Neurological effects of sexual strangulation
Examining the neurological correlates of emerging sexual behaviors (sexual choking/strangulation), which has become increasingly prevalent among young adults and disproportionately affects women.
Sexual strangulation, also referred to as sexual choking, is a prevalent sexual behavior that commonly occurs during consensual, partnered sexual activity. This practice involves one partner applying pressure to the other’s neck using their hands, a limb, or a ligature, with the intent of enhancing sexual arousal or pleasure. Studies indicate that up to 58% of college-aged women have experienced sexual strangulation, primarily in consensual contexts, with 33% of women and 6% of men reporting more than five occurrences.(Herbenick, Fu et al. 2022 J Sex Marital Ther) This research topic, including public awareness, prevalence, perception, and behavioral characteristics has been spearheaded by Dr. Debby Herbenick at IU SPH. Kei Kawata has utmost respect for Dr. Herbenick’s leadership in this research. In December 2020, Kawata met with Dr. Herbenick and learned the increasing prevalence of sexual choking across multiple generations and diverse cultural contexts. Her research, supported by ongoing R01 funding and pilot studies, has been instrumental in uncovering key insights into this behavior. Partnering with Dr. Herbenick, the research team has begun exploring the potential neurological effects associated with sexual strangulation.
In our pilot study, we recruited young adult females with >4 strangulation during sex in the past 30 days (N=20) and females with no lifetime sexual strangulation experience (N=22). Our pilot study found that young adult females who frequently experience sexual strangulation, compared to controls, showed (1) cortical hypertrophy and reduced gyrification,(Hou, Huibregtse et al. 2023 Brain Behav) (2) interhemispheric imbalance in neural activation,(Hou, Huibregtse et al. 2023 J Neurotrauma) (3) recruitment of additional neural resources during fMRI memory tasks,(Huibregtse, Alexander et al. 2022 Front Behav Neurosci) and (4) elevated biomarkers of astrocyte activation and inflammation (Fig 6).(Alexander, Huibregtse et al. 2021 medRxiv)
While our findings were striking, the scientific and public responses to our research have been equally remarkable. For instance, our initial publication detailing fMRI findings has been viewed and downloaded 65,296 times since June 2022, placing it in the top 2% of all Frontiers articles. It has also achieved an Altmetric score of 186, ranking in the top 5% of all research outputs in terms of media coverage(Huibregtse, Alexander et al. 2022 Front Behav Neurosci). Similar exposure patterns were observed in our subsequent publications in seminal journals (Journal of Neurotrauma and Brain & Behavior) (Hou, Huibregtse et al. 2023 J Neurotrauma, Hou, Huibregtse et al. 2023 Brain Behav). Public concern was evident when we were interviewed by, and our research was highlighted in the New York Times,(Orenstein 2024 The New York Times) which generated 1,436 comments within 24 hours, mostly expressing concern. Additionally, I have been invited to speak at ISSWHS annual meeting and IU Health-School of Nursing joint workshop regarding forensic nursing on TBI and strangulation.