Physical violence in sexual assaults against young people has become more common and more severe. This is shown in a new doctoral thesis from Karolinska Institutet. The studies cover both women and men and point to the need for clearer clinical procedures and better education about consent.

The thesis examines how young women and men experience physical violence in sexual situations, both in consensual situations and in case of abuse. The results are based on a combination of medical record reviews and interviews.
A total of over 1,300 people were included in the quantitative analyses, based on anonymised medical and forensic medical records from the Emergency Department for Rape Victims at Södersjukhuset.

Among young women between the ages of 16 and 29 who sought care in 2012, 2017 and 2022, there was a clear increase in severe violence during the assaults. The researchers found that strangulation had become more common over time.
”This type of violence often occurred in the home and in combination with other forms of violence,” says Frida Larsson at the Department of Global Public Health, Karolinska Institutet, who recently presented her doctoral thesis.

Frida Larsson believes that the increase may be due to greater awareness among healthcare professionals, who have become better at asking questions about strangulation and documenting it. But that does not explain everything, she says.
“We cannot say what is behind the increase, as we have not researched the factors driving this development. It is a complex issue that requires further study before we can draw any firm conclusions about its causes,” says Frida Larsson.

Part of the doctoral thesis also covered young men who sought care after sexual violence.
”The results showed that moderate to severe violence was more common when several perpetrators were involved. Among young men, there was also a link between attempts at self-defence and more extensive violence,” says Frida Larsson.

In addition to reviewing medical records, 24 women and men between the ages of 16 and 24 were interviewed about their experiences of sex, violence and consent. Several described how so-called ‘rough sex’ is often shaped by gender roles and ideas of dominance and subordination. Some experienced this type of sex as voluntary and positive, while others felt uncomfortable. The participants talked about the importance of consent in these practices, as they can increase the risk of boundaries being misinterpreted.

”What we see is that young people know that consent should be clear and mutual, but that there are obstacles in practice. These can include fear of hurting someone, expectations linked to gender, or not wanting to appear uncertain,” says Frida Larsson.

Several participants also described how social media, friends and pornography influence their perception of what is ‘normal’ in sexual situations.

”These influences can make some people feel pressured to do things they don't really want to do, or find it difficult to set boundaries,” continues Frida Larsson.

According to the results of the thesis, better procedures are needed within healthcare to identify and deal with strangulation violence. There is also a need for clearer teaching about consent in schools, with a focus on communication, boundaries and power.

The thesis was supervised by Anna Nielsen, Anna Möller, Anna Mia Ekström and Mariano Salazar. The public defence took place on 13 February 2026.