Erotic asphyxia (sexual choking or breath-control play) is a high-risk practice associated with syncope, hypoxic brain injury, and death, yet increasingly normalized in online sexual content. We sought to characterize how erotic asphyxia is portrayed on YouTube, focusing on video quality, safety messaging, and misinformation.

We performed a retrospective content analysis of YouTube videos identified using 16 search terms related to erotic asphyxia. Eligible videos were English-language, had primary erotic asphyxia content, and were viewed between April and November 2025. Trained coders used a standardized abstraction form to collect data on video characteristics, participant demographics, choking techniques, safety messages, and misinformation. Content quality was assessed using the Global Quality Score (GQS), reliability using a modified DISCERN tool, and interrater reliability using Cohen's kappa.

A total of 103 videos met inclusion criteria, with a mean duration of 3.9 ± 2.8 min and a cumulative 3.4 million views (mean 34,702 per video). Content depicted consensual partner choking in 67.0%, nonconsensual choking in 11.7%, and autoerotic asphyxia in 21.3%. Most identifiable participants appeared female (63.8%), Caucasian (59.4%), and aged 20–25 years (51.1%). Thirteen distinct choking or suffocation techniques were described. The median GQS was 2 (interquartile range [IQR] 2–3), and the median modified DISCERN reliability score was 1 (IQR 1–2), indicating low quality and very poor reliability. Only 4 videos (3.9%) included trigger warnings, and 74 (71.9%) contained clear misinformation. Interrater reliability was substantial (κ = 0.79).

Widely viewed erotic asphyxia content on YouTube is low quality, unreliable, and often misleading, highlighting the need for emergency physicians to address sexual choking directly in risk-reduction counseling and for platform-level harm-reduction measures to prevent serious injury and death.