Being strangled, or “choked,” by a sexual partner has emerged as a prevalent, often wanted and consensual sexual behavior among adolescent and young adult women, yet the neurological consequences of repeated exposure to this behavior are unknown. The objective of the study was to examine the association between a history of repeated, recent choking/strangling episodes during sex and fMRI activation during working memory tasks in young adult women. This case-control study involved young adult women (18–30 years old) at a large, public university, and consisted of two study groups: a choking group consisting of participants who were recently and frequently choked/strangled during sex by a partner (≥4 times in the past 30 days) and a choking-naïve (control) group who had never been choked/strangled during sex. Participants completed two variations of the N-back (0-back, 1-back, and 2-back) working memory task during functional magnetic resonance imaging (fMRI): verbal and visual N-back tasks. Data from 20 participants per group were available for analysis. Between-group differences for accuracy and reaction time were not significant for either variation of the N-back task. Significant differences in fMRI activation patterns were detected between the choking and the choking-naïve groups for the three contrasts of interest (1-back > 0-back, 2-back > 0-back, and 2-back > 1-back). The choking group exhibited increased activation in multiple clusters relative to the choking-naïve group for the contrasts between the 1-back and 2-back conditions compared to the 0-back conditions (e.g., superior frontal gyrus, corpus callosum). However, the choking-naïve group exhibited increased activation relative to the choking group in several clusters for the 2-back > 1 back contrast (e.g., splenium, middle frontal gyrus). These data indicate that recent, frequent exposure to partnered sexual strangulation is associated with different neural activation patterns during verbal and visual working memory tasks compared to controls, suggesting that being choked/strangled during sex may modify the allocation of neural resources at increasing levels of cognitive load. Further investigation into the neurologic effects of this sexual behavior is warranted, given the prevalence of sexual choking among adolescent and young adult women.

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Being choked/strangled during a partnered sex is an emerging sexual behavior, particularly prevalent among adolescent and young adult women, but the neurobiological impact of choking remains unknown. This case-control study aimed to test whether frequent choking during sex influences neurological health in young adult women, as assessed by serum levels of S100B and neurofilament-light (NfL). Participants who reported being choking ≥4 times during sex in the past 30 days were enrolled into a choking group, whereas those without were assigned to a control group. Serum samples were collected and assessed for S100B and NfL levels. Demographic questionnaires as well as alcohol use, depression, and anxiety scales were also obtained. Fifty-seven participants were enrolled initially. Due to voluntary withdrawal, phlebotomy difficulties, and scheduling conflicts, the final sample size of 32 subjects (choking n=15; control n=17) was eligible for analysis. After adjusting for a significant covariate (race), the choking group exhibited significantly elevated levels of S100B relative to controls (B=13.96 pg/mL, SE=5.41, p=0.016) but no significant group differences in NfL levels. A follow-up receiver operating characteristic analysis revealed that serum levels of S100B had very good accuracy for distinguishing between the choking and control groups [AUC=0.811, 95%CI (0.651, 0.971), p=0.0033]. Our S100B provide evidence of recurring astrocyte activation due to frequent choking while the NfL data indicate that axonal microstructural integrity may be resilient to these transient hypoxic stressors. Further clinical investigation is needed to clarify the acute and chronic neurological consequences of being choked during sex using a multimodal neurologic assessment.

IntroductionBeing choked/strangled during partnered sex is an emerging sexual behavior, particularly prevalent among young adult women. Using a multiparameter morphometric imaging approach, we aimed to characterize neuroanatomical differences between young adult women (18–30 years old) who were exposed to frequent sexual choking and their choking naïve controls.MethodsThis cross‐sectional study consisted of two groups (choking [≥4 times in the past 30 days] vs. choking‐naïve group). Participants who reported being choked four or more times during sex in the past 30 days were enrolled in the choking group, whereas those without were assigned to the choking naïve group. High‐resolution anatomical magnetic resonance imaging (MRI) data were analyzed using both volumetric features (cortical thickness) and geometric features (fractal dimensionality, gyrification, sulcal depth).ResultsForty‐one participants (choking n = 20; choking‐naïve n = 21) contributed to the final analysis. The choking group showed significantly increased cortical thickness across multiple regions (e.g., fusiform, lateral occipital, lingual gyri) compared to the choking‐naïve group. Widespread reductions of the gyrification were observed in the choking group as opposed to the choking‐naïve group. However, there was no group difference in sulcal depth. The fractal dimensionality showed bi‐directional results, where the choking group exhibited increased dimensionality in areas including the postcentral gyrus, insula, and fusiform, whereas decreased dimensionality was observed in the bilateral superior frontal gyrus and pericalcarine cortex.ConclusionThese data in cortical morphology suggest that sexual choking events may be associated with neuroanatomical alteration. A longitudinal study with multimodal assessment is needed to better understand the temporal ordering of sexual choking and neurological outcomes.

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Symptomatic concussed athletes (tested within ~7 d of injury) exhibit an attenuated rise in blood pressure and heart rate during the cold pressor test (CPT), which is indicative of sympathetic hyporeactivity. However, resting blood pressure is elevated following a sports season that has a high incidence of repetitive subconcussive head impacts (SHI) which suggests autonomic or vascular dysfunction. A single session of experimentally induced repetitive SHI increases circulating biomarkers of neuronal injury. In this context, it is unknown if a session of repetitive SHI alters autonomic function. PURPOSE We tested the hypothesis that the sympathetically‐mediated rise in heart rate and blood pressure during the CPT would be attenuated following a session of repetitive SHI in healthy young adults. METHODS Ten healthy participants (age: 20±2 y; 6 females) with ≥3 years of soccer heading experience completed three separate study visits. The CPT (left hand submerged up to the wrist in agitated 0°C water for 120 s) was conducted before soccer heading (0h) and at 2 h (2h), 24 h (24h), and 72 h (72h) after soccer heading. 20 SHI were completed using a soccer heading protocol (ball projected at ~11.2 m/s from 12.2 m every 30 s). Heart rate (HR; 5‐lead electrocardiogram) and beat‐to‐beat blood pressure (MAP; finger photoplethysmography) were continuously recorded at 1 kHz. Mean HR and MAP were extracted during the final minute of the CPT baseline (BL) and every 30 s throughout the CPT. We used mixed‐effects ANOVAs to compare the change (∆) from BL between and within experimental visits. Values are reported as ∆ BL (mean ± SD). RESULTS There were no differences across timepoints at BL for HR (0h: 58±9 vs. 2h: 60±7, 24h: 59±8, 72h: 62±9 bpm; P=0.19) or MAP (0h: 98±15 vs. 2h: 99±9, 24h: 89±8, 72h: 95±8 mmHg; P=0.09). There was a main effect of time post SHI for ∆ HR (P<0.01) but multiple comparisons did not reveal where differences occurred between 0h (8±6 bpm) vs. 2h (9±7 bpm; P>0.99), 24h (10±7 bpm; P=0.19), and 72h (8±6 bpm; P<0.99). The mean ∆MAP throughout the CPT was lower at 0h (17±13 mmHg) vs. 2h (21±15 mmHg; P<0.01), 24h (23±17 mmHg; P<0.01), and 72h (20±16 mmHg; P<0.01). The ∆MAP during the CPT was lower at 60 s of 0h vs. 24h (24±12 vs. 31±13 mmHg; P<0.01), at 90 s of 0h vs, all post‐SHI (0h: 28±14 vs. 2h: 34±12, 24h: 38±12, 72h: 33±13 mmHg; P<0.01), and at 120 s of 0h vs. all post‐SHI (0h: 27±15 vs. 2h: 33±12, 24h: 37±10, 72h: 34±13 mmHg; P<0.01). CONCLUSION Contrary to our hypothesis, these preliminary data indicate that a single session of repetitive SHI does not attenuate sympathetically‐mediated cardiovascular responses to the CPT. The increase in HR was similar before and after soccer heading; however, the increase in MAP was exacerbated during the CPT at all post‐SHI time points. Thus, there appears to be sympathetic hyperreactivity following a single session of repetitive SHI. This sympathetic hyperreactivity might explain the increase in blood pressure following a sports season associated with a high incidenc...

Cannabis is an increasingly popular recreational drug among college students. Prior investigations have shown that acute cannabis use alters heart rate variability via increased sympathetic activation. However, the effects of chronic cannabis use on heart rate variability (HRV) have not been reported. PURPOSE We tested the hypothesis that HRV would be lower in chronic cannabis users (THC) compared to non‐users (CON). METHODS Eleven cannabis users (age: 21±2 y, 2 females) and six controls (age: 20±2 y; 4 females) completed one study visit. Participants in the THC group self‐reported using cannabis at least once per week for the past year or more. Participants in the CON reported to not use for 6 months prior to enrollment. Participants were instructed to abstain from alcohol for 24 h and cannabis for 72 h prior to the study visit. After 10 minutes of supine rest, heart rate (5‐lead electrocardiogram) was continuously recorded at 1 kHz for 5 minutes of supine rest while participants breathed spontaneously. HRV was assessed using linear analysis via Fast Fourier transformation and non‐linear analysis via Poincare plots. The root mean square of successive differences (RMSSD), percent of R‐R intervals that differ by more than 50 ms (pRR50), and the standard deviation of R‐R intervals (SDRR) were calculated to assess HRV in the time‐domain. Fast Fourier transformation was used to assess HRV in the frequency domain (low‐frequency (LF) and high‐frequency (HF) power). Non‐linear HRV analysis was performed using Poincare plots to calculate standard deviation 1 (SD1) and 2 (SD2). We used one‐tailed unpaired t‐tests to determine if the main outcome variables were different between groups. Values are reported as mean ± SD. RESULTS RRI was lower in THC (THC: 917±109 vs. CON: 1018±141 ms; P=0.06). RMSSD was lower in THC (THC: 57±21 vs. CON: 74±24 ms; P=0.07). There was no difference between groups for pRR50 (THC: 36±20 vs. CON: 47±21 %; P=0.12) or SDRR (THC: 68±16 vs. CON: 78±24 ms; P=0.15). LF power was not different between groups (THC: 1105±850 vs. CON: 1321±852 ms2; P=0.31), but HF power was lower in THC (THC: 1353±925 vs. CON: 2256±1195 ms2; P=0.05). SD1 was lower in THC (THC: 40±15 vs. CON: 53±17 ms; P=0.07). SD2 was not different between groups (THC: 86±19 vs. CON: 96±33 ms; P=0.23). CONCLUSION These preliminary data indicate that college‐aged adults who regularly use cannabis have lower heart rate variability than their non‐cannabis user counterparts. Based on linear and non‐linear analyses, it appears that cannabis users have altered cardiac vagal activity at rest. However, more research is warranted to determine if cannabis use alters autonomic function and reactivity.