Strangulation during consensual sex, also called sexual suffocation, is becoming increasingly normalized in the media and society. Physicians are increasingly aware of the hidden risks, morbidity, and mortality associated with strangulation in intimate partner violence. There are publications and guidelines for the identification and clinical management of intimate partner violence. However, clinicians may not identify patients who practice risky consensual sexual strangulation as part of normal sexual activity. Strangulation is the application of external pressure to the neck that compresses internal structures, including blood vessels, airways and nerves, which can lead to serious and life-threatening consequences. Recent studies show that repeated strangulation can cause both structural and functional changes in the brain even in a consensual context. Strangulation is associated with a higher risk of homicide among those experiencing intimate partner violence. More data from larger samples are needed.