Breathplay and Erotic Asfixiation
Table of Contents
Breath control play, also known as erotic asphyxiation, is the intentional restriction of oxygen intake for the purposes of sexual arousal. Although often associated with the practices of choking and smothering, it can also be achieved through other means, such as stepping or sitting on someone's chest (known as compressive asphyxia). Other ways to impair one's ability to breathe include breath-holding, nose-pinching, any chest compression (corseting) and direct pressure on the larynx or the trachea, especially over the thyroid and cricothyroid membranes (more about those structures on choking).
To understand the perils of breath play, you should familiarize yourself with some key terms regarding this subject:
Asphyxiation (or asphyxia): deficient supply of oxygen (technically O2 or dioxygen, called "oxygen" for the sake of simplicity) reaching the lungs through the airways, or an inability of the lungs to properly extract O2 from the air into the bloodstream, eventually causing hypoxemia. This also generally implies an inability to release carbon dioxide (CO2) from the bloodstream into the atmosphere, causing hypercapnia.
Hypoxemia: abnormally low levels of oxygen (O2) in the bloodstream. Eventually leads to generalized hypoxia.
Hypoxia: lack of adequate oxygen supply to a body tissue. It may be generalized (affecting multiple regions of the body) or local (restricted to one specific region).
Hypercapnia (or hypercarbia): abnormally elevated carbon dioxide (CO2) levels in the bloodstream. CO2 levels are actually what mainly drives breathing in the brain's respiratory center, not O2, as many think. This is a technical detail, but an important one for those who want to better understand this topic. Under "sources for additional reading" below you will find links for where you can learn more about the physiology of respiratory drive.
Although there are clinical differences between hypoxemia, brain hypoxia and hypercapnia, it is enough for the general BDSM practitioner to be aware of the symptoms related to all of those instances in conjunction, which we will simply refer to here as red flags of asphyxiation:
- Rapid breathing and heart rate;
- Full, bounding pulse;
- Visible use of the chest and abdominal muscles to breathe;
- Cyanosis (bluish or purplish discoloration of the skin or mucous membranes, such as on the lips);
- Confusion or lethargy;
- Syncope (passing out).
The tricky aspect of breath play is that some of these instances are often desired by those who enjoy this practice. One must be extremely cautious, however, of pushing it too far, since severe consequences may happen, including:
- Stroke and potentially irreversible brain damage;
- Cardiac arrhythmia and subsequent cardiac arrest;
- Death due to either of the above.
Gradually testing your body's limits is paramount for the safety of this kink. Do not hesitate to stop a scene if one of the red flags mentioned above starts to happen. It is also advisable to seek medical assessment to assure there is no untreated underlying respiratory or cardiac comorbidity, which may exponentially increase the risk of this practice.
Disclaimer about autoerotic asphyxiation (AEA): trying to perform breath play by yourself is an extremely risky and life-threatening activity. We do not recommend trying it under any circumstances, as the risk of accidental death is high and there's not much to be done if something goes wrong, considering you'll be alone.
Sources for additional reading
In case of a partner collapse, it might be difficult for a lay person to differentiate a syncope from a cardiac arrest. It is no longer recommended for a non-healthcare professional to try checking for breathing nor pulse, since multiple studies (see sources below) have shown how unreliable that can be. A lay person should no longer try to execute mouth-to-mouth breathing, either. The "hands-only CPR" approach (only chest compressions) is now enforced for this case, as explained below.
Because of this, the conduct in case of a partner collapse should vary, depending on your education in terms of healthcare:
- Physicians, nurses and paramedics should have their Advanced Cardiac Life Support (ACLS) training updated every 2 years to apply it properly
- Other healthcare professionals should have their Basic Life Support (BLS) training updated every 2 years to apply it properly
- Lay people (i.e. non-healthcare professionals) should learn the current "hands-only CPR" approach, according to the 2020 CPR guidelines from ILCOR*.
Hands-only cardiopulmonary resuscitation (HO-CPR) explanation by the American Heart Association (AHA), including a quick video guide
Always know by heart or have it on your phone contacts the emergency number of the country you are in.
* ILCOR (International Liaison Committee on Resuscitation):
- American Heart Association (AHA)
- InterAmerican Heart Foundation
- European Resuscitation Council
- Heart and Stroke Foundation of Canada
- Australian and New Zealand Committee on Resuscitation
- Resuscitation Councils of Southern Africa