Chronic elevation of serum S100B but not neurofilament-light due to frequent choking/strangulation during sex in young adult women

ABSTRACT 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.