Introduction

Sexual choking is now prevalent among adolescents and young adults in the USA, UK, and New Zealand, disproportionately affects women and sexual minoritized individuals, and is consequential to health (Beres et al., 2020; Coker & Domett, 2022; Herbenick et al., 2020, 2021a, 2021c, 2022a, 2022b; Savanta Com Res, 2019). Although commonly called “choking” (Beres et al., 2020; Cruz, 2022; Herbenick et al., 2022d, 2022e), using one’s hands, limb, or a ligature to squeeze or press against the neck to occlude blood flow and/or airways is a form of strangulation (Sauvageau & Boghossian, 2010). Consequently, what people tend to refer to as sexual choking may share at least some health risks as those arising from strangulation occurring in other contexts, such as the so-called “choking game,” sexual assault, or intimate partner violence (IPV) (Bichard et al., 2022; Busse et al., 2015). These risks may include neck bruising, neck edema, recurrent headaches, tinnitus, alterations in consciousness, and—in rare cases—death (Herbenick et al., 2022a; Schori et al., 2022). In this paper, we use the term sexual choking to refer to strangulation that occurs during sex.

While fatalities from consensual sexual choking/strangulation are rare, they do occur (Schori et al., 2022) and have been documented since at least the 1700s (Tarr, 2016). A recent review of deaths from partnered bondage and discipline/dominance and submission/sadism and masochism (BDSM) practices found that most case reports (88%) resulted from manual or ligature strangulation (Schori et al., 2022). More often, sexual choking leads to euphoric feelings but also to neck pain, neck bruising, and—for nearly 1 in 5 young adults who have been choked—alterations in consciousness, such as feeling dizzy, lightheaded, experiencing visual changes, or losing consciousness (Herbenick et al., 2022a). Such responses are known to be associated with cerebral hypoxia from neck compression (Kabat & Anderson, 1943). Yet, some young people who engage in consensual sexual choking are unaware of the risks involved (Herbenick et al., 2022c, 2022d).

As women, more often than men, are choked during sex, the growth of this sexual practice may exacerbate existing gendered health disparities as women are already overwhelmingly affected by strangulation in other contexts (Matusz et al., 2020; Strack et al., 2001). Thus, it is important to understand what young people are learning about choking, including the extent to which it is a normative, pleasurable, and/or desirable sexual practice. In a series of 2006–2016 convenience surveys, Burch and Salmon (2019) found that about one-third of undergraduate students considered choking to be a form of rough sex. However, in a 2020 campus representative survey, 77% of US undergraduates indicated they considered choking to be a form of rough sex (Herbenick et al., 2021a), suggesting societal shifts in how young adults conceptualize choking and rough sex. A recent descriptive report from New Zealand also noted that youth tend to think of sexual choking as a mainstream, consensual sex act, and not connected to sexual violence (Beres et al., 2020).

In terms of prevalence, two US nationally representative surveys (conducted in 2016 and 2021) found that sexual choking was most prevalent among adults younger than 40 (Herbenick et al., 2020; in press). The 2021 survey found that 1 in 3 US women ages 18–24 had been choked during their most recent sexual event. A 2021 campus representative survey found that significantly more undergraduate students than graduate students had ever been choked during sex (Herbenick et al., 2022a). Also, about one-quarter of undergraduates who had ever been choked, compared to 4% of graduate students, were first choked during adolescence. Similarly, a national poll of 18–39-year-old British women found that 54% of women ages 18–24 had been choked during sex compared to 23% of women aged 35–39 (Savanta Com Res, 2019). Taken together, these surveys suggest a likely age cohort effect.

What might explain why so many young people are now including choking in their sexual repertoires? Qualitative studies in the USA, New Zealand, Sweden, and Mozambique indicate that some adolescents and young adults view pornography as a means of sexual learning, often describing how viewing pornography has influenced their own sexual behaviors, including rough sex (Keene, 2021; Rothman et al., 2014; Tholander et al., 2022; Vera Cruz & Sheridan, 2022). These findings are consistent with sexual scripting theory (Simon & Gagnon, 1986), which explains how people may learn how, when, and in what order to enact certain sexual behaviors. Sexual scripts may be acquired through media (e.g., pornography, television, social media) as well as interpersonal experience (Seabrook et al., 2017; Ward, 2003). Wright et al. (2021) found that young adult men’s pornography use was associated with greater exposure to pornographic depictions of sexual choking which then predicted an increased likelihood of having choked one’s sexual partners through the beliefs that choking is safe, pleasurable, and does not require verbal consent. Wright et al. (2022) also found a relationship between women’s use of pornography, their exposure to depictions of male/female sexual choking, as well as their eroticization of choking and engagement in being choked during sex. However, pornography is just one source of sexual learning and the normalization of choking during sex may also be influenced by other sources.

Internet Memes

In qualitative interviews with young adults who had engaged in sexual choking, men commonly described first learning about choking from pornography as well as from peers and mainstream media, whereas women described learning about choking from partners, peers, and Internet memes (Herbenick et al., 2022c, 2022d). Internet memes have been described as a “piece of culture, typically a joke, which gains influence through online transmission” (Davidson, 2012), “amateur media artifacts, extensively remixed and recirculated by different participants on social media networks” (Milner, 2012), and as “cultural information that passes along from person to person, yet gradually scales into a shared social phenomenon” (Shifman, 2013, pp. 364–365). Although memes may be positioned as funny or as jokes, researchers have noted that the humor may be dismissive or disparaging, and may reinforce sexist or racist ideas (Andreasen, 2021; Cann & Castro, 2022; Yoon, 2016). Memes are commonly comprised of images that are often paired with text that are shared online (sometimes with slight variation, as users interact with them), but videos, written text, catch phrases, fashion trends, and other cultural units can also become memes (Knobel & Lankshear, 2007, Shifman, 2013) as they are widely shared across networks. Memes have been described both as speech acts and as visual culture intended to express feelings, questions, opinions, or ideas (Grundlingh, 2018; Yoon, 2016). They have been a topic of scientific study given their role in the communication about and dissemination of cultural ideas (Iloh, 2021) and their ability to “shape the mindsets, forms of behavior, and actions of social groups” (Shifman, 2013, p. 365). Memes are simultaneously a reflection of contemporary society and public perceptions (Al-Rawi et al., 2021; Meyer, 2020) as well as a powerful, yet subtle means to promote ideologies due to their use of humor (Lomotey, 2020).”

Despite how often memes are shared among young people and used to express and explore ideas related to gender and sexuality (Bragg et al., 2018), we are unaware of research to date that has systematically examined Internet memes as a form of sexual learning. Because young adults in an earlier interview study described learning about choking through Internet memes, we set out to analyze such memes in order to better understand what messages about choking/strangulation during sex people may be exposed to through memes. The purpose of this study was to understand what ideas about sexual choking may be transmitted through social media memes; to do so, we conducted a content analysis of memes related to sexual choking, identifying common shared categories of interest and messages emerging from the memes.

Method

Meme analysis is a form of qualitative content analysis that considers both text and images in the interpretation. We employed a three-step analytical process for inductive content analysis of memes. Following Mayring (2000), we (1) identified emergent codes, (2) generated overarching categories, and (3) moved to interpretation. As with other studies which analyze memes from a qualitative perspective (e.g., Chagas et al., 2019; Foster, 2014; Iloh, 2021), our study was guided by a social constructivist theoretical approach which emphasizes the collaborative nature of learning (Churcher et al., 2014). Accordingly, we consider that images and text that form memes express socially generated understandings of the phenomenon. The research team was interdisciplinary and multigenerational (encompassing undergraduate, graduate, and faculty researchers), thus diluting the potential effect of individual subjectivity on the analysis. The main subjective thrust of the team was a marked interest in better understanding emergent sexual behaviors, such as choking, from a position that values sex positive approaches to sexual health education and intervention.

Meme Identification

We identified Twitter, Instagram, Facebook, and Reddit as websites and social media platforms to be searched for visual and textual memes. These sites were selected as they were known to be popular in adolescence (Pew Research Center, 2018), the developmental time period in which young adults have described first learning about sexual choking (Herbenick et al., 2022c, 2022d). We excluded WhatsApp and other platforms that are largely comprised of private groups and private conversations. We chose straightforward search terms in our efforts to identify English-language memes: choke me, choking during sex, sexual choking memes, choking sex, and expanded these to include others that we noted were present in many of the social media posts. That is, we also searched for choke me daddy, choke me daddy meme, choke her, choking her, choking her daddy, choke me harder, choke me kink, choking her meme, and choking her during sex. When we began to search for Spanish-language search terms, we found that the common hashtags were ahorcar, ahorcame, and ahorcame papi, and thus included those in our search. Spanish-language memes were included in the sample as the most widely spoken non-English language within the USA and because several members of our research team were fluent Spanish speakers.

Three doctoral and two undergraduate research assistants were each assigned a primary and secondary site to search for choking-related memes using the specified search terms and collected up to 75 total memes from each site where possible so that memes from each site were adequately represented. For sites with fewer than 75 memes related to choking, research assistants identified as many memes as possible. After completing a search of their primary site, research assistants skimmed one secondary site to cross-check/fill in memes that may have been overlooked by the other research assistant assigned to that site. Exact duplicates were omitted from the dataset, but partial duplicates were retained (e.g., as is the nature of meme replication, sometimes identical text was used with two different images; other times, the same image was used with different accompanying text). Of 343 total memes identified, 27 memes were excluded due to: (1) the meme no longer being available at the URL where it was identified and logged before being copied as an image file, (2) the meme being a duplicate of another meme in the dataset, with no variation in image or text, or (3) the meme not being about sex-related choking. All remaining memes (N = 316) were copied as image files into online digital folders, separating Spanish and English memes.

Coding Team

Coding was conducted by one faculty co-first author, three doctoral research assistants, and six undergraduate research assistants. The lead analyst is a medical anthropologist who has expertise in applying qualitative methodologies to sexual and reproductive health research topics. She trained the nine other coders, three of whom were doctoral research assistants with experience conducting sexual and reproductive health research and six of whom were undergraduate research assistants who had research experience and/or coursework related to human sexuality. It was important to us to engage undergraduate students as coders because: (1) choking is prevalent among young people and (2) memes tend to be used by, created by/for, and attuned to, the perspectives and sense of humor of, adolescents and young adults (e.g., Wincour & Dussel, 2020). As part of our process, we openly discussed the possibility of perceived power imbalances and yet how important it was to the research for all coders to share their perspectives and to realize the strengths that their age, culture, social location, and/or experience with memes may bring to the analysis of the memes.

Development of a Coding Manual

To develop an initial coding manual, eight members of our research team were each assigned 10 random memes for which they inductively generated codes based on the primary message(s) conveyed. The group of coders then met to review, come to consensus over the categories of interest, and make sense of the salient codes in the context of the larger dataset. Codes were then organized into an initial manual of larger categories that best represented them. We created a coding tree to assist with the ease of coding; larger categories are illustrated in Supplementary Fig. 1.

Coding Process

Ten coders were organized into groups of two to three members each and memes were divided amongst the four teams for coding. Each of the three groups analyzed about 90 English-language memes (n = 262), and one group (all of whom were fluent in Spanish) analyzed the 54 Spanish-language memes.

All groups began by coding 25 memes independently, meeting as a group to come to consensus over the coding, and then coding the remainder of the memes assigned to them independently. All coders then met as a larger group to discuss discrepancies and emergent codes that were not accounted for in the original codebook. Emergent codes were either added into the coding scheme or combined into other existing codes. After all memes were coded, each group met for final consensus and to harmonize coding spreadsheets. The coding spreadsheets were then combined into one cohesive spreadsheet for the final phase of analysis. This included further interpretation and calculating totals relative to each major category identifying relevant patterns across the dataset.

The stepped model of reaching consensus, first small groups then big group, was time consuming but allowed coders to have more meaningful discussions in small groups and reach internal consensus prior to larger group meetings. Reaching consensus was generally unproblematic. Cases that led to much discussion were mostly related to how each coder interpreted the non-textual indicators of the meme, such as inferring tone, sharing perspectives on any humorous aspects of the memes (which may vary by age, culture, or social location; and which was a large reason it was important to us to include undergraduate students as coders), or identifying symbolic meaning in the images. When not able to reach consensus small groups kept the emerging codes and brought them to large group meetings for consideration.

Results

The dataset included 316 visual and textual memes in diverse formats (262 English language, 54 Spanish language). These included text-based images that had been taken from its original source and re-circulated, therefore becoming a meme (e.g., as screenshots of Tweets; text on solid backgrounds circulated on social media) as well as images combined with text that were created as memes. As commonly happens with memes, some images were re-purposed with new text and other times text was re-purposed with different images. Consistent with other meme analyses (Moody-Ramirez et al., 2021; Nissenbaum & Shifman, 2018), identifying information (e.g., social media handles, users’ names) has been removed from the memes and we present only the memes themselves. As shown in Table 1, the following categories were identified from the sample of memes: communication, gendered dynamics, choking as dangerous/related to death, choking as sexy, sexualization of nonsexual through choking/strangulation, shame and worry, romance/rough sex juxtaposition, religious references related to choking, and instructional/informational.

Communication

Issues of communication, or more commonly lapses in communication and/or understanding, were prevalent among both English- and Spanish-language memes. Lapses in communication were characterized by unclear intentions of sexual choking, or suggestive of naiveté about the request to choke someone sexually. Differential or unclear intentions related to choking were illustrated, for example, in memes that depicted one partner (the chokee) engaging in choking for pleasure and the other (the choker) because of frustration with, or anger directed toward, the person being choked (Fig. 1A); a choker not knowing their partner’s intentions for wanting to be choked; someone asking to be choked but being surprised when it happens; or someone asking to be choked but then feeling embarrassed or hesitant to admit that sexual choking is what they asked for, such as if their partner is surprised by the request (Fig. 1B).

Fig. 1
figure 1

Lapses in communication. Note: B translation: “Oh, Yes, Papi(Daddy) choke me harder.” “What?” “What?”

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Memes that depicted requests to be choked with responses of non-sexual choking, such as choking on dry food, suggested naiveté about choking/strangulation as a sexual practice. Examples of these memes included a photograph of a woman looking distraught paired with text that read, “Me: ‘choke me daddy’ Him: ‘shoves Popeye’s biscuit in my mouth’” or a photograph of food paired with text that read, “Her: choke me daddy, Me: *feeds her Weet-Bix with no milk*”.

Another subset of memes that displayed issues of communication were those alluding to the specific request to be choked. While many memes depicted one partner explicitly asking to choke or be choked, specific requests involving the phrase “choke me daddy,” a phrase that is now part of popular culture, was sometimes associated with unintelligence, depicted as less attractive, and/or suggested to be (albeit often humorously exaggerated) less preferential to more sophisticated language requesting sexual choking (Fig. 2).

Fig. 2
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“Choke me daddy” and memes about its more sophisticated iterations

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Gendered Dynamics

Overall

Issues related to the gender of choking participants were prevalent in both English- and Spanish-language memes, which overwhelmingly depicted or described circumstances where a woman was choked by a man. Although memes consistently depicted women being choked by men, the role of the aggressor or initiator of the act varied between genders. We identified memes that portrayed men as the pursuer/aggressor of choking as well as those that portrayed women as initiating choking, often by asking someone to choke them. One meme suggested that women expecting consent in choking scenarios as laughable, pairing an image of two characters from the Goodfellas movie laughing with text that read “She said choking during sex without consent is assault” (Fig. 3A). Other memes suggested that choking was done to appease a partner, typically a man obliging a woman’s desire to be choked. Some memes depicted the initially reluctant participant as learning to enjoy the act of choking their partner (Fig. 3B).

Fig. 3
figure 3

Gendered dynamics and choking

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Physical Strength

References to physical strength were common. Within this subcategory were memes depicting a choker’s absolute strength (e.g., “Harder, or does it scare you?”), their lack of control over their strength, as well as memes that positioned strength, aggression, or higher levels of choking intensity as desirable (Fig. 3C) or mocked a choker’s perceived lack of strength (e.g., “when you want them to choke you but they are younger than you.”).

Confusion Related to Choking, Sex, and Violence

We also identified memes that illustrated men’s confusion about women’s desire to be choked, or those that suggested the desire to be choked did not sensibly align with other aspects of women’s lives or relationships. One meme that featured a photograph of Kermit the Frog was paired with text that read, “girls who like to be choked, tied up, and slapped during sex are also the ones who cry when you yell at them,” (Fig. 3D) suggesting perceived incongruities between their sexual preferences and their interpersonal expectations. Another meme dated December 2020 (nine months into the COVID-19 pandemic) poked fun at women who claimed that wearing face masks suffocates them but then ask to be choked during sex (Fig. 3E). Yet another meme said, “Don’t ask me to choke you during sex and then call the police when I choke you during an argument…Be consistent,” underscoring the potential for blurred lines between sexual choking and intimate partner violence, and suggesting that women who want to be sexually choked don’t have a right to seek help when choked/strangled as part of violence.

Choking as Dangerous

Awareness that Choking Can Kill

Many memes acknowledged the danger involved with sexual choking. In fact, some depicted choking as something scary or as comparable to intimate partner violence. One meme juxtaposed the phrase “how rough she likes it” with the phrase “domestic violence.” Other memes explicitly recognized the possibility that choking can lead to death, with some reflecting an awareness of, or even fears associated with, the potential for being fatally choked. This was reflected in a meme that included images of Tyra Banks with language that said, “Choke me and slap me around, but don’t kill me” (Fig. 4A).

Fig. 4
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Memes positioning choking as dangerous or that referenced death or danger. Note: D may be translated as “Love, I think I squeezed your neck too hard while we made love, no? Love? Love? Looooove?”

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Many memes depicted fictional scenarios that involved someone choking their partner in a way that resulted in unintentional loss of consciousness, injury, or death. These memes seemed to minimize the seriousness of death from sexual choking. In other memes (both English and Spanish), accidental death and loss of consciousness (if not injury) were depicted as resulting from getting “carried away” or going “a bit too far” with choking such that the intended intensity of the choking was surpassed and choking became dangerous (Fig. 4B–D).

Intentional Harm, Including Femicide/Homicide and Suicide

Some memes (though fewer in number) depicted the possibility of the person doing the choking using the experience as an opportunity to hurt, or kill, their partner. This was reflected by the chokee (usually a woman) asking to be choked, or appearing to enjoy being choked, while the choker (usually referred to, or depicted as, a man) was shown as intending to use choking to injure or kill their partner. For example, one meme showed an image of someone choking a woman paired with text that read “when she finally let u hit n says ‘choke me daddy’ n u gotta repay her for all the times she’s curved u” (the phrase “curved u” refers to rejecting someone). Another featured two images of a woman being choked, with the first image showing her seeming to enjoy being choked and the second image showing her seeming to feel worried or scared; the text reads “When he’s giving you the choke & stroke combo that you love so much and then you hear him say, ‘Lord, I offer you this sacrifice’…”

Death was also depicted in the context of desire for death or suicide and using choking as a means for that outcome, suggesting the chokee’s motivation to be choked may be associated with suicidal ideation. We identified both English- and Spanish-language memes that used paintings of women and men being intimate together, with the woman saying “Choke me,” her male partner asking, “Are you into that?” (or, in some versions, “Does that turn you on?”) and her replying, “No, I want to die.” Another meme featured text that read, “when you’re choking her and she whispers, ‘yes, daddy, please kill me’” paired with an image of a smiling man.”

Tangential to these messages, choking was also depicted as being related to crime, such as in instances when a male partner or person who chokes faces legal repercussions from having choked someone, sometimes fatally. For this subset of memes, the ‘danger’ portrayed was not necessarily the danger of a partner being harmed or killed, but the danger of facing consequences for harming or killing a partner, namely for men who had choked women (Fig. 5).

Fig. 5
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Choking/strangulation as dangerous due to potential criminal charges

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Choking as Sexy

Choking as an indicator of sexiness or desire was also prevalent, with some memes suggesting that choking could improve sex, such as by facilitating orgasm (Fig. 6A). Within both English- and Spanish-language memes, some suggested that choking was a feature of desirable sex; others represented an unbridled excitement toward or need for being choked. For example, a common meme was some version of: “Day 98 without sex: I slammed on my brakes so my seatbelt could choke me” (Fig. 6B). Some memes even included images of children, as with one showing a young female child choking herself with both hands paired with language that, translated, meant “When it’s already Friday and you don’t have anyone to choke you.”

Fig. 6
figure 6

Choking as enhancing sex or orgasm or, alternatively, as not being sexy or as disrupting sex. Note: B can be translated as “Day 292 without sex.”

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In contrast, other memes suggested that a request to be choked could disrupt sex (Fig. 6D) or that being choked looks less attractive than people may imagine (Fig. 6D). Most of those that took a critical approach to ‘choking as sexy’ were English-language memes. We also identified many memes that alluded to choking as an expression of arousal or sexual desire. For both English- and Spanish-language memes, this was the most prevalent type of meme within this group. In some memes, the phrases “choke me” or “choke me daddy” were used to indicate desire in contexts that were not explicitly or immediately sexual (Fig. 6E).

Sexualization of the Nonsexual Through Choking/Strangulation

Many memes depicted nonsexual or suggestive choking in popular media and politics, as well as in everyday events involving nonsexual interactions and/or inanimate objects (see Fig. 7A, B). These memes insinuated underlying sexual motivations or sexual interest related to choking/strangulation in examples of objects, actions, and events that were not inherently sexual. In these memes, situations that were not intended to be sexual, such as then-Vice President Joe Biden receiving the Presidential Medal of Freedom (i.e., hands near the neck movements), or serial killer Jason choking a victim (i.e., violent choking/strangulation), were positioned as sexual because they were related to hands near or around the neck in ways that mirrored or shared similarities with sexual choking. The latter also seemed to recognize that choking has only recently become a prevalent sexual practice (Fig. 7B).

Fig. 7
figure 7

Memes that sexualized nonsexual objects/situations through choking/strangulation

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Shame and Worry

Shame and Worry

Though less prevalent as other categories in our sample, messages related to shame and/or worry were present in some memes. Shame related to choking was illustrated in the contexts of shame felt both toward oneself and the shaming of others. English-language memes expressed shame toward oneself for participating in, or for the desire to participate in choking (Fig. 8A). Internalized shame was also demonstrated in memes that sought validation for desiring to be choked, or conversely, not desiring to participate in choking (Fig. 8B). These memes included language formatted as a question or encouraging other social media users to share them in agreement, perhaps to normalize their perspectives related to choking; as an example of the latter, one meme showed a photograph of tacos paired with text that read “Share if you love tacos or being choked during sex.”

Fig. 8
figure 8

Memes related to individual or interpersonal shame related to choking

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Vanilla Shaming

The shaming of others in English memes was sometimes expressed in the form of “vanilla shaming” or shaming a person for not participating in choking, such that not engaging in choking was depicted as boring. One meme said, “Is no choking during sex a deal breaker?” Other memes expressed shame toward a partner’s perceived lack of sexual aggressiveness, or for attempting to choke but not doing so with adequate force (Fig. 8C, D). A Spanish-language meme was translated as, “If you don’t give it to her hard, another will come along and do it for you.”

Romance/Rough Sex Juxtaposition

In another subset of memes, choking appeared to be connected with romance. Memes in this category compared choking to intimate behaviors like cuddling or hugging, depicted choking as part of an ideal date night, and/or as a reflection of an ideal romantic partner or relationship (Fig. 9A, B). Sexual choking was aligned with other types of caring and thoughtfulness desirable in relationships such as a partner saying, “drive safe” or “text me when you’re home.” Partners’ consideration around choking, including being concerned about preventing or avoiding harm or unintentionally killing the person, was framed as a sweet, romantic gesture. Finally, choking was related to feelings of love, such that choking is done with someone you love or care about, or such that someone who chokes you loves you.

Fig. 9
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Examples of memes showing choking as connected to romance

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Choking/Strangulation and Religious References

Ideas of religion or religiosity were almost exclusively found within the Spanish-language memes and fell under three general categories: references to God, references to heaven, and the virgin-whore dichotomy.

Reference to God

A nod to the religious saying, “God squeezes but does not strangle (or choke),” which is generally used to reinforce trust and hope in God that they won’t give a person more hardship than they can handle, emerged in a handful of Spanish memes variations in the saying. For example, in some the translated text stated, “Unlike God, I squeeze, but I also choke” or “God squeezes me, but you choke me” (Fig. 10A, B). Other memes suggested that God squeezes them but doesn’t choke/strangle because he knows choking excites them/is a turn on (“Dios me aprieta pero no me ahorca, porque sabe que me excito.”).

Fig. 10
figure 10

Examples of choking memes with religious references. Note: C can be translated as "When they choke you too much and instead of coming, you left/departed"; “Dead but happy”(text in image). D may be translated as “Your mom is praying for your wellbeing and you're in some guy's bed telling him to choke you”

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Reference to Heaven

The second subgroup focuses on choking accidentally leading the chokee to heaven via death (Fig. 10C). With rare exception, the chokees pictured were women and appeared satisfied despite having died and gone to heaven.

Virgin-Whore Dichotomy

The virgin-whore dichotomy was illustrated through memes that referenced expectations of being a “good girl” as a contrast to engaging in choking behavior. These memes also included a reference to a motherly figure, either a mother-in-law praising her daughter-in-law, or a mother praying for the well-being of her child, who is someone who chooses to be choked (Fig. 10D). Similar to memes referencing heaven, this category of memes expressed awareness of the danger or risk involved with sexual choking.

Instructional/Informational

Very few memes in our sample shared instructions about how to engage in choking, or information related to what they described as safer approaches to choking. Of the few that did so, none provided evidence of the reliability or efficacy of their information. Memes of this nature seemed to emphasize attempts to correct perhaps popular misunderstandings about how to choke a partner so as to reduce the risk of injury or death. One meme (Fig. 11A) explicitly cautioned viewers “not to crush the oesophagus” and mentioned that choking should not be done under the influence of drugs or alcohol. Other memes emphasized ways to ‘properly’ choke a partner to promote pleasure, or described circumstances when choking was particularly pleasurable. For example, Fig. 11B shows a Spanish-language meme that provides information about a preference for being able to still breathe while being choked. Another meme instructed people to “pay attention to the color of [their partner’s] face,” noted that “red spots in the eyes…can be caused by a blood vessel,” and that people should “take breaks” when choking.

Fig. 11
figure 11

Examples of choking memes related to instructions or information. Note: B may be translated as "It turns me on to be choked. But not too hard. So I can still breathe, you know? Hahahaha."

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Discussion

We examined a sample of Internet memes that depict sexual choking, which is a form of strangulation that has grown in prevalence among young people. Following a social constructivist approach, we viewed memes as collaborative forms of knowledge creation and learning which occur primarily is social settings (Churcher et al., 2014). While traditional research about these forms of learning is often focused on intentional pedagogies, we propose that memes leverage forms of co-creation of “common senses” or unintentional socially constructed pedagogies about choking which are one main form of learning about choking for young people. Accordingly, we were interested in identifying the memes’ common implicit and explicit messages—such as whether or to what extent choking was normalized, (un) pleasurable, desirable, or risky—about choking in order to inform media literacy and sexuality education programming. Through a qualitative content analysis, we identified nine main categories: communication, gendered dynamics, choking as dangerous, choking as sexy, sexualization of the nonsexual, shame and worry, romance/rough sex juxtaposition, choking and religious references, instructional/informational. These memes join other media modalities (e.g., television, Internet articles, pornography, social media videos) that describe or depict sexual choking, including those that at times may provide misinformation or may otherwise be potentially harmful (e.g., Herbenick et al., in press).

Romanticization of Danger and Violence

Many of the memes we analyzed depicted gendered power imbalances between those doing the choking (typically men) and those being choked (typically women). Even when a woman was shown as asking a man to choke her (e.g., “choke me daddy”), he would sometimes seek to belittle, threaten, overpower, control, or harm her. Sometimes this was framed as him seeking revenge, expressing anger, or killing her. These messages are reminiscent of messages found in romantic fiction that depict gendered power imbalances as innate or required for romance and sexual pleasure known as the virgin/beast trope (Maas & Bonomi, 2021). This trope is harmful, especially to young women, as it romanticizes danger and can promote tolerance of abusive behavior. Within the memes we analyzed, a male partner showing concern about, or wanting to prevent, unintentionally killing the female partner while choking her during sex, was often framed as a sweet, romantic gesture. However, not killing one’s partner seems like an incredibly low bar to set for relationships or sex, as has been described elsewhere (Herbenick et al., in press). Even though many memes recognized choking as potentially dangerous or fatal, it was rare for memes to feature fact-based information related to harm reduction, or to challenge the mainstreaming of choking. Additionally, although survey data demonstrates that choking disproportionately affects women as well as sexual minorities (Herbenick et al., 2021a), the memes largely represented men choking women.

Consent and Communication During Sex

Within the memes, references to sexual communication offered commentary on the nuances of consent during a sexual experience. Although the memes often depicted miscommunication about sexual choking as common or inevitable, some portrayed disapproval for nonconsensual choking while others minimized (or even seemed to mock) the need for verbal consent for choking. This is important given the potential for memes to have social learning impacts on choking, communication, and sexual consent. Further, the humorous overtones of memes may suggest to some that sexual choking is not consequential, or that it is desirable (especially for women), which can have important implications for relationships, sexual intimacy, and assault (Table 1).

Table 1 Memes by category
Full size table

Consenting to sexual experiences in real time as they develop can often be confusing, particularly as public discourse has shifted to affirmative consent dialogues that are often viewed as unrealistic (Willis & Jozkowski, 2018). However, given recent increases in sexual choking and its potential for harm (Herbenick et al., 2021b, 2021c), understanding how consent for sexual choking/strangulation during sex is negotiated and understood should be a public health priority. Further, some of the memes resonated with findings from qualitative interviews with people who have choked, or been choked, during sex—for example, men who may feel conflicted about wanting to please a partner who has been asked to be choked but also feeling uncomfortable doing something he connects with aggression, violence, or worries may kill his partner (Herbenick et al., 2022d).

Sexual Shame and Religion

The memes we analyzed demonstrated that a desire for sexual choking may be experienced as shameful or stigmatizing to some, and that, especially in the case of Spanish memes, such shame is often rooted in religion (and specifically Christian perspectives of religion). Yet, shame was also sometimes used to mock people who chose not to choke others, and specifically to mock men as too vanilla, too weak, or not masculine enough if they did not choke their (usually female) partner or did not do so with enough force or intensity. In this way, the memes we analyzed were reminiscent of prior research that has identified racism and misogyny in memes (Al-Natour, 2021; Andreasen, 2021; Moody-Ramirez et al., 2021; Yoon, 2016), suggesting that they may also contribute to harmful attitudes about women and people of color. That said, the use of humor may also indicate the intention to highlight and contradict racism and misogyny, including to bring to light problematic viewpoints or practices.

Memes as Social Norms

Memes are most often shared on friends’ or peers’ social media feeds or viewed on other trusted profiles cognitively priming the viewer to receive the information positively (Milner, 2013; Pech, 2003). Social media are new media that are user-generated and endorsed by peers via engagements such as “likes” and “shares,” adding to the power of their influence (Nesi et al., 2021). For example, if a friend or trusted influencer posts to social media, the user is more likely to “agree with” or “trust” the content that is shared (Sherman et al., 2016) compared to more traditional media content that is generated by large corporations (Collins et al., 2017). Thus, if memes are created, endorsed, and distributed by peers, they could be a particularly important contributor to sexual learning.

Memes have also been identified as a kind of media that rationalize, normalize, or minimize depicted experiences that span from everyday frustration to existential despair or violence (Andreasen, 2021; Shifman, 2013). Prior work has demonstrated that memes about climate change help to mitigate anxiety, whereas memes about white supremacy and misogyny make more abhorrent content “more palatable” (Lagerwey & Nygaard, 2020; Shifman, 2013). Thus, the memes that we coded here could have the potential to normalize sexual choking by using humor and depicting assumptions that the behavior is common and enjoyed and that the potential for harm or death (especially for women) is acceptable. Many of the memes may also mislead viewers into thinking that there is a “safe” way to choke a partner, when indeed there is always at least some risk of harm (e.g., Berkman et al., 2021). That said, we acknowledge that more research is needed to understand the risks involved with consensual sexual choking given that it shares some similarities (but also some key differences) with other forms of strangulation. Additionally, although we did not find that these memes reflected auto-erotic asphyxiation, it could be that some people may more generally interpret sexual choking/strangulation as safe (especially those suggesting that a person may start to crave the feeling of being choked, after having been without a partner for some time). As auto-erotic asphyxiation without the presence of a partner has been associated with heightened risks (Sauvageau & Racette, 2006), this deserves further study. Indeed, subsequent research should examine people’s perceptions of the memes, including what they, themselves, understand the memes as meaning to convey.

Strengths and Limitations

Among our strengths, we used an innovative approach (content analysis of Internet memes) to address an important gap related to the understudied topic of how people learn about sexual choking. Both choking during sex and meme analysis are emerging areas of research; to our knowledge, this is one of the first studies examining how memes may contribute to people’s sexual learning. Also, we examined memes written in both English and Spanish languages and 6 of 10 of our coders were undergraduate students and thus closest to the age groups that most heavily engage with memes.

In terms of limitations, we may have identified different memes related to choking had we used different search terms or searched other social media platforms, or had we searched at a different time (e.g., a year earlier or later). Additionally, other researchers may have approached the coding differently than we did or framed findings differently; for example, it may be that the memes related to lack of consent, blurred lines between IPV and choking, or risk of death could be viewed by others as more closely related than we found in our own analysis. Continued attention to memes related to sexual choking is warranted, particularly as memes can be expected to evolve; as an example, after we had already collected and analyzed data, Spanish memes that referenced were collected, Spanish memes that referenced “Viernes de ahorcar rucas” (“on Fridays we choke girls/women”) went viral, with an Instagram account dedicated to such memes. As of this writing, there are 135 posts and new posts continue to be added. Additionally, social media platforms that are video-based (e.g., TikTok) may represent sexual choking in different ways; subsequent research should examine other forms of media.

Although our research team was diverse in terms of age, disciplinary background, sexual identity, and ethnicity, most coders were women as well as white or white presenting. Further, memes are often objects of humor and can have different meanings and interpretations which may vary by social location; thus, another group of coders may perceive these same memes in different ways. Another limitation is that we lack information on who sees and shares the memes (i.e., how they travel through social media) as well as who largely creates the memes. As the memes in our sample largely reflected choking between women and men, and often romanticized aggression in ways similar to mainstream pornography, subsequent research might examine to what extent the production of these memes may be similar to pornography, which is largely created by and for heterosexual men.

Implications

Our findings have implications for sexuality professionals. The memes in our sample reflect ideas about power in (hetero)mantic relationships, connections between pleasure and danger, as well as more obscure messages about religion, shame, and sexuality. Sexuality educators may find it useful to present Internet memes related to sexual choking (or other emerging sexual practices) to generate class discussions, share interpretations, and challenge assumptions that sexual choking is safe. Educators might use media literacy approaches (Celik et al., 2021) to engage learners in a critical appraisal of the sexuality-related memes, the messages being shared through memes, how humor is used, as well as if or to what extent harmful ideas or stereotypes may be conveyed.

Sexuality educators also need to be aware of the diverse and evolving ways that young people learn about sex and that memes are one such source of information. Given the potentially humorous characteristics of some memes and their tendency to normalize difficult experiences (Shifman, 2013), they may be a particularly engaging factor to include in programming, along with the principles of other media literacy efforts to deconstruct messages in the medium. Educators could even encourage their students to create their own memes that convey healthy messages around sexuality while remaining humorous. Subsequent research might examine what people learn about various sexuality topics from engaging with memes.

Conclusion

The depiction of sexual choking has become mainstream, with depictions on television shows such as Euphoria on HBO and Sex/Life on Netflix normalizing the experience as another form of modern sex. However, there is a paucity of research related to what messages about choking or sexual behavior in general people may be exposed to via Internet memes. Memes may hold special significance for learning new behaviors as they combine humor with a topic and are shared by peers, perhaps resulting in a normalizing effect of the phenomenon depicted (Pech, 2003). Due to the distribution of memes via social media, they may serve to gauge current ideas and beliefs about sexual behavior and evolving sexual practices. Thus, memes may be an important, yet poorly understood, element in the sexual learning of young people. Taken out of social context, memes also offer an engaging opportunity for media literacy and sex education. If examined in those contexts, memes could aid in critical thinking about choking during sex, mitigating the potential influence they have when engaged with on social media (Collins, et al., 2017; Nesi et al., 2021; Sherman et al., 2016).