Within the vast array of fetishes and BDSM activities, there are precious few as dangerous as breath play. To be perfectly blunt there is NO safe way to participate in breath play. This is the only activity, that I am aware of, that strictly violates the Safe Sane Consensual regiment. All the instructional articles about breath play state basically the same thing, it can be done with a moderate amount of risk. Nowhere, in over 140 pages of information did I find one single reference to being able to participate in breath play safely.  

Most deaths happen when people try it alone. If you, or someone you know, is drawn to it, read the risks below and talk to someone you trust or a kink-aware professional.

Autoerotic Asphyxia

Autoerotic Asphyxia, sometimes known as sexual hanging, is the practice of inducing cerebral hypoxia while the individual masturbates to orgasm.

The most common participants in this practice are adolescent and young adult males, ranging in age from 15 to 29. Autoerotic Asphyxia counts for 6.5% of all the self-induced adolescent deaths and 31% of all adolescent hanging deaths within the past 10 years. Since in the majority of such deaths it is a family member that finds the individual, the “scene of the crime” is frequently altered to cover up the sexual nature of the death. Due to this fact and since the only ones that get reported are the individuals that die… the true number of individuals that participate in this activity may never be known. Deaths related to autoerotic asphyxia have been reported in victims as young as 9 and as old as 80 yrs, with 71% of the individuals being less than 30 yrs old.

The most common form of Autoerotic Asphyxia is constriction of the neck, or hanging. This form decreases the amount of blood flow to the brain leading to cerebral hypoxia. The resulting effect is lightheadedness, exhilaration, almost giddiness; these effects along with the shear excitement of the moment multiply the effect of masturbation. The risk comes from the fact that the reduced blood flow to the brain also will create disorientation, weakness, loss of coordination and drowsiness. Hence and individual may loose the ability to release themselves from their self-induced prison, and the end result is simply put… death.

There have been documented cases of Autoerotic Asphyxia since the early 1600’s. Oddly enough it was once used as a treatment for erectile dysfunction and impotency. Some documentation noted that a hanged man would sometimes get an erection even ejaculate while being hanged, this indeed may have been the focus point for the interest in the odd practice of asphyxia during sexual actives. Many different cultures have a history of sexual asphyxia, from the Orient, to the South America, from the Celts to the Native Americans; this dangerous practice has held the imagination of many individuals for centuries.

The general taboo of this deadly practice has allured thrill seekers as well as the curious for decades. The dramatic effects of this unusual decadence kept individuals trapped within the weavings of its web. The sudden stop at the end of this ride is what keeps others at bay, and leery of ridding this deadly roller coaster.

Where The Danger Lies

Some people have asked what the real danger in breath play is. Simple. Death. Which does have a tendency to be sort of permanent, and in my honest opinion it can really mess up an otherwise fabulous evening, and it is damn inconvenient to boot.

One statement I have heard is that “breath play is ok as long as you don’t do it until the slave/submissive lapses into unconsciousness.” This statement is disturbing for several reasons. First, there is no medically valid way to know exactly when an individual will become unconscious. Second, when someone looses consciousness it is not an end it is merely a symptom, ranging from mere oxygen depletion to cardiac arrest. Third, if the breath play involves choking then damage to the larynx can occur at any time and is an extremely serious injury that would need medical attention immediately.

Breath play is dangerous whether the slave/sub loses consciousness or not, although the risk of permanent damage or even death is multiplied exponentially when it is taken to that extreme.

The Risks

Choking

• • Anytime there is pressure put on the neck,  you run the risk of causing severe and perhaps permanent damage to the carotid arteries. This may lead to numbness, weakness, dizziness and difficulties speaking.
  • The larynx is incredibly fragile and easily injured; pressure to the larynx should be avoided at all costs. Any injury, even a minor injury to the larynx, may cause swelling of the airways leading to coughing, choking and inability to speak, and possibly the inability to breath.
  • While choking someone the airway may become obstructed by the tongue. Swelling of the tongue and lips is quite normal when someone is being choked. Unfortunately it is impossible to tell just how much swelling is going to occur, since each individual is different, it is also impossible to tell when the swelling will reach that dangerous level.
  • The reduction of blood flow to the brain tissues during choking may cause Ischemia. Since blood contains both oxygen and glucose, when ischemia occurs, it can lead to hypoxia which is a reduction of oxygen to the brain, as well as hypoglycemia which is low blood glucose level. Prolonged hypoxia – ischemia is associated with Ischemic Attack (stoke), Transient, Brain Infarction, Brain Edema, Coma and other conditions.
  • Another associated physical problem is cerebral anoxia. Hypoxia is the reduced oxygen flow to the brain; anoxia is the total absence of oxygen within the brain tissue. If oxygen is prevented from reaching the tissues for too long, tissue death can occur. If severe, it can cause irreversible brain damage. Less severe cases can cause sensory distortions and hallucinations. Hence pressure on the carotid arteries can lead to ischemia, which is directly associated with hypoxia and if the restriction of oxygen to the brain continues for more than three to five minutes then cerebral anoxia is a very real possibility. If the circulation to the brain is insufficient for more than three to five minutes the consequent damage can lead to death even days or weeks after the initial incident.
  • The lack of blood flow to the brain may also force the heart to beat more rapidly or beat erratically in an effort to increase the level of blood to the brain; hence, heart arrhythmia.
  • Oxygen deprivation of the heart or Anoxaemia will trigger what is called premature ventricular contractions or PVC’s for short. Basically the lower the heart gets on oxygen the more PVC’s it generated and the more vulnerable to their effect the heart will become, thus this will increase the possibility of ventricular fibrillation and the risk of its causing a cardiac arrest. There is no way to know when this will happen to a particular person, during a particular session, not even with the most advanced cardiac monitors available.

Bags and Gags

Placing a barrier of some form over the slave/sub’s mouth and nose during play is another popular method of breath play. The use of a plastic bag is probably the most popular barrier used, followed closely by tape and barrier gags. This form of breath play has it’s own unique set of problems to add to the above list.

• • Sometimes when an individual begins to choke they will vomit, if the individual is unable to expel the vomitus, mucus or saliva they may inhale this material into his or her lungs. Normally a person will not actually draw the materials completely into their lungs, but if there is a barrier in place the chances of this occurring is raised exponentially. Even removal of the barrier immediately will not prevent damage to the respiratory system. Aspiration may lead to unconsciousness, cyanosis, cardiac arrest and the cessation of breathing.
  • Another thing to remember is that when you use tape, the most common being duck tape, there is a very real possibility of an allergic reaction. This may cause swelling of the air passageways, anaphylactic shock, unconsciousness, and again even death, depending on the degree of allergic reaction.

Additional Risks

Any form of breath play has some basic health risks. These risks depend on the age, and health of the slave/sub, it also depends on the specific type of breath play you are participating in. No list can be truly complete because of all the possible pre-existing conditions that may be present, but I believe this will give you some idea of the dangerous nature of breath play.

The list goes on; while this list only has the most dramatic possibilities they are still very real possibilities.

The cumulative damage from repeated breath play is still in question, researchers have experimented on a variety of animals but the information is still pretty sketchy. One fact is quite certain, reduced blood flow and in turn reduced oxygen to the brain kills brain cells. Once a brain cell is damaged it cannot be repaired or replaced, this is one of the few cells in the human body that does not regenerate.

Who tends to be injured or who has the highest mortality rate in reference to lack of oxygen during breath play.

• • Men over the age of 40
  • People with a history of seizure disorder
  • People suffering from mental illness, especially manic-depressives in the manic phase
  • Anyone under the influence of drugs or alcohol (even prescription drugs)
  • Anyone taking any form of digitalis or tricyclic antidepressants
  • Anyone with a history of respiratory, heart, or blood pressure problems
  • People who are overweight (especially if they have high cholesterol levels)
  • Anyone that has a cold or other respiratory problems at the time of the play cession.
  • Anyone that is diabetic or hypoglycemic.
  • Realistically: Everyone else

Safe, Sane and Consensual…. Is this play safe? No. There is no safe way to do breath play. Is this play sane?  No. Since you cannot do this play safely and cannot predict the level of damage done there is no true way to intelligently say it is sane. Is this play consensual? Laws have proven time and time again that consent to cause severe injury or death is not consent. Without the ability to fully understand the risks, and possible long term dangers with this type of play then you cannot give informed consent, hence it cannot be consensual.

The thrill is exhilarating; the moment is a wondrous flow of emotion, adrenalin, and anticipation. But no matter how spectacular the effects of the moment, no matter how high someone can get or the feeling of trust that must be present, nothing is worth the loneliness if something goes wrong.

So why do people do it?

Like many other kinks and sexual curiosities, breath play is of interest to people for many different reasons. Here are three common ones.

Physiological

During breath play, you or your partner restrict oxygen to your brain. This is step one of the process. When your oxygen levels are low, you may feel lightheaded or dizzy. But when the pressure is released and oxygen and blood begin to flow again, you may feel another type of rush, caused by a release of dopamine, serotonin, and endorphins that can cause head-spinning exhilaration.

Psychological

Some breath play fans like the power play element of the arrangement. As the person in charge, you can choke or suffocate your partner. Or as the submissive, you can be controlled. Your partner is dominant and guiding the events. This dynamic provides a second layer of sexual arousal for some people.

Physical

In the immediate aftermath of choking, suffocating, or strangling, your body may confuse the rush of endorphins and hormones as a positive, pleasurable thing. In reality, those hormones were caused by your body’s protective reaction. But in the crossfire of emotions and pleasure, these sensations may feel more like “pain is pleasure” rather than warning signals from your brain and body.

If something goes wrong

If someone loses consciousness, isn't breathing normally, has a seizure, or has been choked or strangled, call your local emergency number straight away, even if they seem to recover. Injuries to the throat and brain can get worse over the following hours and days. Knowing CPR can save a life.

For many people it's the power exchange, not the loss of oxygen, that they're really after. The alternatives below can give that without the same risk.

Alternatives To Breath Play

If breath play comes with too many risks for your comfort, feels too intense, or it isn’t something you enjoy, you can still enjoy other forms of stimulation that perhaps satisfy a different need. There are many different kinks to explore, and it is okay if breath play doesn’t do it for you! If still interested in the idea of breath play in a less extreme form, I have a couple of suggestions for you:

• Simply having your partner’s hand around your throat with no choking can be incredibly powerful and arousing.
• Some couples may prefer to use different kinds of gags, such as ball gags, to restrict normal breathing. These do not restrict the airways, but are a method of suppressing speech and can trigger the same “fight or flight” reflex as choking and also be very exciting!

This is Edge Play

When all is said and done, breath play is one of the most dangerous forms of edge play, and many things can go wrong. Know the risks, know the dangers, and know the alternatives, and make an informed decision that is right for you.