Erotic Asphyxia: Dangerous Misinformation and Poor-Quality Content on YouTube.

Authors

• Sebastian Loonen, Michigan State University College of Human Medicine Medical Student
• Ritisha Ghosh, Michigan State University College of Human Medicine Medical Student
• Andrea Ramirez, Michigan State University College of Human Medicine Medical Student
• Kimberly Forman, Michigan State University College of Human Medicine Medical Student
• Gracie Meijer
• Reed Stevens, Michigan State University College of Human Medicine Medical Student
• Nicholas Castle, Michigan State University College of Human Medicine Medical Student
• Matt Singh, Corewell Health West
• Tom Peterson, Corewell Health West
• Jeffrey S. Jones, Corewell Health West

Document Type

Article

Publication Date

7-2026

Publication Title

American Journal of Emergency Medicine

Abstract

STUDY OBJECTIVE: Erotic asphyxia (sexual choking or breath-control play) is a high-risk practice associated with syncope, hypoxic brain injury, and death, yet increasingly normalized in online sexual content. We sought to characterize how erotic asphyxia is portrayed on YouTube, focusing on video quality, safety messaging, and misinformation.

METHODS: We performed a retrospective content analysis of YouTube videos identified using 16 search terms related to erotic asphyxia. Eligible videos were English-language, had primary erotic asphyxia content, and were viewed between April and November 2025. Trained coders used a standardized abstraction form to collect data on video characteristics, participant demographics, choking techniques, safety messages, and misinformation. Content quality was assessed using the Global Quality Score (GQS), reliability using a modified DISCERN tool, and interrater reliability using Cohen's kappa.

RESULTS: A total of 103 videos met inclusion criteria, with a mean duration of 3.9 ± 2.8 min and a cumulative 3.4 million views (mean 34,702 per video). Content depicted consensual partner choking in 67.0%, nonconsensual choking in 11.7%, and autoerotic asphyxia in 21.3%. Most identifiable participants appeared female (63.8%), Caucasian (59.4%), and aged 20-25 years (51.1%). Thirteen distinct choking or suffocation techniques were described. The median GQS was 2 (interquartile range [IQR] 2-3), and the median modified DISCERN reliability score was 1 (IQR 1-2), indicating low quality and very poor reliability. Only 4 videos (3.9%) included trigger warnings, and 74 (71.9%) contained clear misinformation. Interrater reliability was substantial (κ = 0.79).

CONCLUSIONS: Widely viewed erotic asphyxia content on YouTube is low quality, unreliable, and often misleading, highlighting the need for emergency physicians to address sexual choking directly in risk-reduction counseling and for platform-level harm-reduction measures to prevent serious injury and death.

Volume

109

First Page

204

Last Page

208

Recommended Citation

Loonen S, Ghosh R, Ramirez A, Forman K, Meijer G, Stevens R, et al. [Castle N, Singh M, Peterson T, Jones JS]. Erotic asphyxia: Dangerous misinformation and poor-quality content on YouTube. The American journal of emergency medicine. 2026;109:204-8. doi: 10.1016/j.ajem.2026.07.033. PMID: 42497600.

DOI

10.1016/j.ajem.2026.07.033

ISSN

1532-8171

PubMed ID

42497600