Erotic asphyxiation (EA) is the official term for breath play.

This type of sexual activity involves intentionally cutting off the air supply for you or your partner with choking, suffocating, and other acts.

People who are into breath play say it can heighten sexual arousal and make orgasms more intense.

But it isn’t without its risks — and lots of them. It can turn deadly if you don’t take the proper precautions.

Here’s what you need to know to ensure your safety and have a good time.

Many sexual activities carry some risk, but there’s no denying that the several types of breath play have some more significant risks.

“EA is truly very risky and may lead to serious injury, including cardiac arrest, brain damage from lack of oxygen, and death,” says Janet Brito, PhD, LCSW, CST, who specializes in sex therapy.

“Knowing EA may lead to experiencing irregular heart rate, cardiac arrest, and death, most experts advise against it.”

Still, this activity is an increasingly recognized kink, and steps can be taken to make it somewhat safer for the curious.

Different types of breath play pose different risks, and precautions can help you prevent possible issues.

Like many other kinks and sexual curiosities, breath play is of interest to people for many different reasons. Here are three common ones.

Physiological

During breath play, you or your partner restrict oxygen to your brain. This is step one of the process.

When your oxygen levels are low, you may feel lightheaded or dizzy.

But when the pressure is released and oxygen and blood begin to flow again, you may feel another type of rush.

This one is caused by a release of dopamine, serotonin, and endorphins that can cause head-spinning exhilaration.

Psychological

Some breath play fans like the power play element of the arrangement.

As the person in charge, you can choke or suffocate your partner.

Or as the submissive, you can be controlled. Your partner is dominant and guiding the events.

This dynamic provides a second layer of sexual arousal for some people.

Physical

In the immediate aftermath of choking, suffocating, or strangling, your body may confuse the rush of endorphins and hormones as a positive, pleasurable thing.

In reality, those hormones were caused by your body’s protective reaction.

But in the crossfire of emotions and pleasure, these sensations may feel more like “pain is pleasure” rather than warning signals from your brain and body.

If you practice EA alone, it’s known as auto asphyxiation or autoerotic asphyxiation.

Solo breath play is more dangerous than partnered play.

Many people who practice EA alone try to create a “fail safe.” This may include using a knot that’s meant to give way if you pull hard, or hitting your knees on a closet if you pass out.

These strategies are designed to prevent death, but many fail.

A better strategy is to clue a close friend or trusted individual in and ask them to keep watch. This could mean being on standby in the next room or checking on you at a set time.

Breath play can still be dangerous if you’re with a partner. You or your partner may not recognize when the choking or strangulation has gone too far.

This can prolong side effects or increase the risk for serious complications.

If you are curious about EA, the following are essential for safe, enjoyable play.

Education

Take time to learn about the anatomy of the neck, head, and chest. This will help you better understand the limits of pressure and force.

Incremental increases will help you avoid injury, too.

Learning the anatomy will also highlight the importance of proper hand placement, or where to place restraints like belts, scarves, or ties.

The arteries around the neck can take some pressure, but you won’t want to apply a great deal of force at first.

Communication

“Before a couple considers EA, it’s best to set time aside to communicate their interests in detail — specifically what types of boundaries are needed,” says Brito.

Creating a set of nonverbal cues can help create a sense of safety.

Depending on the scene, you or your partner might consider:

  • holding something in your hand, such as your keys, and dropping it when you’d like to stop
  • tapping three times on your partner’s hand or nearby surface
  • snapping your fingers

Consent

Neither you nor your partner can properly give consent when under the influence of drugs or alcohol.

Instead of waiting until you’re a few drinks in, you and your partner should discuss consent for breath play before you’re even in the bedroom.

What’s more, drug and alcohol use during breath play increases the risk for injuries and complications.

Not each type of breath play is equal in terms of risks. Here are some of the most common types and how you should prepare for them.

Choking

Pressing on the outside of your throat cuts off air and blood to the brain from two main arteries. This makes breathing difficult and can lead to the feel-good symptoms of EA.

As long as you avoid intense pressure on the trachea or Adam’s apple, you may be able to practice this type of breath play safely.

Bag over head

Slipping a bag over your head can immediately cut off access to oxygen or greatly reduce it. With too little oxygen, you may grow dizzy or lightheaded.

With a partner, this type of breath play may be safer, but alone, you run the risk of passing out before you can take the bag off your head.

Strangulation

When your body senses blood flow is low, blood pressure increases.

Releasing the strangle hold can cause an intense rush of blood, then euphoric sensations like disorientation and loss of focus.

But strangulation, which may be done with the hands or a belt, tie, scarf, or other instrument, can quickly become dangerous.

If pressure is too great or goes on for too long, it could cause cardiac arrest, even death.

You can help prevent cardiac arrest and death by leaving at least two fingers’ width between the neck and the apparatus used.

This ensures that it isn’t fitted too tightly around the neck, while still allowing you or your partner to make up the difference manually.

Smothering

Having your partner sit on your face, or vice versa, is a popular type of breath play. Sometimes gas masks can accomplish the same end.

This airway obstruction scenario limits oxygen to your brain, which can cause lightheadedness and weakness.

Practiced alone, smothering may be dangerous because you may pass out before you can remove the obstruction.

Smothering may be safer with a partner, but you’ll need a safe word or signal to indicate when the pressure is too great.

Even if you take all proper precautions, you may still experience some side effects.

This includes:

  • coughing
  • disorientation
  • muscle weakness
  • numbness
  • drowsiness
  • loss of coordination

A single side effect isn’t particularly dangerous.

But if you’re practicing EA alone, experiencing multiple side effects at once could prevent you from removing yourself from the scenario.

That can ultimately make them deadly.

Because the line between safe play and danger is so very fine with EA, most doctors and experts advise against it.

These long-term complications are just some of the reasons why.

Brain damage

Every time your brain goes without oxygen, you’re causing brain damage. The cumulative effect of regular asphyxia can be problematic.

Damaged larynx

Pressing down on the larynx can damage the delicate muscular organ.

At the same time, the force may break or fracture the hyoid, a bone in the neck that supports the tongue.

Aspiration

Some of the sensations caused by EA may make you nauseous. This can lead to vomiting.

Though uncommon, some people may end up aspirating the vomit. That means they somehow manage to get vomit into their airway or lungs.

This can cause long-term breathing problems and increase your risk of infection, among other complications.

Heart attack

The chemical makeup of blood changes when oxygen is low. These changes can upset the heart’s natural rhythm and may lead to deadly abnormalities.

Ultimately, this can cause cardiac arrest, though it’s rare.

Orbital subperiosteal hematoma

In one rare instance, a woman who had practiced EA reported to an emergency department with orbital subperiosteal hematoma, or a hemorrhage in the eyeball.

This can lead to permanent vision loss, as well as long-term optic pain.

If your partner has stopped breathing, immediately call your local emergency service. Then begin CPR.

If you know this lifesaving technique, you can perform it right away. If you don’t, the emergency responder will guide you through the process.

If you’re practicing EA alone and experience side effects or complications, seek help from someone in the home with you. You may just need a few minutes to restore blood flow and oxygen.

Call your local emergency service right away if your breathing is unstable or you’re having chest pains.

Because of the potential dangers associated with breath play, it’s a good idea to talk to a professional sex therapist before you attempt any activity.

They can help you learn the proper anatomy, answer questions, and direct you to additional resources.

You can also seek tutorials through classes at local adult shops. Many of these venues host workshops or training sessions.

Keep in mind that many experts actively encourage individuals to steer clear of EA. It can quickly jump from a fun sexual activity to a dangerous pursuit.