My name is Dr.

Lindsey Doe, I'm a doctor of human sexuality and a clinical sexologist, I've been hosting this sex education show for over four years -- putting out weekly videos and now podcasts all about sex. A question I've been repeatedly asked since the beginning is whether or not there's a safe way to do erotic asphyxiation -- cutting off your air supply or someone else's for sexual pleasure. [WHIP CRACKING, COUGH].

Deep breath. Asphyxiation is considered one of the highest risk sexual behaviors because of the potential for permanent brain damage and death. People die from this.

There isn't a safe way to asphyxiate but there are safer ways. I'm going to explain why people are into it and how to lower the risk of doing it because. I'm devoted to harm reduction.

I believe that we engage in a really diverse range of behaviors and that education is crucial for us all to figure out the best ways to live. Breath play is growing in popularity, I see depictions of it all over social media, and the last thing I want is for anyone to feel ashamed of their interest in asphyxiation and or put themselves in danger because they weren't given safer alternatives. Here are some of the reasons people like it.

Erotic asphyxiation works in a few ways -- one, the restriction of air (or blood depending on how you do it) causes the body to release endorphins which make the gasper feel high. The strategy is: match this with climax and maximize pleasure. Another motivation that's chemical is dopamine, triggered by the endorphins.

Dopamine which is linked to pleasure also increases testosterone which boosts sex drive so you want the pleasure more. Then there's the psychological component -- the edge-play. The intense threat that you could die, hopefully followed by the relief that you didn't die are very powerful.

The mind trip grounds you in your body so you can't worry about work or kids or the house. You have to focus on how you.could.die. There's also a sort of trauma-bonding if you're playing with someone else -- because the other person is not only giving you an orgasm; by no longer constricting your breath -- they're giving you lifeeeeee.

Asphyxiation can be a form of bondage, powerplay, sadomasochism, and or sexual discipline. Listed as asphyxiophilia in the Diagnostic and Statistical Manual of Mental Disorders, other reasons someone might desire not breathing are all the explanations of other paraphilias and fetishes such as conditioning, imitation, and compensation. Finally, on this list, curiosity.

Sometimes we do things just to learn for ourselves what it's like. That's the why, what about the how? From the highest risk to lowest risk here's how people asphyxiate and some suggestions to reduce the harm.

The most dangerous version of asphyxiation is anything that restricts breathing or blood flow that can't be undone if you pass out. This can happen from suspending oneself with a something like a tie or cord connected to furniture or a door, known as scarfing; covering the head with a tight bag, hood, or mask and then tying it; or sticking something jagged into the throat. Please don't do any of this.

It's too easy to miscalculate how much air to cut off. Enough to enhance orgasm but not too much that you faint or die is called the critical line and it is different for everyone every time. Breath play basics: you have to be able to control pressure and if you're unconscious you can't do that.

So higher risk asphyxiation requires supervision and communication. Ask a friend or partner, hire a professional if you need to, establish consent (preferably in writing in case you die) then make sure this person knows the plan, including a clear nonverbal way to say “caution” or “stop” -- a safe signal. Amp and Bolt have a wonderful breath play 101 video on their channel Watts the Safeword where they recommend jazz hands, tapping, and eye contact. [

Amp:] That's a really good easy one to do because as soon as you're going unconscious your eyes are [probably] not going to be making that eye contact.” Manual strangulation. Pressure on the front of the neck cuts off air, the sides cuts off the carotid arteries, so blood, and pressure on the back triggers nerves which can send the gasper into cardiac arrest. For a few seconds, you're probably okay but the longer you hold it the higher your risk. Instead of doing long holds, repeat shorter holds over time.

OR learn how to track arousal and the timing of orgasm so you're only choking at climax. This is so risky. You also need to be realllly careful with how tight you grip.

A secondary downside of choking is suffocating hours later from internal swelling that blocks the windpipe. Smothering. Using pillows, breasts, towels and the like to cover a person's face is problematic because you can't see if or when they become unconscious.

So for this I suggest practicing with eye contact a few times -- just isolating the smother to the nose and mouth -- so you go through the routine of safe signalling and trust everyone involved to do their part. Compressors and corsets. Using objects to restrict the capacity of the lungs to breathe is also a form of erotic asphyxiation.

Like lying under something heavy or wedging oneself into a tight space. Asphyxiation binders and corsets can take away a third of your respiration in addition to altering other abdominal organs. If these are forms of breath-play you want to experiment with, I propose incremental changes going from lighter to heavier or looser to tighter with days in between to observe how your body recuperates.

You'll also want to make sure to decompress slowly. When you're no longer smashed, blood and air will rush in. Too much at once can make the gasper dizzy or sick.

Choking games, Choke holds, Choke outs. This is when people aim for the carotid arteries like trained fighters to cause temporary unconsciousness. A little pressure here and here -- sleepy-time.

Close to 20% of teenagers have participated in this ‘activity' and most guardians don't know it. Centers for Disease Control and Prevention recommend you watch for: “talk of ‘the game', bloodshot eyes, marks on the neck, severe headaches, disorientation, ropes, scarves, and belts tied to bedroom furniture or door knobs or found knotted on the floor, and unexplained presence of things like dog leashes, choke collars and bungee cords” then address it. Show them this video.

Face-sitting. Also known as kinging or queening is not strictly asphyxiation -- but can be. Essentially the gasper is lying down while someone else sits on their face for oral sex -- cunnilingus, anilingus, fellatio.

It can block airflow so again safe signals are essential. Even with stools designed for face-sitting called smotherboxes -- you're being smothered by someone's crotch so you need a way to show it's too much asphyxiation and ideally that's not by biting anyone's genitals. One safer method for erotic asphyxiation is covering the mouth and nose with your hand for no more than 30 seconds while applying light pressure to the sternum for affect.

It still achieves the high from oxygen deprivation and the thrill of pushing limits but it's unlikely you'll konk out or cause irreparable damage. Simulation is playing with the sensation of choking without actually restricting air supply. It's what most people are aiming for when they say “choke me.” The goal is to feel someone's hands around their throat but not have breathing restricted.

They want the theatrical version, not the real thing. Which is why it's a smart idea to have an explicit conversation with your playmates about what you want before performing these acts. Say exactly what you want and only do what everyone is comfortable with.

Breath swapping is pretty low risk. Lips locked, Person A breathes in through their nose - out through their mouth into the Person B's mouth. Then Person B exhales through their nose.

Person B will consistently get the carbon dioxide of Person A and eventually run out of oxygen but you can stop at anytime or trade who inhales the oxygen. Thoracic Fixation is holding your own breath which we actually do for things like childbirth, defecation, heavy lifting, and singing. This would merely be the sexual version of it. [HOLDS BREATH].

That's it, and no major threat to my well-being. Tantric Pranayama: this is breath control where you use the prana or vital life force to achieve sexual enhancement. And at the very end of the risk continuum for asphyxiation is fantasizing about it.

No harm done in imagining any of these practices. You can picture yourself wearing a condom over your head, tying yourself upside down around the neck, with a stuffed animal between your teeth, and masturbate to your heart's content, so long as you still do jazz hands. It's your fantasy with my safety precautions.

One of the key principles of harm reduction is understanding behaviors are complex and multi-faceted. Another is acknowledging that asphyxiation exists on a continuum from severe abuse to abstinence and that some ways are safer to engage in than others. I hope you find that this episode is in line with this.

I worked really hard to approach the topic with care and respect. I believe we need to teach and learn best practices and good decision making. We need to stay curious.

If you're curious or concerned that your interest in asphyxiation is unhealthy for you I recommend consulting a kink-friendly doctor or therapist. They'll be able to help you assess your unique sexuality for risk and offer solutions individualized for your needs. And very important: if anything should go wrong in any of your sexual experiences, vanilla or kinky, dry humping to strangulation, seek medical care.

CPR is valuable as well. Asphyxiation play can be very dangerous and there are many ways to reduce risk and harm. I care about you. [OUTRO MUSIC] [L

INDSEY:] I don't know why I'm running out of air... [MAIA LAUGHS IN THE BACKGROUND] [

MAIA:] Haha, do you get it? [LINDSEY LAUGHS].