flow and oxygen to the brain, resulting in damage that may not manifest immediately. Even if the survivor regains consciousness quickly, the lack of oxygen can kill brain cells, impair cognitive functions, and cause permanent neurological damage.

Immediate and Long-Term Effects:
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Short-term Symptoms: Confusion, dizziness, headaches, visual disturbances, and difficulty speaking.
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Long-term Symptoms: Persistent memory loss, chronic migraines, vertigo, difficulty concentrating, and emotional dysregulation.
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Fatal Consequences: Brain damage, stroke, or delayed death due to blood clots or swelling in the brain.
Immediate and Long-Term Effects

Strangulation-related injuries are often internal, making them difficult for healthcare providers to detect without specialized training or advanced imaging technology. Survivors might not seek medical attention due to fear, shame, or a belief that their injuries are minor because they cannot “see” them. 

Psychological and Emotional Trauma
The Invisible Scars Strangulation is not just about physical harm—it’s about silencing and terrorizing a victim. Survivors frequently report heightened anxiety, depression, PTSD, and suicidal ideation following an assault involving strangulation. 

Cognitive Impacts of Strangulation-Related Brain Injury: 

  • Short-term memory loss
  • Impulsivity
  • Emotional volatility 
  • Difficulty focusing on tasks 

These symptoms often mirror those of mental health disorders, and survivors may face misdiagnoses or accusations of being uncooperative or “lazy.” Survivors may even internalize these misunderstandings, believing they are fundamentally broken rather than understanding they are living with the consequences of physical brain trauma. 

The Health Risks of Strangulation

Strangulation is not a benign act—it’s a form of violence with severe health consequences. Medical experts and neurologists agree: 

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Six to nine seconds of carotid artery compression can cause unconsciousness. 
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Brain damage can begin almost immediately due to lack of oxygen. 
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Symptoms can include neck pain, swelling, difficulty breathing, and even involuntary loss of bodily functions. 
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Neurological Consequence can include potential long-term neurological damage, such as cognitive and mental health issues, even in cases where no immediate physical signs are present. 
One survivor explained: "For years, I thought I was stupid. I couldn’t remember things, I couldn’t focus, and no one ever told me it might be because of what he did to me."

The Gendered Nature of Strangulation in IPV

Strangulation disproportionately affects women and non-binary individuals, reflecting deeply rooted power imbalances in intimate relationships. The act underscores the historical entitlement some men feel over women’s bodies and lives.

A Pattern of Violence
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Strangulation is more common in IPV situations where there is an existing pattern of coercive control.
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Many survivors report that strangulation incidents escalate over time, often marking a turning point in the severity of abuse.
Silencing Survivors
The threat of strangulation often silences survivors, both metaphorically and literally. Survivors may hesitate to report abuse, fearing escalation or disbelief from authorities and medical professionals.

When survivors do speak up, the onus is often placed on them to “prove” their abuse—an impossible task when injuries are invisible, and trauma impacts memory and communication.

Strangulation, Sexuality, and Cultural Narratives
Strangulation, often referred to as “choking” in sexual contexts, has gained prominence in mainstream pornography and popular culture. Its portrayal often romanticizes or trivializes the act, framing it as a standard part of modern sexual behaviour. This normalization creates dangerous dynamics where individuals may feel pressured to accept strangulation as a routine sexual act, even if they are uncomfortable or unaware of the risks.

The Eroticization of Violence against Women

The blending of strangulation with sexual pleasure can obscure its inherent dangers. The act carries significant physical risks, including unconsciousness, brain injury, and even death. Yet, these risks are rarely discussed openly, leaving many people unaware of the potential consequences.

Power Dynamics and Consent
Strangulation in sexual contexts can blur lines of consent, particularly when power imbalances exist in a relationship. Coercion, intimidation, or a lack of informed consent can transform what may seem consensual into a dangerous act of violence.
The Normalization of Strangulation in Sexual Encounters
Strangulation, often misrepresented as “choking,” has become increasingly common in sexual relationships, especially among younger demographics. According to Dr. Debbie Herbenick’s research: 
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Nearly 40% of women aged 18-24 reported being choked during sex.
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One in three women reported being choked during their most recent sexual encounter.
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The behaviour often occurs without explicit consent, dialogue, or an understanding of its risks. 
Consent vs. Coercion: 
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Consent must be enthusiastic, informed, and freely given. Many survivors report being pressured into acts of choking during sex without full understanding of the risks involved. 
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Survivors who are choked during sex without consent often face dismissiveness from authorities and medical professionals who assume it was part of a consensual act. 
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“Safe words” become meaningless if a person loses consciousness during strangulation. 
Cultural Catalysts: 
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Pornography: A significant driver, with millions of videos normalizing strangulation as a sexual act. 
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Mainstream Media: Shows like Euphoria and Idol depict choking during sex casually. 
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Social Media Memes: Normalize and trivialize strangulation, often presenting it humorously. 
The combined impact of these influences has blurred the line between consensual sexual exploration and dangerous behaviour. 

The Legal and Social Blind Spot

The “rough sex defense” has been used in multiple court cases to absolve perpetrators of responsibility, shifting blame onto the victim for allegedly consenting to a fatal act. 

It’s vital to recognize:
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Choking during sex can lead to fatal or life-altering injuries, even if the act appears consensual. Strangulation can cause severe and often invisible damage, including brain injuries, memory loss, stroke, or even delayed death days or weeks after the act. The lack of visible physical marks does not mean no harm was done. Survivors may experience confusion, dizziness, headaches, trouble concentrating, or emotional dysregulation as a result of brain damage caused by oxygen deprivation. 
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The line between consensual rough sex and abuse is not always clear. Power dynamics, coercion, and fear can cloud consent. If a partner ignores a safeword, continues after the other person says “stop,” or pressures someone into activities they’re uncomfortable with, this crosses into abusive behaviour. 
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Consent must be ongoing, enthusiastic, and freely given. Even if someone consents to choking during sex initially, they have the right to withdraw that consent at any time. Additionally, someone under the influence of drugs or alcohol may not be in a position to give proper consent, increasing the risks associated with choking. 
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There is a difference between fantasy and reality. Many portrayals of choking during sex in media or pornography fail to address the risks, portraying it as safe or glamorous. In reality, even brief strangulation can have severe medical consequences. 
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Survivors of strangulation may not recognize or disclose the severity of their injuries. Symptoms like memory problems, irritability, or trouble sleeping may be dismissed as stress or unrelated health issues. Medical attention is essential after any act of strangulation, whether consensual or not. 
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While Canada hasn’t explicitly banned the “rough sex defense,” legal precedents like R v. J.A. and legislative updates through Bill C-75 and Bill C-3 create a legal framework that reduces the likelihood of this defense succeeding. Strangulation is now recognized as a distinct and severe crime, and judicial and prosecutorial guidelines are increasingly focused on survivor protection and accountability for perpetrators. See the end of this article for more information on the “rough sex” defense and legal cases from Canada and other parts of the world. 
Recent Statistics Demonstrate how Strangulation is Increasing

Understanding the prevalence of strangulation in IPV is crucial for addressing it effectively. Recent studies highlight the alarming frequency and devastating consequences:

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68% of IPV survivors report experiencing strangulation at least once in their relationship.
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Survivors of strangulation are 750% more likely to be killed in subsequent violence.
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In Canada, 30-68% of domestic violence victims report strangulation as part of their abuse. 
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According to the Canadian Femicide Observatory, strangulation was identified as a leading cause of death in femicide cases involving intimate partners. 

Despite these staggering numbers, strangulation often goes unrecognized by healthcare systems, law enforcement, and even survivors themselves. The lack of visible injuries and general societal ignorance about the effects of non-fatal strangulation contribute to this crisis. 

Practical Tools and Resources for Survivors

Survivors of strangulation face unique barriers to care, healing, and justice. Fortunately, there are emerging resources that provide crucial support: 

Educational Tools for Survivors:
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www.BWSS.org and Ending Violence blog: A comprehensive platform offering shelter directories, articles, webinars, and survivor toolkits. 
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BWSS (Battered Women’s Support Services): Offers crisis support, trauma counseling, and advocacy for survivors. 
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Canadian Femicide Observatory for Justice and Accountability (CFOJA): Research and advocacy organization focusing on gender-based violence and femicide. 
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Women’s Shelters Canada: A nationwide organization providing support and advocacy for survivors across shelter networks. 
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Ending Violence Association of Canada (EVA Canada): Offers training, policy advocacy, and resources focused on ending gender-based violence. 
Healthcare Tools: 
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Symptom tracking worksheets to identify potential brain injury symptoms:
https://www.abitoolkit.ca/supporting-survivors/screening-for-brain-injury/
https://msktc.org/tbi/factsheets/cognitive-problems-after-traumatic-brain-injury

Final Thoughts: Naming the Violence, Breaking the Silence

Strangulation in IPV is not merely a “red flag”—it’s a flashing warning sign of imminent danger. Addressing this issue requires multi-level engagement:

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Healthcare Providers: Must be trained to recognize symptoms of strangulation and conduct thorough evaluations, including advanced imaging when necessary. 
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Law Enforcement: Should treat non-fatal strangulation with the seriousness it warrants, recognizing it as an indicator of escalating violence. 
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Advocates and Support Workers: Must integrate tools and education around brain injury and strangulation into their services. 
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Advocates and Support Workers: Must integrate tools and education around brain injury and strangulation into their services. 
Strangulation in intimate partner violence is a silencing tactic, a form of coercive control, and a profound violation of bodily autonomy. It is an act that demands attention—not just from survivors and advocates, but from every sector of society. 

Survivors often carry these invisible wounds in silence, misdiagnosed or dismissed by those who should support them. But with growing awareness, increased resources, and systems that prioritize survivor safety, healing is possible. It’s necessary to unpack how cultural narratives have shaped perceptions of strangulation, challenge harmful portrayals in media, and create space for honest conversations about consent, safety, and risk. 

If you or someone you know has experienced strangulation in an abusive relationship, remember:
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It is not your fault. 
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You deserve support and care. 
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Help is available. 
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BWSS – Crisis Line: 1-855-687-1868 
Let us name this violence, advocate for change, and commit to building systems that support survivors—not just in surviving, but in thriving. 

Sources and Legal Cases

Notable legal cases and media reports where the “rough sex defense” was used to absolve perpetrators of responsibility: 
1. Grace Millane Case (New Zealand, 2018)
Details: British backpacker Grace Millane was murdered by a man she met on a dating app while traveling in New Zealand. The perpetrator claimed that her death resulted from consensual rough sex. 

Outcome: The jury rejected the defense, and the perpetrator was convicted of murder. 

Source: BBC News – Grace Millane Case 

2. Sam Pybus Case (UK, 2021)
Details: Sam Pybus claimed that his partner’s death occurred accidentally during consensual strangulation. 

Outcome: He was sentenced to just under five years in prison, a decision criticized for its leniency. 

Source: The Guardian – Sam Pybus Sentencing 

3. Natalie Connolly Case (UK, 2016)
Details: Natalie Connolly died after sustaining more than 40 injuries, including a fatal head wound. Her partner, John Broadhurst, claimed the injuries were a result of consensual rough sex. 

Outcome: He was convicted of manslaughter, not murder, and sentenced to three years and eight months in prison. 

Source: BBC News – Natalie Connolly Case 

4. Lara Prychodko Case (USA, 2018)
Details: Lara Prychodko was found dead at the bottom of a trash chute in her Manhattan apartment building. Her husband attempted to use a narrative suggesting consensual rough sex gone wrong to explain her death. 

Outcome: The case remains unresolved, and suspicions of foul play persist. 

Source: New York Post – Lara Prychodko Case 

5. Sophie Moss Case (UK, 2021)
Details: Sophie Moss died during an act of strangulation described as consensual rough sex by the perpetrator, Sam Pybus. 

Outcome: The perpetrator’s sentence sparked public outrage due to its perceived leniency. 

Source: BBC News – Sophie Moss Case 

6. Alexandra Harlequin Case (UK, 2019)
Details: A man claimed that injuries leading to Alexandra Harlequin’s death were accidental and occurred during rough sex. 

Outcome: The jury rejected the rough sex defense, and he was convicted of murder. 

Source: The Independent – Alexandra Harlequin Case 

7. Legislative Changes in Response:
In 2021, the UK government banned the “rough sex defense” under the Domestic Abuse Act, making it illegal for defendants to claim consensual rough sex as a defense for serious injury or death. 

Source: UK Parliament – Domestic Abuse Act 2021 

Notable legal cases from Canada
1. Bill C-75 (2019)
Overview: This legislation made strangulation, choking, and suffocation a standalone criminal offense under the Criminal Code of Canada (Section 267(c)). 

Key Changes: Strangulation is now considered an indictable offense, carrying a maximum sentence of up to 10 years in prison. 

Significance: Recognizes the lethality of strangulation in IPV cases and makes it easier to prosecute as a separate charge. 

Source: Government of Canada – Bill C-75 

2. R v. J.A. (2011) - Supreme Court Decision
Overview: In this landmark decision, the Supreme Court of Canada ruled that consent cannot be given in advance for acts that result in unconsciousness. 

Key Takeaway: The court emphasized that unconscious individuals cannot consent to sexual activity, including acts involving strangulation or choking. 

Significance: This decision limits the scope of the “rough sex defense” in Canadian courts. 

Source: Supreme Court of Canada – R v. J.A. 

3. Bill C-3 (2021)
Overview: Requires judges to undergo mandatory training on sexual assault law, including issues related to consent and IPV. 

Key Takeaway: Ensures judges are well-informed on the nuances of consent, strangulation, and the myths surrounding IPV cases. 

Significance: Reduces reliance on misconceptions or outdated beliefs in IPV cases. 

Source: Government of Canada – Bill C-3 

4. Canadian Guidelines for Police and Prosecutors on IPV and Strangulation (2021)
Overview: Developed guidelines to improve investigations and prosecutions in cases involving strangulation and IPV. 

Key Focus: Training officers to recognize strangulation injuries, improve evidence collection, and ensure survivors are supported during legal processes. 

Significance: Aims to reduce reliance on subjective claims of “consent” in cases of IPV-related strangulation. 

Source: Canadian Resource Centre for Victims of Crime 

Statistics

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“Survivors of strangulation are 750% more likely to be killed by their abuser in subsequent attacks” –This statistic comes from a study published in the Journal of Emergency Medicine titled “Strangulation and Intimate Partner Violence: A Deadly Combination” (2017) by Dr. Nancy Glass and Dr. Gael Strack. The study found that survivors of non-fatal strangulation are up to 7.5 times more likely to become victims of femicide by the same perpetrator. 
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“68% of IPV survivors report experiencing strangulation at least once in their relationship.” Source: Glass, N., et al. (2008). Non-fatal strangulation is an important risk factor for homicide of women. Journal of Emergency Medicine. 
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“Survivors of strangulation are 750% more likely to be killed in subsequent violence.” Source: Glass, N., et al. (2008). Non-fatal strangulation is an important risk factor for homicide of women. Journal of Emergency Medicine. 
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“In Canada, 30-68% of domestic violence victims report strangulation as part of their abuse.” Source Canadian Domestic Homicide Prevention Initiative (CDHPI). Understanding Strangulation in Domestic Violence Cases. 
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“According to the Canadian Femicide Observatory, strangulation was identified as a leading cause of death in femicide cases involving intimate partners.” Source: Canadian Femicide Observatory for Justice and Accountability (CFOJA). Annual Report on Femicide in Canada. 
As an organization dedicated to ending violence in all its forms, BWSS stands in solidarity with victims and survivors. For resources on safety, accessing support, and taking action against gender-based violence, visit our website.

You are not alone.

If you or someone you love is in need of support, please contact the Battered Women’s Support Services Crisis Line:

Call toll-free: 1-855-687-1868 Metro Vancouver: 604-687-1867 Email: EndingViolence@bwss.org

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