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!

May 192013
 

I got back from the 2013 National Transgender Health Summit (NTHS) in Oakland last night. What a fabulous conference! I’m still processing a lot of my notes, but wanted to give a quick report on it before I flood the blog with new resources.

First some basic information. NTHS is cosponsored by UCSF’s Center of Excellence for Transgender Health and the World Professional Association for Transgender Health. It’s designed for medical professionals, mental health professionals, advocates, health administrators, students, and others. I can’t speak for previous years, but this year it was a two-day event. Sessions were broken into various tracks: research, medical, mental health, policy, and special topics. And boy, did we cover quite a lot! And, as always, I wanted to be in five different places all at once.

Aside from the official session topics, though, there were some themes that stood out to me…

  • There’s a very strong need for cross-cultural trans care. Trans care, like lots of medicine, has been focused on white people. I admit to being guilty of this too! I don’t know how being trans is handled in, for example, an urban latino/a community, and I don’t know how I can best respond to those needs as a future health care provider. I met some folks who were involved in the Trans People of Color Coalition, and I hope to not only educate myself but bring more awareness to my posts here.
  • There’s a disconnect in some areas between cultural knowledge about medical treatments in trans communities and medical knowledge. I want to give a shout out to Trystan Cotten, author of Hung Jury, for bringing attention to this within trans male communities. One of his examples? Something new for me, certainly: there are anecdotal reports that some trans men can have penetrative sex after metoidioplasty. Sounds like there needs to be a community-level conversation.
  • It sounds so far like the ICD-11 system will handle both the transgender/transsexual diagnoses and the paraphilia diagnoses much better than the previous ICDs and certainly better than the DSM system. More details when the preliminary criteria are out for comment.
  • Insurance coverages for trans-related care may improve with the Affordable Care Act. Again, more on this as information becomes more available.
  • There is a lot of research going on! Yay! I’ll try to link to some of the studies I heard about in a follow up.

Plus so much more! It was really exciting. I hope to post again with more information, links to lots of new resources and shout outs for on-going studies and organizations.

Jan 042013
 

CC BY 2.0 - Maegan Tintari

What is a “paraphilia”? I think Wikipedia’s definition is the clearest, stating that the term “describes sexual arousal to objects, situations, or individuals that are not part of normative stimulation.” The American Psychiatric Association whittles that down to: “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving a) non-human objects, b) the suffering or humiliation of oneself or one’s partner, c) children, d) non-consenting persons”.

According to the American Psychiatric Association, when a paraphilia causes distress to self or others, they are considered mental disorders. The Diagnostic and Statistical Manual IV-TR lists eight specific paraphilias, not including the all-inclusive category of “Not Otherwise Specified”:

  • Fetishism: arousal in response to inanimate objects
  • Transvestic fetishism: erotic cross-dressing
  • Sexual masochism/sadism: arousal when receiving/giving pain or humiliation (respectively). The pain or humiliation has to be real, not simulated.
  • Exhibitionism: arousal when exposing one’s genitals to non-consenting people
  • Voyeurism: arousal when watching non-consenting people doing intimate or sexual acts
  • Frotteurism: arousal when rubbing one’s genitals against a non-consenting person
  • Pedophilia: sexual attraction to pre-pubescent children

The whole concept of paraphilias is under considerable debate in the scientific community. If paraphilias are essentially “abnormal sexuality” then where is the boundary? For example, if being aroused by knee-high black leather high-heeled boots is a fetish (paraphilia), what about nylon stockings? Frilly lacy women’s underwear? What if the clothing is on a person? And so on… the lines are very blurry. Another problematic aspect for paraphilias is that homosexuality was once considered a paraphilia.  There’s a lot more to the debate, but I’m going to have to save it for a post or two of its own.

This study looked at a sample of middle aged, mostly straight adult men in Berlin, Germany; paraphilias are more commonly diagnosed in men, except for sexual masochism. Participants were evaluated via questionnaire for whether they would meet criteria for a paraphilia. Their results are illuminating. 62.4% of their participants reported sexual arousal in response to a paraphilic stimulus. Here’s some of the breakdown:

Fantasy (%) Reality (%) Distress? (%)
Fetishism 30.0 24.5 0
Transvestic Fetishism 4.9 2.7 3.7
Masochism 15.8 2.3 1.5
Sadism 21.8 15.5 0
Voyeurism 34.9 18.0 0.7
Exhibitionism 3.5 2.2 0
Frotteurism 13.4 6.5 1.8
Pedophilia 9.5 3.8 5.3
Not Otherwise Specified 6.3 4.6 6.9
More than 1 58.6 44.4 1.7

 

Where “Fantasy” refers to a sexual fantasy which did not involve masturbation, “Reality” refers to actual sexual experiences, and “Distress” reflects the percentage of participants who reported being upset by their arousal.

There’s a lot of analyzing you can do on just those numbers alone. I want to call attention to the numbers for fetishism (~25%), voyeurism (18%) and sadism (15.5%). I don’t know about you, but I think about things a lot better this way…

  • Roughly 1 in 4 men in this sample had fetishistic experiences, where they were aroused by a non-sexual object.
  • Roughly 1 in 6 men in this sample had sadistic experiences, where they were aroused by the pain or humiliation of their partner(s).
  • Roughly 1 in 6 men in this sample had voyeuristic experiences, where they were aroused by watching others doing intimate things.
  • Further, nearly half of the men had more than one paraphilic sexual experience.
That’s really pretty common for a “mental illness.”

Now, it’s not known how well these participants actually fit the diagnostic criteria for a paraphilia. For example, it’s not known whether the men who participated in sadistic experiences actually had the consent of their partners or not. It’s not known whether the participants were distressing others. But it IS worth noting that very few men were actually distressed by their arousal. Hmm…

The other point of focus I find interesting is the difference between fantasy and reality, and in how much that difference differs between paraphilias. What influenced these participants to not act on their fantasies? Or, from my perspective, what can be done to help some of them express themselves safely with no harm to others, and what can be done to help others (e.g., pedophiles) refrain? What’s going on here? Sadly, I don’t have answers here.

In conclusion, the authors state: “The findings suggest that paraphilia-related experience can not be regarded as unusual from a normative perspective.” I whole-heartedly agree.

The abstract is publicly available on PubMed.

Edit (2/24/2013):

There has been some confusion over the percentages I quoted. Let me clarify:

There were 367 participants total. As an example, of those, 27 reported having either fantasy, masturbation fantasy, or real experience with transvestic fetishism. And that breaks down to 18 having fantasy, 21 having masturbation fantasy, and 10 having reality. The researchers divided those breakdown numbers by the total number of participants (367) to get the percentages (i.e., 4.9% of the sample having transvestic fetishism fantasies, 2.7% of the sample having transvestic fetishim real experiences). Of those 27 people, only 1 was distressed by it. Thus, 3.7% were distressed by their arousal.

 

Feb 252011
 

(UPDATED 3/30/11 – take a look at the bottom of the post)

A case report showed up in my feed recently. A woman and her partner were using a glue container in her urethra and it got lodged in her urinary bladder. They couldn’t remove it, so they went to the emergency department, where it was removed. She was discharged after a few hours of observation.

I thought this would be a good opportunity to talk about urethral sounding. Urethral sounding (usually just called “sounding” in the kink community) is when a cylindrical object is inserted into the urethra. Most of the resources I found were aimed at men, but women can do this also (Note: the urethra in men and women are different lengths and shapes! Knowing anatomy is helpful here).

Sounds should be made out of stainless steel, hardened rubber, or a similar material. They should not have ANY cracks or deformities. Glass, although traditional, is a bad idea because it can break within the urethra. Sounds need to be sterilized before and after use! Lubrication should be water-based and glycerin-free (Source). Glycerin (aka glycerol) is a sugar, and thus can serve as food for bacteria. Yickes! I’ve seen at least one guide recommend using individual lube packets to prevent contamination.

Risks include urinary tract infections (UTIs), from poor sanitation or scratching the urethra. UTIs can lead to bladder infections and kidney infections if not treated. Cranberry juice or pills can be taken to help prevent UTIs, but should NOT replace proper hygiene.

Please talk with your doctor regarding sounding and your own health history if you plan to play with it.

Other resources (may be seriously NSFW):

Medicaltoys.com Library

Sin Central Forums

 

UPDATE 3/30/11:

Hey folks! Thanks for all the interest in this post. If you want to know more about urethral sounding (especially female sounding), check out Mistress160’s excellent informational page on her blog (warning: site contains very graphic images). If you have further questions, feel free to ask here, on Fetlife, or contact your local BDSM organization(s) and/or dungeons.