Mar 202017
 

The term “gender and sexual minorities” isn’t just sexual orientation and gender identity. It also includes relationship structures, like non-monogamy, and sexual practices. Perhaps the most common minority sexual practice is BDSM/kink. BDSM stands for bondage, dominance, submission/sadism, and masochism. The terms BDSM and kink are roughly interchangeable. For today’s article I’ll be using the term kink.

Kink is an activity between consenting adults for the purpose of creating intense physical and/or psychological experiences. The intense sensations can range from physical restraint (bondage) to tickling to pain. Psychological experiences can include role playing and voluntary power exchanges. Power exchange is where one person “takes control” for a period of time. Fetishes are common. Experiences are often called “play.” There can be significant overlap between kink, polyamory, sex positivity, and LGBT communities.

As many as 2-10% of people enjoy kink. Many more have thoughts of it. Some prefer kink activities over non-kink activities. Others identify as kink-oriented or kinky. Kink-oriented people see it as part of their identity, like being gay. Still others only enjoy it from time to time. They dabble but don’t feel strongly attached.

Unfortunately, kink is heavily stigmatized in the United States. As a result kink-oriented people are afraid of “coming out”. There is also minimal understanding or acceptance of kink in the medical community. In fact, it is often confused for abuse or intimate partner violence. Patients who practice kink may not be able to get the healthcare they need.

The Kink Health Project
Rope

Rope is commonly used in kink

So what about the study? Today’s study, the Kink Health Project, was a qualitative study. The researchers came together with community members and asked open ended questions. They collected the free-form information and found themes. Aside from the demographics, no statistics here, just concepts and idea.

The study was done in the San Francisco Bay Area in California. TASHRA played a huge role. The study was designed with input from 16 community members. Then there were large “town hall” meetings, small focus groups, and interviews. So participants could keep the level of privacy they wanted. Researchers asked about experiences and thoughts about health care and kink.

In total, 115 people participated. Although they were mostly non-heterosexual (79%) and white (81%), they were also diverse in terms of age, experience in kink, and gender identity. 19% were gender non-conforming. Preferred kink role (dominant, submissive, or switch) was evenly distributed across the participants.

Despite concerns of stigma, 44 participants had visited a health care provider for a kink-related concern. 38% were “out” to their provider about practicing kink.

Themes

When researchers analyzed the data, they saw five themes emerge:

  • Physical health
  • Sociocultural aspects
  • Stigma’s impact on interactions with physicians
  • Coming out to health care providers
  • Kink-aware medical care

Physical health is perhaps the easiest aspect to grasp. Many of the practices in kink can impact health. The most common injuries in this study include bruising and related trauma, broken skin, nerve damage, fainting, burns, and needle-sticks (and other blood exposure). Despite these risks, some participants reported better physical health because of kink. They felt better about themselves. So they took better care of themselves.

As part of taking care of themselves, they wanted specific testing. Participants wanted the ability to have more frequent or complete STD or blood-bourne disease testing. They wanted testing based on their own individual risks. Not testing based on the population at large. Population risks often simply didn’t apply. It’s like pregnancy testing a lesbian who’s never had sex with a man.

Most said they got health information from their communities, not physicians. Why? Certainly they did want good health information. They especially wanted individualized medical care so they could play safely. So why get information from the community? Because they had a lot of fear of stigma from medical professionals. And because healthcare professionals don’t often know about kink, they could get better knowledge from the community. Groups like the Society of Janus exist specifically to spread knowledge.

Participants interacted with healthcare professionals differently because of the fear of stigma. They hid their activities. Some even gave false information. Others delayed appointments until bruises faded, or tried to hide marks from their play.

One area of particular concern was the fear that kink would be confused for domestic violence. Health care providers are often taught that “Bruises = abuse”. This is not always the case. Women in particular were afraid of this confusion. Delays in seeking health care were commonly reported.

Those who did come out to their health care provider, and they did have good experiences. However they were also in the San Francisco Bay Area. San Francisco is well known for being an accepting place. So participants suspected their positive experiences were probably unusual.

How can health care providers do better?
Kink Pride Flag in San Francisco

Kink Pride Flag in San Francisco

Participants in the Kink Health Project brain stormed ways that the medical profession can serve their needs better. Here are some:

  • Differentiate between domestic violence and consensual activities
  • Ask open ended questions about sexual behavior
  • Individualize screenings for sexually transmitted infections and blood-bourne infections
  • Acknowledge alternate family structures, including multiple partners
  • Provide non-judgmental counseling on decreasing risks
What can a kinky patient do?

So what can a kink-oriented patient do to potentially improve their experience in health care?

  • Consider coming out to your provider. This is an incredibly individual decision, however. Only do so if you think you’ll be safe
  • If and when you come out, give that provider resources. TASHRA is probably the best resource to start with.
  • Emphasize your desire for safety and the consensual nature of your activities. A health care provider’s first concern should be your safety. They need to know that no one is truly causing you harm.
  • If you need to, ask for a referral or seek another opinion. Not all providers are going to be comfortable treating kinky patients. It is, however, their responsibility to refer you to another provider if they’re not able to provide the care you need.

And remember: You deserve to have a health care provider who treats you with respect.

Want to read the study for yourself? The abstract is publicly available

Aug 152013
 

Rope (often used in BDSM ) smiley face - CC BY 3.0 Rose Lovell

A new psychological study of BDSM practitioners has just been published. This is the first such research to specifically examine the “Big Five” personality characteristics.

For those of you not interested in the nitty-gritty, here’s the digest: As a group, people who practice BDSM report a better sense of well-being and are more open to new experiences, extraverted, conscientious, and less sensitive to rejection than people who don’t practice BDSM. As with all correlations, this does not mean that BDSM activities caused these differences. Rather, people with these characteristics may be more likely to investigate BDSM.

Are you interested in the details? Cool! Let’s break this study down then.

First, some basics on BDSM. As some readers may remember, BDSM is an acronym standing for: Bondage, Dominance/Submission, SadoMasochism… and probably a few others besides. BDSM is considered an “alternative” sexuality and is highly stigmatized here in the United States. BDSM is often misrepresented as a purely sexual practice focused on pain. In truth, it’s often more sensual than sexual or painful. Many forms of BDSM “play” involve no sex or pain at all. Specific practices vary a lot depending on the people involved**.

Within BDSM, a person is typically in one of three roles: dominant (dom/domme), submissive (sub), or switch. The terms are fairly self explanatory. Dominant “has” control, submissive “gives” control, a switch is someone who switches roles*. Sometimes being a dom/sub/switch is referred to as an orientation, sometimes it’s a role for a particular activity (“scene”)***.

What about these personality characteristics? In personality psychology, there’s the concept of the “big five” personality characteristics, OCEAN: Openness, Conscientiousness, Extraversion, Agreeableness, and Neuroticism. Personality characteristics are thought to be innate. You’re born with a certain personality, and it’s relatively unchangeable. Each of the “big five” can be thought of as a line, and each person falls somewhere along that line. To wit….

  • Openness: How open to new experiences are you? Open vs cautious
  • Conscientiousness: How tidy, thorough and responsible are you? Organized vs careless
  • Extraversion: How much do you enjoy being around other people? Extravert vs introvert
  • Agreeableness: How trusting and cooperative are you? Friendly vs cold
  • Neuroticism: How easily do things tip you emotionally off balance? Easily upset vs steady

Some of these traits are associated with greater happiness and resiliency (e.g., Openness, Agreeableness and Extraversion) whereas others are associated with mental instability or illness (e.g., Neuroticism). There are nuances, overlaps, and arguments over these concepts that I won’t address here, but I hope that gives you a good starting place for understanding the study results. Let me know in the comments if it doesn’t and I’ll gladly expand. This study looked at more than just the “big five”. It also included measures of rejection sensitivity, attachment style, and subjective well being.

So why look at the “big five” and all those others in the context of BDSM? The arguments of the researchers make some sense. While BDSM and the “big five” have not been directly compared before, there is some evidence that the “big five” is associated with certain sexual attitudes. The more open you are, the more permissive your attitudes around sex. The more neurotic you are, the less stable your relationships, thus impacting your sexual life. And so on. Similarly, people with secure attachment styles are more likely to have a wide variety of sexual behaviors and better trust with partner(s) than people with insecure attachment styles.

So we have our variables: the “big five”, rejection sensitivity, attachment style, subjective well-being. What about our participants?

BDSM participants were 902 Dutch people, 464 male and 438 female (no mention of trans or genderqueer folks), recruited from one Dutch BDSM forum. Control participants were 434 Dutch people screened for BDSM behavior, 129 male and 305 female, recruited from magazine ads or websites having to do with “secrets”. Men in the study were older than women. I’m really not sure this control is an adequate control for this study because of the recruitment methods… but I’m not sure it’s not either. Differences between the groups? There certainly were some other than the practice of BDSM. There were significantly more women in the control group than the BDSM group. The control group was younger and less well educated than the BDSM group, although both were more well educated than the average Dutch citizen. Whether these differences affected the study results is unknown, but a possibility.

The researchers also note a gender difference between roles in the BDSM group. Men were 33.4% submissive, 18.3% switch, and 48.3% dominant identified. Women, on the other hand, were 75.6% submissive, 16.4% switch, and 8% dominant. This is certainly reflected in the stereotypes associated with BDSM activities.

Results included:

  • People who practice BDSM were more Open, Extraverted, and Conscientious than the control participants.
  • People who practice BDSM were less Neurotic and Agreeable than the control participants
  • People who practice BDSM were less sensitive to rejection than people who didn’t practice BDSM. Within the BDSM participants, submissives were more sensitive to rejection than dominants
  • People who practice BDSM had a greater sense of well-being than control participants. Dominants scored the highest on well-being.
  • Relatively few differences between BDSM participants and control participants was found when attachment styles were examined. When there was a difference, BDSM participants had a more secure attachment than control participants.

Effect sizes were small to medium. That is about average for a psychological study.

The OCEAN results make sense within the context of BDSM. In order to even try BDSM activities, you’d need to be open to new experiences. Conscientiousness is also valued, in order to be safe. Extraversion is helpful within a community setting. The rejection sensitivity results also make sense to me – a timid person may not continue to explore BDSM after one or two rejections. But this is all after-the-fact reasoning, and not particularly predictive or scientific.

The authors note that these results contradict the long-standing assumption that women who participate in BDSM so do because they were abused as children. But they didn’t ask directly about childhood sexual abuse. Rather, they draw this conclusion from the established relationship between attachment styles and abuse history. Childhood abuse is associated with insecure attachment. But in this study, BDSM folk were more likely to have a secure attachment than the control group. I think this logic is fairly sound, though a definitive answer will need to wait for a study where childhood abuse is specifically asked about.

The most obvious limitations to this study are the participants. The BDSM and control participants were not necessarily comparable, and there were significant known differences between the groups. Those differences could have affected the study’s results. Also, as usual, this study’s results may not be generalizable to BDSM communities in other countries (e.g., the United States).

Despite the limitations, these results are a delightful breath of fresh air, when so much of the literature treats BDSM as psychopathology. People who practice BDSM has long argued that there is nothing inherently “wrong”, “sick” or “dangerous” about their sexuality. These results absolutely support their assertion. The study authors state “We therefore conclude that these results favor the view […] that BDSM may be thought of as a recreational leisure, rather than the expression of psychopathological processes.” Yes, yes and yes.

The study was published in the Journal of Sexual Medicine. The abstract is publicly available.

* This is a highly simplified description. Power, and the exchange of power, is complex.

** It’s important to note, though, that for many people who participate in BDSM pain is very important, if not the central experience.

*** In addition to Dom/Sub/Switch, there’s also the idea of “topping” and “bottoming”. Topping and bottoming are much more transitory than Dom/Sub/Switch. In any particular activity, the Top is the “do-er” and the Bottom is the “do-ee”. But being Top or Bottom is activity specific and not as much of an orientation as Dom/Sub/Switch.

Jul 022013
 

CC BY-NC-ND 2.0 by flickr user aling_

Time for the last month’s news. Hope you all are having fun out there. This month’s image is the theoretical flower for the month: the rose.

Gender-related news…

  • A preliminary report presented at the Endocrine Society meeting in June appears to confirm that cross-sex hormone therapy is safe in the short term (12 months). Summary.
  • Finasteride, a commonly used anti-androgen used to prevent hair loss in both cisgender men and transgender women, has now been reported to reduce alcohol consumption. Summary.
  • GnRH agonists, also called “puberty blockers”, have been shown to be safe in one study. The prime concern for years has been about bone health. Previous studies had shown a drop in bone density while on the medication. This new study confirms that bone density returns to normal after going off GnRH agonists. Summary. This study will be covered more thoroughly in a later blog post.
  • The folks at Skepchick did a wonderful piece on a recent news article on an intersex person. Check it out!

Sexuality

  • In high doses, testosterone appears to help cisgender women retain their sex drive after hysterectomy/oophorectomy. The rub? Testosterone should be given either through the skin (creams, patches, etc) or by intramuscular injection. Summary.
  • Many cisgender men are now being treated for “low testosterone levels”… when their testosterone levels were never checked. This could be very risky. Summary.
  • Exodus International has apologized to gay people and closed down. Exodus was well known for its promotion of reparative therapy for gay people. Summary.
  • The American Medical Association has come forward arguing that the ban against blood donation by men who have had sex with men (the “gay blood ban”) should be lifted. Summary. The FDA recently reviewed their policy, but decided that the ban should stay. Currently in the United States, any man (male-bodied) who has had sex with a man since 1977 is ineligible to give blood. Additionally, any woman (female-bodied) who has sex with a man who had sex with a man since 1977 is ineligible to donate for the next 12 months. The FDA’s policy on trans folk is unclear, but some trans folk report being turned away because of their gender identity.
  • A case report of “foot orgasm syndrome” was reported in the literature. A woman reported having orgasms whenever her feet were stimulated. Summary.
  • A study found that people who practice BDSM (bondage, dominance/submission, sadomasochism) are not psychologically “sick”. Summary. I’ll be covering this study in a later post. It’s interesting and need a lot of breaking down.
  • A study by Durex reports that the vast majority of people enjoy sex most when they are emotionally attached to their partner(s). Summary. Because a sex study conducted by a condom maker is totally not biased.

And the biggest item of news? The US Supreme Court declared that Section 3 of the Defense of Marriage Act was unconstitutional. Federal and state governments are currently scrambling to figure out all the ramifications. And Proposition 8, here in California, was effectively reversed. Marriage equality now exists in my home state. Yipee!

Did I miss a piece of news? Let me know in the comments!

Jul 022011
 

I’ve gotten some questions in, so it’s time to do a question and answer post!

~~

Question: Can urethral sounding be done with cooking oil?

Answer: NO. Cooking oil = edible fat = energy. Micro-organisms (like bacteria) can use it as a source of food. Using cooking oil in the urethra can increase your chances of a urinary tract infection (or bladder infection or kidney infection…). Use a lubricant without glycerin instead.

 

Question: Can rubber urethral sounds be used by women?

Answer: Rubber should not be used for sounds for women or men. Why? They cannot be sterilized at home. The recommended method of sterilization (very hot steam in a pressure cooker) will ruin the rubber (Source). Stick to sounds made of stainless steel to be safe.

 

Question: Why does urethral sounding feel good?

Answer: That depends on whether your genitals are male or female. For men, it can stimulate the corpus spongiosum, which can be pleasurable. For women, it can stimulate the Skene’s Gland, which can also be pleasurable.

 

Question: Do heterosexual women get anal cancer?

AnswerYes.

 

Question: What kind of steel is used in genital piercings?

Answer: Surgical steel. There are a few grades of surgical steel that are appropriate. Specifically, “steel that is ASTM F-138 compliant or ISO 5832-1 compliant; ISO 10993-(6,10, or 11) compliant; or (EEC [European Economic Community] Nickel Directive compliant.)” (Source).

 

Question: Can HPV be passed by oral sex?

Answer: Yes. It’s been implicated in head and neck cancers for that very reason.

 

Question: Why is it bad to do rope bondage on joints?

Answer: Two big reasons. First, joints are very sensitive. If they get damaged, they take a long time to recover and may not recover at all. So it’s best to avoid damage. Second, a lot of nerves and blood vessels travel through joints. This makes them ideal for cutting off blood/nerve supply to a limb… definitely a no-no.

 

Question: Can a post-operative transsexual have an orgasm?

Answer: Yes. The quality of the orgasm may be different than it was before transition. A recent study came out about sexual health for transmen.

 

Question: Would a genital piercing affect the way I pee?

Answer: If it passes through the urethra, yes. If it could be in the path of the urine, yes (e.g., labia or foreskin piercings). Otherwise, probably not.

Jun 252011
 

Bondage(noun): the state or practice of being physically restrained, as by being tied up, chained, or put in handcuffs, for sexual gratification. Bondage can be done with many materials, including: rope, chains, body wraps, and cuffs (whether metal, leather, hand- or thumb-). Today we’re focusing on rope bondage.

A few notes before we begin: First, remember BDSM should never be done without consent. Also, consider using a safeword. Second, some acts may be illegal in your jurisdiction. Please check your laws and choose your actions accordingly. Third, I won’t be talking about suspension, or self-bondage. Those are topics for another time. And lastly, for simplicity’s sake, I’m going to use the term “top” for the person doing the tying, and “bottom” for the person being tied.

Rope? Yep, rope. What kind? Many kinds! Multifilament, nylon, and hemp are common materials for rope. Natural materials usually need some conditioning before use. Make sure the rope doesn’t have the potential to splinter, stretch or shrink.

A warning: Do Not use things like ribbons, scarves, or ties instead of rope. They narrow as they tighten and can end up cutting through skin. Ow!! Essentially: don’t use ribbons/scarves/etc any place you wouldn’t be willing to use dental floss.

Safety concerns:

  • Falling: Restrained arms and legs limit how well the bottom can balance. This increases the chance of a fall. If the bottom’s arms or hands are tied, they may not be able to catch themselves. Falls can be avoided by: a) having the bottom sitting, lying down, or leaning, b) watching the bottom carefully, c) making sure they don’t get lightheaded, d) tying certain areas but not others (e.g., the ankles, but not the hands).
  • Fainting. Yes, bottoms can and do faint. Some people are more prone to fainting than others. Bondage can create a light-headed sensation. Be careful when doing bondage with those at higher risk.
  • Joint issues. The positions involved in some bondage can make some joint problems worse. Choose positions accordingly, and change positions as needed. Discomfort should be taken seriously, since it can signal an imminent problem, like torn ligaments or dislocated joints. Ow!
  • Restricted blood flow. Without fresh oxygen, provided by blood flow, tissue can die. Dead tissue cannot magically recover. Check bound extremities (hands and feet) frequently. If they are cool to the touch or pale in color, loosen the binding. Also watch out for tingling and burning sensations.
  • Rope burn. Rope can burn skin when it’s dragged across it, just like a carpet burn. Synthetic fibers are particularly prone to this. Slow down.
  • Nerve damage. Tingling and/or numbness in a limb? Loosen the rope immediately! The best way to help prevent this is to communicate frequently.
  • Breathing constrictions. Some positions can make breathing difficult – avoid these or limit the bottom’s time in them and communicate frequently.
  • Emotional. Bondage can be a very emotional experience. Aftercare is highly recommended. If you think you might need professional help, there are bondage-friendly professionals you can turn to.

Special precautions may need to be taken with people with certain medical conditions, like diabetes (which affects circulation), fibromyalgia, or joint problems.

So… how can you improve the safety of rope bondage?

  • Frequent, open, and clear communication before, during and after the experience. Don’t just rely on a safeword!
  • Be careful about who you do bondage with. This goes for both tops and bottoms – both are vulnerable here.
  • Be very careful about mind-altering substances, like alcohol and marijuana. Many people avoid them altogether when doing BDSM. The ability to think and judge clearly is very important for safety.
  • Never tie certain areas of the body, like the neck and joints. I really do mean Never on this. Neck restriction can choke, and joint restriction can do a lot of damage. Just don’t do it.
  • Make sure the rope isn’t too tight. One way to tell is the “one finger” rule: Can you slide one finger between skin and rope?
  • Keep EMT (bandage) scissors nearby, just in case. They’re designed to cut fabric off skin without hurting the skin.

Curious? Want more information? Check out these resources (recommendations are always appreciated!):

  • SM 101 by Jay Wiseman. Has a good beginner’s section on bondage, including technique and rope selection.
  • Bondage safety on Wipi
  • Wikipedia’s article
  • TwistedMonk.com has tutorials
  • Graydancer’s Ropecast (a podcast)
  • And, as always, your local BDSM community and its workshops. Can’t find your local group? Try your adult shops, or FetLife.