Debby Herbenick

Questions of whether, to what degree, and through what mechanisms exposure to sexual media may or may not affect audiences have been a focal point of studies in The Journal of Sex Research (JSR) fo...

The absence of representative media and imagery has been shown to have mental and physical health impacts on adolescents and adults (Jackson-Lowman 2013; Sagrera et al. 2022). These impacts include...

Introduction: Sexual practices commonly described as “rough sex” (e.g., choking, slapping) have become prevalent among young adults in the U.S. and internationally. Little is known about adolescents’ engagement in such behaviors. Using U.S. population data, we examined the prevalence and demographic correlates of rough sex behaviors among U.S. adolescents ages 14- to 17- years old. Method: Data are from a confidential online U.S. nationally representative survey conducted in December 2022 and January 2023. Results: Of the 1010 adolescents surveyed, 180 had engaged in partnered sex and were then shown questions about ten rough sex experiences. Nearly one in three (30.1%) sexually experienced 14– to 17-year-olds had done one or more of the ten rough sex practices to a partner in the prior year and 36.6% ever in their lifetime. More than one-quarter (27.6%) of sexually experienced adolescents reported that someone had done one or more of the rough sex practices to them with permission or consent in the prior year and 37.1% in their lifetime. Also, 11.7% reported that someone had done one or more of the rough sex practices to them without permission or consent in the prior year and 17.3% in their lifetime. Conclusions: Among adolescents who had ever engaged in partnered sexual activities, both consensual and non-consensual rough sex experiences were prevalent. Some of these sexual practices—such as sexual choking/strangulation and smothering—pose significant risks to young people’s health. Policy Implications: Findings may inform sexuality education curricula, clinical guidance, and public health guidance and interventions.

Sexual strangulation (also referred to as choking during sex) has become increasingly prevalent among young adults and disproportionately affects females. Epidemiological studies indicate that more than half of college-aged women report a lifetime history of being strangled during sex, and it is most often described as consensual. Despite its widespread occurrence, little is known about the acute and cumulative neurological consequences of this behavior. Pilot studies suggest associations between frequent sexual strangulation and elevations in blood biomarkers of neural injury, alterations in brain structure and connectivity, and increased mental health symptoms; however, existing evidence is limited by cross-sectional designs, short-term follow-ups, and small sample sizes. This prospective cohort study is designed to characterize both the acute and longitudinal neurological effects of sexual strangulation using multimodal assessments. A total of 200 young adult females (100 with frequent sexual strangulation exposure and 100 controls with no lifetime strangulation history), along with a pilot cohort of 40 males, will undergo comprehensive evaluations including blood-based biomarkers of neural injury and inflammation, multimodal MRI, cognitive and oculomotor testing, retinal imaging, and mental health assessments. Acute neurological responses will be assessed approximately 24 hours following a sexual event involving strangulation (or non-strangulation sex in controls), while longitudinal follow-up will occur every six months over 30 months to examine cumulative exposure effects. Semi-structured interviews conducted at each time point will characterize strangulation practices, contextual factors, consent dynamics, and associated symptoms. The primary objectives are to (1) examine baseline group differences in neurological health between individuals with frequent sexual strangulation exposure and non-strangulation controls, (2) identify acute neurological alterations following sexual strangulation, (3) determine associations between cumulative strangulation exposure and neural cellular, physiological, and functional integrity over time, and (4) characterize young adults’ experiences, contextual factors, and perceptions of sexual strangulation through semi-structured interviews. Collectively, this study aims to establish temporal relationships between sexual strangulation and neurological health outcomes and to inform clinical guidance, sexual health education, and harm-reduction strategies related to this increasingly common sexual practice.

Masturbation is associated with positive sexual development. However, there is limited research on masturbation in India, where sexual health efforts center on disease prevention and often neglect sexual pleasure. In this study, we aimed to examine Indian women’s experiences of masturbation and sexual pleasure during the COVID-19 pandemic. In 2021, we conducted 22 semi-structured virtual interviews with women aged 20–43, based in India. Interviews were conducted in English, Hindi, and Marathi and were transcribed and translated into English, as needed. Thematic analysis was employed with an inductive coding approach (Nowell et al., 2017). We discerned three themes: (1) ways of learning about masturbation and associated emotions, (2) cultural regulation of women’s sexuality, and (3) change in sexual life due to the COVID-19 pandemic. We found that participants faced early barriers to masturbation due to limited access to sexual knowledge and the absence of comprehensive sex education. Families and social norms stigmatized women’s sexual pleasure, limiting their agency and discouraging self-exploration. The COVID-19 pandemic intensified these barriers by reducing privacy and increasing surveillance, yet participants found ways to explore self-pleasure and masturbation. Our findings challenge the Indian cultural silence and stigma around women’s masturbation by showing that it is not just a private act, but one that is shaped by sociocultural norms and used by participants to reclaim their sexual agency. Our findings highlight the need for sexuality education and public health strategies that are culturally responsive, comprehensive, and pleasure centered.

The intersection of pornography and morality has been a focal point of pornography scholarship for decades. Surprisingly little research has focused on whether and why moral views impact pornography use, however, despite increased attention paid to the study of pornography across the social and behavioral sciences. This letter has three aims. First, to call for increased research on moral views about pornography and pornography use. Second, to suggest that this relationship may be more complicated than at first it might appear. Third, to provide preliminary support for our contention of complexity via an empirical examination of three plausible but competing hypotheses on moral opposition to pornography and pornography use employing campus-representative data gathered from a large sample of undergraduate and graduate students. We hope this epistle inspires our colleagues to develop and test their own hypotheses on moral views and pornography use and to consider Journal of Sex & Marital Therapy as a dissemination outlet for these efforts.

Introduction: Sexual strangulation, commonly referred to as “choking”, has become increasingly common among young adults, yet its neurobiological consequences remain poorly understood. Preclinical and clinical evidence suggests strangulation may trigger axonal injury, neuroinflammation, and blood–brain barrier dysfunction. Blood biomarkers of neural injury and inflammation provide a sensitive means to detect subtle effects. Aim: To examine whether consensual sexual choking/strangulation acutely alters blood biomarkers of neural injury and inflammation compared to non-choking sexual activity in young adult women. Methods: In a randomized crossover study, 29 women (mean age 21.5 ± 2.7) completed three laboratory visits: baseline (≥24 h abstinence), post-choking sex, and post-non-choking sex. Blood was collected within 24 h of sexual events. Neural injury biomarkers (NfL, tau, GFAP, UCH-L1, S100B) and inflammatory markers (IL-1ra, TNF-R1, CCL-2, VEGF-A, VCAM-1) were analyzed using Quanterix and Luminex multiplex immunoassays. Mixed-effects regression models tested exposure-by-time interactions, adjusting for age and brain trauma history. Results: Neurofilament light (NfL) significantly increased after choking-involved sex but remained unchanged after non-choking, which resulted in a statistically significant exposure-by-time interaction [ β = −0.21, 95% CI (−0.38, −0.03), p = 0.021]. Other neural biomarkers did not differ by exposure. Among inflammatory markers, CCL-2 and VEGF-A demonstrated a similar pattern as NfL, with acute increases after choking-involved sex, but not following non-choking sex, yielding in exposure-by-time interaction effects (CCL-2: β = −14.60, 95% CI [−25.70, −3.43, p = 0.011; VEGF-A: β = −9.29 (−19.71, 1.13), p = 0.079]. IL-1ra, TNF-R1, and VCAM-1 remained stable. Discussion: Consensual sexual strangulation elicited acute increases in NfL and CCL-2, with VEGF-A showing a similar pattern, suggesting transient axonal stress and hypoxia-related inflammatory signaling. These findings indicate that sexual choking/strangulation, even in consensual contexts, may have subtle, yet detectable cellular burden. Future studies with larger samples, refined temporal sampling, and multimodal outcomes are needed to clarify short- and long-term implications.