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How Bad Is Oral Sex for Your Neck?

Porn stars and doctors weigh in on the musculoskeletal hazards of giving head

In a nifty, stock-photo-heavy slideshow, WebMD lists a series of unfortunate circumstances that can cause neck pain, including “sleeping in a weird position,” hunching over your smartphone and herniated discs. Treatments range from over-the-counter anti-inflammatory pills to invasive surgeries. Conspicuously absent from this slate, however, is the excessive administration of oral sex. 

It certainly fits the bill. “Sustained neck flexion (bending your head forward) and neck extension (bending you[r] head backward) may be a risk factor for developing pain in the neck, shoulder and upper extremities,” explains Febin Melepura, medical director at the Sports & Pain Institute of New York. “If your head is flexed forward or extended backwards for an extended period of time, your muscles will spasm and develop into muscle knots.” He adds that repetitive motion while in an uncomfortable neck position is “a recipe for musculoskeletal injury,” with one of the more severe symptoms being “radiating pain down the arm.”

Uncomfortable neck positions? Repetitive motion? Head flexed forward or extended backwards for an extended period of time? Sounds familiar, right? 

It does for 36-year-old porn star Sarah Vandella, who has dealt with neck pain throughout her 13-year career. She says its cultivation may have partially been due to questionable posture in her past, but is convinced that providing copious amounts of oral sex — during shoots that can last hours — is the primary cause. “I’ve coined the term ‘blow-job neck,’” she says. “To be really good at blow jobs you’ve got to hurt your neck a little bit.”  

Throughout her tenure in porn, Vandella has developed a series of remedies for blow-job neck, treating it with heat, ice, and sometimes, Tiger Balm muscle rub. Pre-shoot stretches — tilting her head to one side and, with that same side’s hand, lightly pulling it closer to the shoulder — are a must, and she sees a massage therapist two or three times a week. (“Much like the secretary that develops carpal tunnel syndrome in their wrist, porn stars have their specific occupational hazards,” Melepura says.) Yoga helps a lot, too, and she sleeps with a Tempur-Pedic curved neck pillow, bringing it on the road with her in a special case. She’s also minimized her caffeine intake. “If I drink too much espresso, I start to tense up and feel that tension in my neck,” she says, offering that acupuncture treatments might be in her future as well. 

Melepura champions a number of these treatment methods, and suggests that, if a case of neck pain doesn’t subside after seven to 10 days, the stricken should seek the care of a pain-management specialist. “They will assess if you’ll need different medications and to start physical therapy, occupational therapy, transcutaneous electrical stimulation and/or acupuncture,” he says. “They’ll also determine if further diagnostics evaluation is needed (e.g., X-ray or MRI), especially if the pain has been reoccurring for a long time.”

Despite the constant neck discomfort she experiences, Vandella says she’s still willing to give head for long stretches of time. When she pulls shifts at Mustang Ranch, a brothel in Sparks, Nevada, she says she can fellate a client for up to a half hour before she feels the need for a break. The most problematic of positions: taking a man in her mouth from underneath him, or if her head is resting over a ledge or the end of a bed. “Then I’d just probably be a little more mindful of the rhythm,” she says. 

Most of the male talent Vandella has worked with are sensitive to such needs. “These are pro guys who have been in the business for years,” she tells me. “They know how to make something look rougher than it necessarily is.”

But when it comes to the severity of her blow-job neck, size and shape does matter. “If he’s got one of those straight cocks that’s any-position-friendly, I can move around it and do what feels good for me, too,” Vandella says. “If it’s curved, I generally have to come from a certain side.” That can be challenging should she wish to execute the deep-throat technique for an extended period of time. In choosing to proceed with repeated deep throats, she’ll oscillate between a couple of different angled approaches that prove pathways to success (and alleviate any pain).

Pornstar Emma Hix, 22, also says her neck gets “extremely sore” from conducting oral sex on a man during shoots. She, too, stretches her neck, gets weekly massages and treats the muscle pain with hot packs at home in the evening. “Sometimes it’s hard when I’m super into the scene, or I’m distracted, so I won’t feel the pain until after the scene is over,” she writes over email. “I try to do continuous takes, and if I do feel pain, I’ll take a break, usually around five minutes in.”

Offering women oral pleasure, on the other hand, can be less painstaking. Because while a performer typically has to be “open to the camera” during blow-job scenes — so that the lens captures their face and their partner’s parts, tilting the administrator’s head and insufficiently supporting their neck in the process — porn for a more female-forward audience tends not to be as interested in so many tight vaginal shots, allowing the oral-giver’s head to be supported by both legs of her partner. 

The body part of the giver that suffers most in these oral sex scenarios is the actually the frenulum — the membrane fold connecting the tongue to the floor of the mouth (there’s also a frenulum on the penis, but that’s a different story). “You know you eat good pussy when that piece of skin is ripped to shreds,” Vandella declares. 

Meanwhile, Nathan Bronson, 31, who’s been a porn performer for four years, says he often arrives on set without an oral sex segment to shoot — the dominant straight male audiences just aren’t that into them (annoyingly, they’re not that into eating pussy IRL, either). So he hasn’t dealt with much neck pain from porn. “The girls have a rougher time with that because they have a lot more scenes focused on blow jobs,” he tells me. “For a guy, it’s going to be hurting mostly in the hip area, the pelvis and the core. That’s where it gets really tight.” 

But when Bronson does prepare for a scene that requires some oral techniques, he’ll ask his female scene partner what she likes so the director can more quickly catch the footage they need, keeping Bronson’s neck muscles intact, and helping everyone on set clock out faster. “I ask the girls beforehand, ‘Would you like lots of pressure on your clit? Do you like subtle pressure? Do you just like me to blow on it? Do you want me to finger the fuck out of you?’” Bronson explains. “I’ve had some girls who want me to chew on their clit, and I’ve had some girls that don’t even want me to touch it at all.”

Most of the neck discomfort he’s experienced in his life from giving oral sex has come during private encounters, particularly while 69-ing, with his head propped up to reach his partner’s vagina. As with Vandella, the jaw and tongue become far more stressed than the neck after going down on a woman for a long time, he says.

And what about viewers? As it turns out, even watching porn could lead to injury as well — in the neck and just about anywhere else. Usually, this is because people try to mirror what they see in porn in their real-life interactions, a move that doesn’t always bode so well. 

“Porn is awesome entertainment, a good portion of the time, [but] unfortunately people use that as a measure of how to do things,” says Rosalyn Dischiavo, founder and director of the Institute for Sexuality Education & Enlightenment, and author of The Deep Yes: The Lost Art of True Receiving. Porn producers choose the most titillating, exciting moments from a shoot and splice them together to create a scene that’s optimal viewing for its masturbating audience, Dischiavo observes. “And there’s nothing wrong with that except that people unconsciously, then, think that’s what sex looks like,” she continues. 

She’s not surprised to learn of pornstars with neck pain manifesting from oral sex, because “they’re doing it in a highly energetic fashion.” She does mention, though, that there’s less risk of injury and great pleasure to be enjoyed during sex by slowing things down, and suggests that while fellating a male, the giver introduces one or both hands into the mix, which is “extremely pleasurable and often preferable.” 

Better yet, she adds, “The best oral sex that someone can give is oral sex that they enjoy. Because if they enjoy it, they’re going to want to do it more often, and if they enjoy it, their partner can tell they’re enjoying it, and that’s going to add to their enjoyment, too.” 

Everyone wins — except maybe your chiropractor.