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

Oct 032016
 

Pain is an interesting phenomenon. It is nearly a human universal. The vast majority of humans have experienced it. Some experience it daily. Yet we all have different relationships with pain. Pain can be the enemy. It can be something to run away from or something to be endured if running doesn’t work. Or it can be something to come to terms with, like an old friend. Physical pain can be a tool too, muting emotional pain. Lastly, pain can be embraced. Some people ride the pain like a wave and find enjoyment in the intensity. They are often called “masochists”.

Masochism is the enjoyment, often sexual in nature, of receiving and experiencing pain. Masochism is typically practiced in a consensual “session”, paired with sadism. Some masochists prefer pain to come with physical restriction (bondage) and/or power exchange (dominance/submission). Yes, this is the same thing as BDSM or “kink.”

Researchers wondered if there was anything different about masochists’ sensation of pain. After all, most people avoid pain. Pain is unpleasant. Why deliberately seek it out? Can the experience of masochists tell us about how humans experience pain? Most importantly — can we learn anything that might help alleviate the suffering associated with chronic pain?

To answer these questions, Defrin et al invited 34 people to participate in a study. Half of those people were masochists involved in the local BDSM scene. The other half was a control group who did not. Both groups filled out surveys about pain. They answered questions on…

  • how much they feared pain
  • their experiences of pain in everyday life
  • how much they catastrophize pain. How terrible is it when they do experience pain? And how do they cope with pain when they do experience it? Different aspects of catastrophizing include rumination on the pain, magnification of that pain, and a feeling of helplessness.
  • the masochists were also surveyed about their BDSM experiences

Defrin et al tested the pain threshold of both groups. They tested the pressure required for the participant to report feeling pain, while the participants were “seated on comfortable armchairs”. (No! Not the Comfy Chair!)

The comfy chair might be a torture beyond what masochists were expecting

The comfy chair might be a torture beyond what masochists were expecting

If you don’t get that reference, stop reading this article right now. Go watch the glory that is Monty Python. Then come back. Don’t worry, I’ll wait.

What did Defrin et al find?

First – what were masochists doing and enjoying? The majority enjoyed whipping on the buttocks. Other areas of the body were also involved. Generally, the more pain and the more areas of the body they experienced pain in, the more they enjoyed the experience. Masochists in this study had weekly to monthly sessions. 

What about everyday pain? When you stub your toe and go “ow!”? As groups, both masochists and non-masochists reported the same amount of pain. Both disliked that kind of sudden, unpredictable pain. However there were some differences. Among masochists, those who had more frequent sessions reported less pain in their every day lives. Interestingly, some people from both groups reported some enjoyment with everyday pain (65% of masochists and 24% controls).

When tested, masochists had a higher pain threshold than non-masochists. For both groups, the more frequently they encountered pain the higher their pain threshold was.

Masochists also reported lower levels of pain catastrophization. They ruminated and magnified pain less and had more of a sense of control surrounding pain than non-masochists did. And the more frequently they had sessions and the more parts of their bodies that were involved, the less fear of pain they had.

So in summary — compared with non-masochists, masochists were better able to cope with everyday pain and had a higher pain threshold. The more the masochist experienced pain in their sessions, the bigger this difference.

Why might there be this difference?

This was a correlational study. So it’s impossible to say for certain why there were these differences between masochists and controls. There are three possibilities:

  • Masochists naturally have a lower pain threshold
  • The experiences of being a masochist and having frequent exposures to pain increases their pain threshold
  • There is a third factor that wasn’t found in this study

To me, the second explanation is most likely. I would expect that if masochists naturally had a lower pain threshold then the number of sessions wouldn’t make a difference. But that wasn’t the case.

Masochistic sessions are highly pleasurable. Rather than attempting to reject or escape the pain, masochists embrace it in a positive, safe environment. That environment matters! The way that we approach pain absolutely affects how much pain we feel and how intense that pain is.

This study does have a number of holes. It has a small sample size. That always limits how applicable the study is. In addition the pain experiences used in the study were predictable, just like the pain in masochistic sessions. Predictable pain is a very different experience from unpredictable pain. If pain is predictable the brain can prepare. Neurotransmitter amounts can change and blunt the feeling of pain. So can we really extrapolate predictable pain thresholds to everyday, nonpredictable, pain thresholds?

I find it interesting too that some of the control group reported everyday pain to be enjoyable. Perhaps there are more people who would participate in masochistic activities given the chance and societal acceptance?

What does this mean for those who suffer with chronic pain?

Well, no one is going to suggest that they all start masochistic sessions. But perhaps borrowing the mindset of masochism would be helpful. Working to help those with chronic pain accept and work positively with their pain may be helpful. It’s hard to say.

What do you think?

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

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.