---
title: "Breath play: breath control in BDSM and its risks"
description: "Breath play means breath control in BDSM. What happens in the neck, why the scene stopped calling it safe and what the law says."
url: https://gay-blog.tomrockets.com/en/breathplay-bdsm/
date_published: 2023-02-23
date_modified: 2026-07-25
---
# Breath play: breath control in BDSM and its risks

## Inhaltsverzeichnis

- [Why do we practise breath play?](#h-why-do-we-practise-breathplay)
- [How dangerous breath play really is](#h-how-dangerous-breath-play-really-is)
- [Safety during breath play: what to look out for](#h-safety-during-breathplay-what-to-look-out-for)
- [Different forms of breath play](#h-different-forms-of-breathplay)
- [Extreme forms of breath play?](#h-extreme-forms-of-breathplay)
- [Lower-risk alternatives](#h-lower-risk-alternatives)
- [Legal perspective](#h-legal-perspective)

Breath play, written as one word breathplay in most search queries and also known as breath control, refers to playing with the breath in [BDSM](https://gay-blog.tomrockets.com/en/bdsm-fetish-kink/ "BDSM") ([Bondage](https://gay-blog.tomrockets.com/en/penis-bondage-positions/ "Bondage"), Discipline, Dominance, Submission, [Sadism](https://gay-blog.tomrockets.com/en/sadism-and-bdsm/ "Sadism"), [Masochism](https://gay-blog.tomrockets.com/en/bdsm-masochism/ "Masochism")). The submissive partner’s breathing is restricted, the dominant partner controls it. For many the appeal lies in handing over control completely. The drop in oxygen produces a state somewhere between euphoria and fear.

This type of play differs from every other BDSM practice in one respect. Technique can shrink its risk, but nothing dissolves it. The clinical term for the [fetish](https://gay-blog.tomrockets.com/en/vore-fetish/ "fetish") is asphyxiophilia, used mainly in psychology and in legal contexts. The scene has been moving away from the idea of a safe execution since the 1990s.

## Why do we practise breath play?

Breathplay serves 2 different motives. The dominant partner seeks control over another person’s breathing, the submissive partner seeks to hand that control over. The resulting power gap is starker than in almost any other practice. A [power imbalance in BDSM](https://gay-blog.tomrockets.com/en/bdsm-master-sub/) otherwise rests on negotiation and trust. Here the stake shifts to physical safety.

On the submissive side, 4 physical effects combine. As the oxygen level in the blood falls, carbon dioxide rises and the body switches into a stress response. Dizziness, a rushing sound in the ears, a feeling of warmth and a raised heart rate are part of it. Once the restriction ends, [gagging](https://gay-blog.tomrockets.com/en/gagging-facts/ "gagging"), coughing and tears often follow. Many find precisely this sense of release appealing.

You will frequently read that oxygen deprivation releases adrenaline and endorphins and thereby creates an intoxicated state. The first half holds up. The release of adrenaline and related stress hormones under oxygen deprivation is well documented physiologically. The endorphin half looks different. 3 human studies found unchanged endorphin levels under oxygen deprivation, while raised levels showed up mainly in animal experiments. The related explanation for the runner’s high is considered outdated too, with newer research pointing to endocannabinoids rather than endorphins. So the altered state itself is real and described in the literature, while its usual explanation is more thinly evidenced than commonly claimed.

The psychological side weighs just as heavily. Being at someone’s mercy is a particularly intense form of submission and creates a strong bond with the dominant partner. Some reach a trance state similar to [subspace](https://gay-blog.tomrockets.com/en/subspace-bdsm-achieving/). Breathing in and out deeply together after the session settles the circulation. This practice equally triggers a feeling of constriction, panic and strong feelings of dependence. That makes [aftercare](https://gay-blog.tomrockets.com/en/aftercare-why-it-is-important/) more important here than in most other types of play.

## How dangerous breath play really is

The central statement on this subject comes from Jay Wiseman, author of the BDSM standard work „SM 101“ and a trained emergency medical technician. In his essay „The Medical Realities of Breath Control Play“ from 1997 he writes: „I know of no way whatsoever that either suffocation or strangulation can be done in a way that does not intrinsically put the recipient at risk of cardiac arrest.“ In the same essay he records that he looked for an execution without danger to life and found none.

That position has prevailed in the scene. Breathplay is now largely filed under Risk Aware Consensual [Kink](https://gay-blog.tomrockets.com/en/bdsm-fetish-kink/fetishes-kinks/ "Kink") ([RACK](https://gay-blog.tomrockets.com/en/safety-philosophy-rack/)) and explicitly outside Safe, Sane, Consensual (SSC). The reason is a matter of logic: SSC presupposes safety, and that precondition is missing here. This puts breath play in the same category as other [edge play](https://gay-blog.tomrockets.com/en/edgeplay-what-is-that/). The residual risk is carried knowingly there rather than removed.

Research by Debby Herbenick and colleagues at Indiana University shows how widespread the practice is. The sample covered college students in the United States. In figures published in 2025, 45 % of the women surveyed, 25 % of the men and 61 % of gender-diverse participants reported having been choked during sex at least once. Earlier waves from the same group produce different figures, but the order of magnitude holds.

### What happens in the neck

The neck carries 5 delicate structures within a very small space: the carotid arteries, the jugular veins, the trachea, the larynx and the vagus nerve. Forensic literature gives orders of magnitude for the force involved. Roughly 2 kilograms is enough to occlude the jugular veins. The carotid arteries take 2.5 to 10 kilograms, the trachea around 15 kilograms. These figures come from a chain of citations that is hard to trace to its origin. Their ranking, however, is reproduced consistently across the literature.

From that follows the decisive point. The carotid arteries close well below the force needed to compress the trachea. Anyone who believes they are choking gently may already be closing off the carotid arteries. With effective carotid compression, unconsciousness typically sets in after 7 to 14 seconds. Pressure on the carotid arteries and the vagus nerve also triggers the carotid sinus reflex. That reflex lowers the heart rate and can lead to cardiac arrest. It is what makes the practice unpredictable, because it depends on individual reflex sensitivity rather than on the force applied.

Pressure on the trachea brings different [injuries](https://gay-blog.tomrockets.com/en/fisting-injuries/ "injuries") to the fore. The trachea consists of cartilage rings and ligaments, and the larynx can be crushed or fractured. Even light pressure can cause hoarseness, coughing and difficulty swallowing lasting several days. A fractured larynx can make an emergency airway procedure necessary.

### Why passing out is not a success

Some accounts treat fainting as the peak of the experience. Medically it is a protective response to an acutely threatened oxygen supply to the brain. Anyone who loses consciousness has already passed the point at which the course of events can still be steered. From that moment on, the other person’s reaction alone determines the outcome.

Then there are consequences that only surface later. Forensic case series document tears in the carotid artery following strangulation, known medically as carotid dissection. Some only become apparent days to months afterwards through a stroke. Systematic frequency data does not exist so far, while the cases themselves are well documented. Pinpoint bleeding in the eyes and face, known as petechiae, counts as a classic sign that strangulation took place.

Whether repeated choking leaves long-term brain damage is currently an open question. A review article in Nature Reviews Neurology explicitly named it a research gap in 2024. The case reports available come from a domestic violence context and transfer poorly to consensual play.

### Doing it alone

**Never perform breath restriction alone or on yourself.** This is the one rule on the subject that holds without qualification. Autoerotic asphyxiation accounts for the largest share of documented deaths. The reason lies in the mechanics: once unconsciousness sets in, any means of releasing the pressure is gone. With constructions involving ligatures, bags or straps, the pressure keeps working after consciousness is lost, and no one is there to intervene.

The figures deserve a closer look, because an outdated one is in circulation. The frequently quoted 250 to 1,000 deaths per year in the USA come from the 1983 book „Autoerotic Fatalities“. Its authors extrapolated British and Canadian data onto the US population. Forensic pathologist Anny Sauvageau reviewed that figure in 2012. Her basis was 38 documented cases in the Canadian province of Alberta between 1985 and 2009. She arrived at around 0.5 deaths per 1 million inhabitants per year, extrapolating to 62 to 156 cases annually in the USA. Her reason for the review: the field had kept quoting numbers from a book without checking them.

Even the lower estimate remains a floor, since a share of cases is classified as suicide or [accident](https://gay-blog.tomrockets.com/en/anal-sex-accident/ "accident").

## Safety during breath play: what to look out for

The starting position is this: risk reduction is achievable, safety is not. Anyone who practises breathplay carries a residual risk that technique can shrink but cannot dissolve. The points below lower the risk, but they do not replace the decision against the practice.

Before the session, experience level, pre-existing conditions and medication need to be discussed openly. Cardiovascular disease, epilepsy, asthma and blood thinners shift the risk considerably. Alcohol, [poppers](https://gay-blog.tomrockets.com/en/poppers-en/ "poppers") and other substances shift it too, because they affect perception and circulation. Anyone who has defined their own [boundaries in BDSM](https://gay-blog.tomrockets.com/en/bdsm-limit-boundaries/) clearly brings the most important groundwork with them.

Three rules apply during the session. Short intervals rather than long phases. Uninterrupted eye contact with the submissive partner’s face. And an immediate stop at any sign of blue discolouration, cramping or disorientation. The dominant partner carries the entire responsibility here, because beyond a certain point the submissive partner loses judgement over their own state. The usual [red flags in BDSM](https://gay-blog.tomrockets.com/en/red-flags-bdsm/) weigh double with this practice. Anyone applying pressure, overriding agreements or dominating without experience is the wrong partner for it.

That brings a limitation which matters less in other types of play. At a sex party, in a [darkroom](https://gay-blog.tomrockets.com/en/darkroom-etiquette/ "darkroom") or on a first hookup from an app, the precondition is missing. The entire emergency chain depends on the other person reading your state correctly and acting rather than disappearing. With a stranger you know neither.

For emergencies, keep a phone within reach. The emergency number is 999 in the United Kingdom, 911 in the United States and 112 across the European Union. **If unconsciousness occurs, call the emergency services immediately, whether or not breathing returns.** Until help arrives, place the person in the recovery position and check their breathing. If breathing stops, begin chest compressions. Even if consciousness returns within seconds, the incident still belongs in front of a doctor, because injuries to the neck vessels surface days later.

### Safety mechanisms during breath play

A spoken [safeword](https://gay-blog.tomrockets.com/en/safeword-during-bdsm/) only works to a limited extent in this type of play, because the mouth or airway is occupied. A non-verbal signal is needed instead, often called a safe sign:

- Tapping out as in martial arts: light taps with the hand or leg against the controlling person’s body.
- An object that makes itself noticed when dropped: a bell or a squeaky toy works well, because losing grip strength sets it off by itself.
- An outstretched limb: if the raised arm drops or body contact is lost, that counts as a stop.

The second and third signals have an advantage over tapping out: they work passively. Losing strength triggers them automatically instead of requiring an active movement. Practise both signals in a situation without arousal so they hold up when it matters.

## Different forms of breath play

Breath control covers 3 levels: setting the rhythm, making breathing harder and shutting it off. The transition between these levels is gradual, and the risk rises with it. The forms below are ordered by risk. They start with the harmless variant and end with those that regularly cause deaths.

### Breath control without additional equipment

The lowest-risk form works without any physical interference at all. Breath control by command means the dominant partner sets the pace: breathing together, deliberately deep or deliberately shallow breaths, brief holds on cue. The submissive partner keeps full control over their body throughout, and the power gap comes from the instruction. Meditation and tantra use this shared breathing as a means of connection.

Variations combined with other types of play stay on this level as well. A vibrator stays on the genitals for as long as the breath is held. A candle in front of the face is meant to keep burning.

Rebreathing sits one level higher: some enjoy inhaling the dominant partner’s used air, either directly or through a balloon. This variant is often combined with the [smoking fetish](https://gay-blog.tomrockets.com/en/smoking-fetish/ "smoking fetish"). Despite the harmless impression it belongs in the second category, because rebreathing used air genuinely lowers oxygen and raises carbon dioxide.

### Breath play with suitable equipment

Tight clothing restricts lung volume without closing the airway. Corsets are common for this, as is wrapping the upper body in fabric or [bondage tape](https://gay-blog.tomrockets.com/en/bondage-tape/). How far the volume drops depends on the height and tightness of the wrap, and both are hard to judge from the outside. The basic [bondage](https://gay-blog.tomrockets.com/en/bondage/) rule applies here too: whatever you put on has to come off within seconds, so keep safety shears within reach.

Collars belong in a category of their own. A [BDSM collar](https://gay-blog.tomrockets.com/en/bdsm-collar/) is a symbol of belonging and is worn loosely. The moment it is pulled or sits tight, it acts as a choking instrument, with every risk described in the section above.

When the mouth is closed with gags, tape or inflatable gags, nasal breathing is the only remaining route. A blocked nose, a cold or an allergic reaction therefore turn a gag into a serious problem. Watch the saliva as well, since swallowing while lying on the back with an open mouth is difficult.

### Smothering

[Covering](https://gay-blog.tomrockets.com/en/bdsm-covern/ "Covering") mouth and nose with a hand, the thighs or the chest is the most widespread form of breath play of all, because it needs no equipment. The neck stays untouched, so the injury risks of choking fall away. What remains is the oxygen deprivation itself, including unconsciousness if it lasts too long. Where body weight is added, as in sitting on someone’s face, restricted movement of the ribcage comes on top.

### Choking

Choking is the best-known form of breath play and at the same time the one where the idea of a correct technique holds on most stubbornly. A distinction is made between pressure on the trachea (air choke) and pressure on the carotid arteries (blood choke). In practice mixed forms occur, which is why the effect in any individual case is hard to predict.

Grips taken from martial arts such as the rear naked choke are considered more controlled in the scene, because the force spreads across the arm instead of acting through fingertips at single points. Those grips still expose the person to the risk of cardiac arrest, and in martial arts they are trained under supervision with an immediate stop available. A learned grip shifts the risk, it does not remove it.

What is established: pressure from the front onto the trachea causes injuries and does the greatest damage. Using your own body weight to increase pressure on someone lying on their back is the most dangerous variant of all, because losing balance raises the force in an uncontrolled way. And the longer the pressure lasts, the worse the outcome, regardless of technique.

## Extreme forms of breath play?

The 4 practices below carry a considerably higher risk than everything named so far: plastic bags, masks, waterboarding and unconsciousness play. [Films](https://gay-blog.tomrockets.com/en/gay-films/ "Films") and pornography have made them familiar, their actual risks far less so.

### Plastic bags or cling film

A bag over the head closes mouth and nose at once, and the visual and psychological impression is intense accordingly. The core problem is dosage. From the outside there is barely any way to judge how much air is left, and oxygen and carbon dioxide levels move fast inside a closed volume. Once the bag is taped shut or wrapped with cling film, opening it in an emergency takes longer than the remaining time allows. If [vomiting](https://gay-blog.tomrockets.com/en/blowjob-vomiting/ "vomiting") is added, the situation becomes life-threatening. This is one of the variants that turns up regularly in forensic statistics.

### Masks

Latex and gas masks are widespread in the fetish scene, where look, feel and material usually count for more than the breath restriction. The [latex fetish](https://gay-blog.tomrockets.com/en/latex-fetish/) lives largely off that material sensation. Hoses and openings allow the air supply to be dosed, which makes these masks look more controllable than a bag at first glance.

The real problem lies elsewhere. Under a full mask, [facial](https://gay-blog.tomrockets.com/en/fancy-a-self-facial/ "facial") expression and skin colour stay hidden, so exactly those warning signs that reveal someone’s state fall away. Anyone using masks therefore needs all the more reliable non-verbal signals and a fastening that opens with one hand.

### Waterboarding

Waterboarding is a torture method and is used as one. The procedure triggers a drowning reflex that cannot be suppressed by will. Alongside the acute danger of water entering the lungs, the psychological consequences stand in the foreground: panic attacks and lasting trauma are documented reactions.

### Unconsciousness play

Some deliberately seek the state up to the point of fainting. As described above, fainting is an emergency response of the body to an acute threat to its oxygen supply. Set as the goal of a session, this practice moves the entire outcome onto a point that no agreement can reach any more.

## Lower-risk alternatives

The psychological core of breath play is the surrender of control. Oxygen deprivation is the route there, and that route can be replaced. Sex education sources such as Scarleteen and Our Bodies Ourselves name 7 variants for it. These rest on practical experience rather than clinically tested equivalence:

- A hand on the throat without pressure, sometimes called symbolic choking. The gesture stays, the compression goes.
- Pressure on the back of the neck instead of the front, for example holding the head from behind.
- A [collar](https://gay-blog.tomrockets.com/en/bdsm-collar/ "collar") that is worn but never pulled.
- Verbal breath control by command, as described in the section on breath control without equipment.
- A hand over the mouth with the nose left free, which creates the feeling of control while the airway stays open.
- Sensory deprivation through a blindfold or hood without any breath restriction.
- Restraint of non-vital body parts, meaning arms and legs rather than neck and ribcage.

For many, one of these variants covers the desired sensation entirely. The feeling of being at someone’s mercy stays intact, while the oxygen deprivation and its consequences fall away.

## Legal perspective

In Germany, Section 228 of the Criminal Code governs when [consent](https://gay-blog.tomrockets.com/en/bdsm-consent/ "consent") to bodily harm is valid. The Federal Court of Justice defined the limit in its 2003 decision BGHSt 49, 34. The act remains contrary to public policy, in German sittenwidrig, and therefore punishable, once the consenting person is objectively placed in concrete danger to life. Applied to breath play, the submissive partner’s consent protects the dominant partner only up to that threshold. Where permanent damage or death follows, the person performing the act carries criminal responsibility regardless of what was agreed beforehand.

In the United Kingdom the position has been clearer since 2021. Section 71 of the Domestic Abuse Act rules out consent to serious harm for the purpose of sexual gratification as a defence. The trigger was the death of Natalie Connolly in 2016, whose partner invoked consensual rough sex and was convicted of manslaughter rather than murder, receiving 44 months. The campaign We Can’t Consent To This documented 67 comparable cases since 2010 and generated the political pressure behind the change.

Austria has a structurally comparable limit on consent in Section 90 of its Criminal Code, though no leading decision with the same clarity as the German one.

## FAQ

### What is breath play?

Breath play, often written breathplay and also called breath control, means controlling the submissive partner’s breathing in BDSM. It ranges from verbal instruction through restrictive clothing to choking. The clinical term for the fetish is asphyxiophilia.

### Is there a safe way to do breath play?

According to the state of the literature, every form that actually lowers oxygen levels carries a risk of cardiac arrest and brain injury. Jay Wiseman stated in 1997 that he knew of no execution which excludes that risk, and the scene has filed breath play under RACK rather than SSC ever since. Risk reduction is possible, safety in the narrower sense is not.

### Why is choking more dangerous than it looks?

The carotid arteries close well below the force needed to compress the trachea: 2.5 to 10 kilograms against around 15 kilograms. So anyone who believes they are choking gently can trigger the more critical effect. Under effective compression, unconsciousness sets in after 7 to 14 seconds, and pressure on the carotid artery and vagus nerve can lower the heart rate through the carotid sinus reflex.

### How many people die from autoerotic asphyxiation?

Forensic pathologist Anny Sauvageau estimated around 0.5 deaths per 1 million inhabitants per year in 2012. Her basis was 38 documented cases in Alberta between 1985 and 2009, which extrapolates to 62 to 156 cases annually in the USA. The older and more frequently quoted figure of 250 to 1,000 deaths per year in the USA comes from a 1983 projection and is considered outdated.

### Is breath play legal in Germany and the UK?

In Germany, consent covers bodily harm only up to the threshold of concrete danger to life, a line drawn by the Federal Court of Justice in BGHSt 49, 34 in 2003. In the United Kingdom, Section 71 of the Domestic Abuse Act 2021 removes consent as a defence where serious harm is caused for sexual gratification.

### What should you do if someone passes out during breath play?

Release the pressure and call the emergency services immediately. Unconsciousness after strangulation is always an emergency, even if the person comes round straight away. Then place them in the recovery position and check their breathing. If breathing has stopped, start chest compressions. The incident needs medical assessment in every case, because injuries to the neck vessels can surface days later.

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