There are three different types of shrine rooms, and using any one of them the first time will unlock this.
The paths are Wishful, Shrine of Neglect, and Shrine of Sacrifice.
The effects and rewards for the shrines are as follows.
Wishful - Can sacrifice an equipped charm to gain its secondary effects.
Doing this also unlocks Shrine of Neglect - Sacrifice a random primary stat. Do this 5 times in the same room to receive a Bloodstone card. (Legendary Gem)
Shrine of sacrifice - Sacrifice health for souls.
Doing this five times in the same room is the only way to unlock the Choker item for your collection.