Sex in Australia: Autoerotic, esoteric and other sexual practices engaged in by a representative sample of adults

An Evolutionary Psychological Approach Toward BDSM Interest and Behavior

Bondage/discipline, Dominance/submission, and Sadism/Masochism (BDSM) have gained increased attention and discussion in recent years. This prevalence is accompanied by a shift in perceptions of BDSM, including the declassification of sadomasochism as a paraphilic disorder. Evolutionary psychology offers a unique perspective of why some individuals are interested in BDSM and why some prefer certain elements of BDSM over others (e.g., dominance versus submission). In this paper, we examine BDSM from an evolutionary standpoint, examining biopsychosocial factors that underlie the BDSM interests and practice. We articulate this perspective via an exploration of: proximate processes, such as the role of childhood experiences, sexual conditioning, and physiological factors; as well as ultimate explanations for power play and pain play dimensions of BDSM, highlighting the potential adaptive advantages of each. While BDSM may not be adaptive in itself, we examine the literature of sex differences in BDSM role preferences and argue that these preferences may stem from the extreme forms of behaviors which enhance reproductive success. In the realm of pain play, we explore the intersection of pain and pleasure from both physiological and psychological perspectives, highlighting the crucial role of psychological and play partner factors in modulating the experience of pain. Finally, we encourage future research in social sciences to utilize evolutionary frameworks to further explore the subject and help alleviate the mystification surrounding BDSM. This multifaceted exploration of BDSM provides valuable insights for clinicians, kink-identified individuals, and scholars seeking to understand the evolutionary perspectives of human sexual behavior and preferences.

Do Sex Toys Make Me Satisfied? The Use of Sex Toys in Denmark, Norway, Sweden, Finland, France, and the UK

Sex toys are easily accessible in many countries in the Western world. Yet, cross-country studies on sex toy ownership and use and their association with relationship, sexual, and life satisfaction are rare. Using a cross-country convenience sample of 11,944 respondents from six European countries (Denmark, Sweden, Norway, Finland, France, UK), we investigated the rate and factors linked to sex toy ownership and use and their associations with sexual, relationship, and life satisfaction. Data were collected in May and June 2022 through respondent panels by Cint, a market research software platform. Participants received an e-mail invitation for the study and completed an online self-report survey. We found that more than half of respondents owned or had owned a sex toy, with the most common sex toys owned being dildos and vibrators, followed by handcuffs, penis rings, and anal sex toys. Across countries, the majority of sex toy owners reporting using these either alone or with a steady partner (55-65%) and a minority with casual partners (10-15%). Controlling for socio-demographics, parental status, sexual orientation, number of sex partners, and relationship status and length, we found that sex toy ownership and use were significantly associated with higher sexual and life satisfaction, while higher relationship satisfaction was only significantly associated with currently owning a sex toy (but not number of sex toys) and frequency of use with a partner (but not alone). Across results, we generally found little cross-country variation.

BDSM in North America, Europe, and Oceania: A Large-Scale International Survey Gauging BDSM Interests and Activities

BDSM bondage and discipline, dominance and submission, and sadism and masochism is a widespread and highly prevalent yet stigmatized practice of intimacy and sexuality. In recent years, international interest in BDSM research has grown, mainly resulting in prevalence studies in various countries. To date, however, no research has investigated international and intercontinental differences in the nature of BDSM interests and fantasies, BDSM roles and practicing contexts among BDSM practitioners. In order to explore international discrepancies in BDSM identity, fantasies, and activities among self-identified BDSM practitioners, a group of FetLife (a social network website for BDSM and kink interested individuals) members (N = 1,112) originating from North America (n = 458), Europe (n = 566), Oceania (n = 46), and Other (n = 42) completed the survey. Europeans reported an earlier age of onset of fantasizing about BDSM than did North Americans. More North Americans indicated practicing BDSM in a public context than did Europeans and Oceanians. These differences could in part be explained by different cultural backgrounds, higher levels of religiosity, and current stigmas toward non-traditional sexual interests. Future research should focus on clarifying whether cultural mechanisms underlie these dissimilarities.

Clinical Guidelines for Working with Clients Involved in Kink

People involved in kink (BDSM or fetish) subcultures often encounter stigma and bias in healthcare settings or when seeking psychotherapy. Such individuals typically encounter well-meaning clinicians who are not prepared to provide culturally competent care or who have not recognized their own biases. Over a two-year period, a team of 20 experienced clinicians and researchers created clinical practice guidelines for working with people involved with kink, incorporating an extensive literature review and documentation of clinical expertise. This article summarizes the guidelines and discusses relevant issues facing clinicians and their clients, as well as implications for clinical practice, research and training.

Youth sexual offending in Hong Kong: examining the role of self-control, risky sexual behaviors, and paraphilic interests

Introduction

Little is known about the nature and prevalence of sexual offending among youth in Hong Kong.

Methods

Testing self-control theory and sexual health risk factors (i.e., risky sexual behaviors [general and two subtypes] and paraphilic interests [general and 14 subtypes]), the prevalence of self-reported sexual offending behaviors (i.e., threat of sexual assault, penetrative sexual assault, and nonpenetrative sexual offense) was examined in a community-based sample of 863 young people (aged 17 to 20) in Hong Kong.

Results

In this study, men reported significantly higher levels of threat of sexual assault and of general and 12 subtypes of paraphilic interests than women; and women reported a significantly higher level of a specific paraphilic interest subtype (i.e., transvestic fetishism) than men. Logistic regressions found that, in general, a low level of self-control and high levels of risky sexual behaviors and paraphilic interests were important factors in the participants' likelihood of issuing threats of sexual assault and engaging in penetrative and nonpenetrative sexual assault.

Discussion

Important practical implications for reducing the tendency of young people to engage in sexual offending behavior can be derived from this study.

Psychological and Developmental Correlates of Paraphilic and Normophilic Sexual Interests

The classification of sexual fantasies and behaviors (here referred to as 'sexual interests') has historically been divided into 'paraphilic' and 'normophilic'. However, studies on paraphilic interests are often limited to clinical or forensic samples and normophilic interests are rarely assessed in tandem. Previous research has found mixed results for psychological and other correlates of sexual interests, potentially due to inconsistency in operationalism and measurement of fantasies and behaviors. The aim of the current study was to quantify correlates of sexual interests via the Sexual Fantasies and Behaviors Inventory, containing factors related to general fantasies/behaviors, normophilia, power dynamics, sadomasochism, and courtship paraphilias, using a large (N = 4280) non-clinical sample. Psychological, developmental, sexual, and demographic correlates were investigated via bivariate correlations, mean difference testing, and multiple regression. Sexual interest domains were largely unrelated to psychopathology and developmental factors. Sociosexuality and more accepting attitudes towards sadomasochism was generally related to more arousal to/engagement in normophilic and paraphilic domains. More autism spectrum disorder traits were related to decreased normophilic interests. Psychopathic traits, sexual sensation seeking, and sexual compulsivity were related to paraphilia dimensions, especially courtship paraphilias and domination/sadism; the former was also associated with negative attitudes about establishing consent. Men, non-monogamous, and non-heterosexual participants indicated greater sexual fantasies and behaviors compared to women (except in the case of submission and masochism), monogamous, and heterosexual participants, respectively.

Associations between sexually submissive and dominant behaviors and sexual function in men and women

The current study investigated the associations between sexually submissive and dominant behaviors and sexual dysfunction in Finnish men and women. We analyzed three population-based data sets from 2006, 2009, and 2021-2022, including 29,821 participants in total. Participants filled out a questionnaire about their sexually submissive and dominant behaviors, Sexual Distress Scale, Checklist for Early Ejaculation Symptoms and International Index of Erectile Function Questionnaire-5 (men), and Female Sexual Function Index (women). Pearson Correlations showed that for both sexes, sexually submissive (men: r = 0.119, p < 0.001; women: r = 0.175, p < 0.001) and dominant (men: r = 0.150, p < 0.001; women: r = 0.147, p < 0.001) behaviors were both associated with more sexual distress. However, for men, sexually submissive (r = -0.126, p < 0.001) and dominant behaviors (r = -0.156, p < 0.001) were associated with less early ejaculation symptoms. Both sexually submissive (r = 0.040, p = 0.026) and dominant behaviors (r = 0.062, p < 0.001) were also associated with better erectile function while sexually dominant behavior alone was associated with better orgasmic function (r = 0.049, p = 0.007), intercourse satisfaction (r = 0.068, p < 0.001), and overall satisfaction (r = 0.042, p = 0.018). For women, both sexually submissive (r = 0.184, p < 0.001) and dominant behaviors (r = 0.173, p < 0.001) were also associated with better overall female sexual function. One possible explanation is that these individuals have a clear idea of what they prefer sexually facilitating arousal. Particularly, sexually submissive behavior may reduce high-level self-awareness and, in this way, contribute to reduced performance anxiety. However, non-normative interests seem to simultaneously result in increased sexual distress probably due to the absence of self-acceptance. Further research about the causal mechanisms between non-normative sexual interest and sexual function is needed.

The Prevalence of BDSM in Finland and the Association between BDSM Interest and Personality Traits

According to previous research, interest in BDSM (Bondage-Discipline, Dominance-Submission and Sadomasochism) activities is high in several European countries and various BDSM practices are not uncommon. There is a limited amount of research on the personalities of BDSM practitioners, but in previous research practitioners have been found to have better overall well-being and to be more educated than the general population. The current study explored the prevalence of BDSM interest and practice in a Finnish sample (n = 8,137, age range 18-60, M = 30.14, SD = 8.08) and investigated the association between BDSM interest and personality measured with the six-factor personality measure HEXACO. A total of 38% of the sample was interested in BDSM sex and non-heterosexual individuals displayed almost twice as much interest and at most 83% more participation in BDSM than heterosexual individuals. Younger participants (18-28 years old) displayed almost three times as much interest than older participants. There were some associations between BDSM interest and personality factors, but the effect sizes of these associations were modest. The study shows that BDSM interest is quite common among the Finnish population.

Risky Sexual Behavior, Paraphilic Interest, and Sexual Offending: The Study of a Community Sample of Young Adults in Hong Kong

Limited information is available on the prevalence and nature of sexual offending in Hong Kong. This cross-sectional study seeks to explore the role of risky sexual behavior (RSB) and paraphilic interests in self-reported sexual offending behavior (i.e., nonpenetrative-only, penetrative-only, and nonpenetrative-plus-penetrative sexual assault) in a community sample of young adults in Hong Kong. Using a large sample (N = 1885) of university students, the lifetime prevalence of self-reported sexual offending was 18% (n = 342; 23% males (n = 166), 15% females (n = 176)). Based on the study subsample of 342 participants who self-reported sexual offending (aged 18-35), the findings indicated that males reported significantly higher levels of general, penetrative-only, nonpenetrative-plus-penetrative sexual assault; and paraphilic interest in voyeurism, frotteurism, biastophilia, scatophilia, and hebephilia than females; while females reported a significantly higher level of transvestic fetishism than males. No significant difference was found in RSB between males and females. Logistic regressions found that the participants who possessed a higher level of RSB, particularly penetrative behaviors, and paraphilic interest in voyeurism and zoophilia were less likely to engage in a nonpenetrative-only sexual offense. Conversely, the participants who possessed higher levels of RSB, especially penetrative behaviors, and paraphilic interest in exhibitionism and zoophilia, were more likely to engage in nonpenetrative-plus-penetrative sexual assault. The implications for practice in areas such as public education and offender rehabilitation are discussed.

Sexual Subjectivity in Solo and Partnered Masturbation Experiences Among Emerging Adult Women

This qualitative study aimed to examine the experiences and attitudes toward masturbation among emerging adult women. The study was the first to compare women's solo and partnered masturbation experiences, focusing on how feelings of pleasure, sexual desire, and a sense of empowerment-important markers of women's sexual subjectivity-varied across the two contexts. The sample consisted of 40 women between the ages of 18 and 22 years. The majority of participants identified as Latina (33%) or Black (30%) and were enrolled in community college. Semi-structured interviews about women's masturbation experiences were analyzed using thematic analysis. Women described a multitude of feelings, including pleasure but also awkwardness and guilt. Although women did not describe their masturbation practices as morally wrong, they often alluded to disliking masturbation and preferring it less to partnered sex. Whereas some attitudes and feelings (e.g., awkwardness) arose in the context of both solo and partnered masturbation encounters, others were prevalent only in one (e.g., guilt in the solo encounters). Feelings of pleasure, sexual desire, and empowerment manifested differently in the two contexts. There was more focus on self-knowledge, control, and physical pleasure in the solo encounters and more enjoyment of a partner's desire and intimacy in the partnered encounters. We examine the findings through a feminist lens and consider how race/ethnicity, sexual scripts, and contemporary societal contexts shape women's sexual lives.

Sexuality and psychological well-being in different polycystic ovary syndrome phenotypes compared with healthy controls: a cross-sectional study

Introduction

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. The present study aimed to compare the women with different PCOS phenotypes with the healty group in terms of sexual function, depression, anxiety and quality of life scale.

Materials and methods

The present cross-sectional study was carried out on 192 women with PCOS (classified on the basis of Rotterdam criteria into four categories) and 50 healthy controls. All participants were asked to fill out the valid and reliable questionnaires of FSFI (Female Sexual Function Index), HADS (Hospital Depression and Anxiety Scale) and SF-12.

Results

In the HADS questionnaire, phenotype B achieved the highest mean score in anxiety and depression domains, whereas, phenotype B had the lowest mean score in the FSFI and SF-12 quassionnaires. Furthermore, there was a significant difference between the women with PCOS phenotypes and the control grroup in arousal, lubrication, pain, and mean total score of FSFI (P < 0.05). In regression logistic analysis, age, infertility and depression were predictors of sexual dysfunction (P < 0.05).

Conclusion

The results indicated significant differences in terms of sexual dysfunction, depression, anxiety and quality of life in the women suffering from different phenotypes of PCOS compared with the healthy group. These results provide evidence that care and recommendations for improving women’s QoL and sexual function should be considered according to the relevant PCOS phenotypes.

Women’s techniques for pleasure from anal touch: Results from a U.S. probability sample of women ages 18–93

The study purpose was to assess, in a U.S. probability sample of women, the specific ways women have discovered to experience pleasure from anal touch. Through qualitative pilot research with women that informed the development of the survey instrument used in this study, we identified three previously unnamed, but distinct, anal touch techniques that many women find pleasurable and that expand the anal sexual repertoire beyond the more commonly studied anal intercourse behaviors: Anal Surfacing, Anal Shallowing, and Anal Pairing. This study defines each technique and describes its prevalence among U.S. adult women. Weighted frequencies were drawn from the Second OMGYES Pleasure Report—a cross-sectional, online, national probability survey of 3017 American women’s (age 18–93) sexual experiences and discoveries. Participants were recruited via the Ipsos KnowledgePanel^®. Data suggest that 40% of women find ‘Anal Surfacing’ pleasurable: sexual touch by a finger, penis, or sex toy on and around the anus. Approximately 35% of women have experienced pleasure using ‘Anal Shallowing’: penetrative touch by a finger, penis, or sex toy just inside the anal opening, no deeper than a fingertip/knuckle. Finally, 40% of women make other forms of sexual touch more pleasurable using ‘Anal Pairing’: touch on or inside the anus that happens at the same time as other kinds of sexual touch such as vaginal penetration or clitoral touching. These data provide techniques that women can and do use to explore the anus as a pleasurable region for touch—which can enable women to better identify their own preferences, communicate about them and advocate for their sexual pleasure.

Prevalence and characteristics of choking/strangulation during sex: Findings from a probability survey of undergraduate students

In a random sample of undergraduate students, we aimed to: (1) establish the prevalence of choking and being choked; (2) examine demographic and situational predictors of being choked, and (3) examine demographic and situational predictors of choking someone. Participants: 4168 randomly sampled undergraduates at a large public U.S. university. Methods: A cross-sectional, confidential online survey. Results: We found that 26.5% of women, 6.6% of men, and 22.3% of transgender and gender non-binary participants reported having been choked during their most recent sexual event. Additionally, 5.7% of women, 24.8% of men, and 25.9% of transgender and non-binary participants reported that they choked their partner at their most recent event. Choking was more prevalent among sexual minority students. Conclusions: Choking is prevalent among undergraduate students; implications for college sexual health education are discussed.

Clinical use and implications of sexual devices and sexually explicit media

Given that sexual pleasure is a core component of sexual health, devices that are designed to enhance and diversify sexual pleasure are particularly useful in clinical practice. Despite their growing popularity and widespread use in various biopsychosocial circumstances, many taboos still seem to exist, as indicated by the paucity of scientific literature on the prevalence, application and effectiveness of sexual devices for therapeutic use. However, sex toys and sexual devices are commonly used and have a variety of indications to expand individual and partnered sexuality and to treat sexual difficulties. Different devices are associated with specific advantages and potential risks, opportunities, barriers and ethical challenges when used in a clinical context. Increased knowledge about the aim and functional possibilities of sexual devices might help health-care professionals overcome potential embarrassment, preconceptions and other barriers, learn which patients might benefit from which products, consider their use in treatment programmes, educate about correct use and safety issues, and facilitate open communication about sexual pleasure with their patients.

Women's techniques for making vaginal penetration more pleasurable: Results from a nationally representative study of adult women in the United States

The study purpose was to assess, in a U.S. probability sample of women, the specific ways women have discovered to make vaginal penetration more pleasurable. Through qualitative pilot research with women that informed the development of the survey instrument used in this study, we identified four previously unnamed, but distinct, techniques women use to make vaginal penetration more pleasurable: Angling, Rocking, Shallowing and Pairing. This study defines each technique and describes its prevalence among U.S. adult women. Weighted frequencies were drawn from the Second OMGYES Pleasure Report—a cross-sectional, online, national probability survey of 3017 American women’s (age 18–93) sexual experiences and discoveries. Participants were recruited via the Ipsos KnowledgePanel®. Data suggest that 87.5% of women make vaginal penetration more pleasurable using ‘Angling’: rotating, raising, or lowering the pelvis/hips during penetration to adjust where inside the vagina the toy or penis rubs and what it feels like. Approximately 76% of women make vaginal penetration more pleasurable using ‘Rocking’: the base of a penis or sex toy rubbing against the clitoris constantly during penetration, by staying all the way inside the vagina rather than thrusting in and out. About 84% of women make vaginal penetration more pleasurable using ‘Shallowing’: penetrative touch just inside of the entrance of the vagina—not on the outside, but also not deep inside—with a fingertip, sex toy, penis tip, tongue, or lips. Finally, 69.7% of women orgasm more often or make vaginal penetration more pleasurable using ‘Pairing’: when a woman herself (Solo Pairing) or her partner (Partner Pairing) reaches down to stimulate her clitoris with a finger or sex toy at the same time as her vagina is being penetrated. These data provide techniques that are at women’s disposal to make penetration more pleasurable—which can enable women to better identify their own preferences, communicate about them and advocate for their sexual pleasure.

What Is Rough Sex, Who Does It, and Who Likes It? Findings from a Probability Sample of U.S. Undergraduate Students

Using data from an undergraduate probability sample, we aimed to: (1) describe the prevalence and demographic characteristics of students who reported having engaged in rough sex with their current partner; (2) assess which sexual behaviors students consider to be rough sex; (3) describe the frequency with which participants report engaging in rough sex as well as their reports of initiating and liking rough sex, in relation to gender and sexual identity; and (4) examine predictors of rough sex frequency. Participants were 4998 students randomly sampled from a large Midwestern university who completed a confidential Internet-based survey (2453 women, 2445 men, 41 gender non-binary, 36 transgender or other gender non-conforming identities). Within these, 1795 individuals who reported a romantic/sexual partner of at least 3 months responded to questions about engaging, liking, and initiating rough sex. The most common behaviors participants considered to be rough sex were choking, hair pulling, and spanking. Transgender and gender non-binary students more often endorsed behaviors as rough sex. Also, rough sex was conceptualized as multidimensional, with one cluster being more consistent with earlier conceptualizations of rough sex (e.g., hair pulling, spanking) and the second cluster including behaviors such as choking, slapping, punching, and making someone have sex. About 80% of those with a current sexual or romantic partner engaged in rough sex with them and most who engaged it liked it. Bisexual women reported greater rough sex frequency and enjoyment (54.1% indicated enjoying it "very much"). Implications for sexuality research and education are discussed.

Experiences with Diverse Sex Toys Among German Heterosexual Adults: Findings From a National Online Survey

Studies from English-speaking countries show that sex toy use is common in various populations and often associated with sexual well-being. Empirical data on sex toy use and perceived effects in other countries is still missing. Based on the Positive Sexuality framework and the Positive Technology framework, this study documented the prevalence of sex toy use in solo and partnered sex among heterosexual-identified women and men in Germany, as well as perceived positive and/or negative effects of sex toy use on sexual well-being. A survey was conducted with a national online sample of 1,723 heterosexual-identified adults in Germany (M_age = 42.71, SD = 13.25, 49% women, 51% men). The majority (52%) reported sex toy use in partnered sex, and 45% reported sex toy use in solo sex. Stronger positive than negative perceived effects of sex toy use were reported by women and men alike. Findings indicate that professionals in sexual health/sexuality education should consider sex toy use as a common and beneficial sexual behavior. Future studies could explore specific effects of sex toy use and their predictors in more detail.

A Systematic Scoping Review of the Prevalence, Etiological, Psychological, and Interpersonal Factors Associated with BDSM

BDSM (bondage, discipline, dominance, submission, and sadomasochism) encompasses a diverse set of sexual interests. Research interests in BDSM have been historically underpinned by examining potential mental health issues, unhealthy fixations on specific sexual behaviors, and/or the presence of childhood trauma, as is predicted by psychopathological and psychoanalytic models. The objective of this scoping review was to provide an overview of the current landscape of BDSM research, including incidence rates, evidence for psychopathological, psychoanalytical, biological, and social etiological factors, demographics of BDSM practitioners, and the psychological correlates of those with BDSM interests. After the literature search and screening process, 60 articles were included. BDSM related fantasies were found to be common (40-70%) in both males and females, while about 20% reported engaging in BDSM. Results show little support for psychopathologic or psychoanalytic models. In the selected samples studied, BDSM practitioners appear to be white, well educated, young, and do not show higher rates of mental health or relationship problems. Research supports BDSM being used as a broadening of sexual interests and behaviors instead of a fixation on a specific interest. Future empirical research should focus on non-pathological models of BDSM, discrimination of BDSM practitioners, interpersonal relationships, and biological factors.

A Survey on BDSM-related Activities: BDSM Experience Correlates with Age of First Exposure, Interest Profile, and Role Identity

BDSM is an omnibus term covering a spectrum of activities within bondage/discipline, dominance/submission, and sadism/masochism relationships. To date, BDSM practitioners experience stigma due to a general unfamiliarity with the practice and marginalization of this type of sexual behavior. Destigmatization occurs partly through knowledge expansion and identification with the stigmatized group. In this study within the Belgian population, we aimed to characterize certain aspects of socioeconomic status and specific BDSM preferences of individuals with differing BDSM experience levels. We show that individuals who perform BDSM in a community setting (BDSM clubs, events. BDSM-CP) are generally higher educated, are significantly younger when first becoming aware of their inclination toward kink-oriented sex, and have a more strict BDSM role identity (Dom vs. Sub) than individuals who engage in BDSM-related activities in a private setting (BDSM-PP). This latter group in turn display a more pronounced Dom/Sub identification than individuals who only fantasize about the practice (BDSM-F). Our data indicate BDSM interest is a sexual preference already manifesting at early age, with role identification profiles becoming gradually more pronounced based on the practitioner's contextual experience.

Exploring the relationship between paraphilic interests, sex, and sexual and life satisfaction in non-clinical samples

Limited research has indicated that paraphilic interests and behaviours do not necessarily decrease sexual and life satisfaction; some research suggests such interests may actually enhance satisfaction. The present study assessed how paraphilic-associated interests and behaviours were related to sexual and life satisfaction in a sample of 173 men and 356 women. Paraphilic interest rates were similar to existing population-based studies. Men reported significantly higher levels of most paraphilic interests than women, apart from masochism. Those with paraphilic interests rarely felt negatively affected. However, those interested in criminal paraphilic interests or both criminal and legally feasible paraphilic interests had lower levels of sexual satisfaction when they did not engage in paraphilia-associated sexual behaviour. The sexual satisfaction of those interested only in legally feasible paraphilic interests was not impacted whether or not they engaged in paraphilia-associated sexual behaviour. Further analyses indicated that those without a paraphilic interest and those who have a paraphilic interest and have disclosed to their partner have higher levels of sexual satisfaction than those who have not disclosed to their partner or who do not have a stable partner. Additionally, among those who had disclosed to a partner, sexual satisfaction was not affected whether the individual engaged in the paraphilic interest with or without their partner. These results suggest a multifaceted relationship that warrants further consideration and examination.

Bondage-Discipline, Dominance-Submission and Sadomasochism (BDSM) From an Integrative Biopsychosocial Perspective: A Systematic Review

INTRODUCTION

BDSM (bondage and discipline, dominance and submission, and sadism and masochism) increasingly receives attention from the scientific community. Where earlier research efforts mainly focused on epidemiologic characteristics, psychological and biologic factors driving BDSM preferences have recently gained interest as well.

AIM

To bring together all the existing scientific literature on BDSM from a biopsychosocial perspective.

METHODS

Based on the PRISMA guidelines, the current systematic review brings together all the existing literature on BDSM from a biopsychosocial perspective.

MAIN OUTCOME MEASURE

Prevalence rates of BDSM interests were investigated in the literature, as well as the associations between BDSM interests on one hand and personality traits, adverse childhood experiences, education levels, sexual orientations and biological markers on the other.

RESULTS

Biologic factors such as gender identity, sex hormone levels, and the neurologic constitution of the brain's pain and reward systems influence BDSM orientation. With regard to psychological factors, both personality traits (eg, higher levels of openness or extraversion) and the presence of a personality disorder have been associated with a heightened interest in BDSM, although only limited supporting evidence is available. Additionally, sensation-seeking levels and impulsivity seem to contribute, because they presumably guide one's drive to explore new or more-intense kinks. Whereas attachment styles impact couple dynamics, they also influence willingness to explore limits in a BDSM context. Lastly, education levels impact relational and sexual dynamics.

STRENGTHS AND LIMITATIONS

The limitations of the current review reflect those of the topical scientific literature. Although the number of studies focused on all aspects of BDSM is exponentially growing, most of these are only descriptive, and very few focus on underlying driving processes.

CONCLUSION

From this biopsychosocial perspective, we offer a dimensional approach while integrating the factors driving the onset and evolution of BDSM interests. De Neef N, Coppens V, Huys W, et al. Bondage-Discipline, Dominance-Submission and Sadomasochism (BDSM) From an Integrative Biopsychosocial Perspective: A Systematic Review. Sex Med 2019;7:129-144.

Sexuality in autism: hypersexual and paraphilic behavior in women and men with high-functioning autism spectrum disorder

Like nonaffected adults, individuals with autism spectrum disorders (ASDs) show the entire range of sexual behaviors. However, due to the core symptoms of the disorder spectrum, including deficits in social skills, sensory hypo- and hypersensitivities, and repetitive behaviors, some ASD individuals might develop quantitatively above-average or nonnormative sexual behaviors and interests. After reviewing the relevant literature on sexuality in high-functioning ASD individuals, we present novel findings on the frequency of normal sexual behaviors and those about the assessment of hypersexual and paraphilic fantasies and behaviors in ASD individuals from our own study. Individuals with ASD seem to have more hypersexual and paraphilic fantasies and behaviors than general-population studies suggest. However, this inconsistency is mainly driven by the observations for male participants with ASD. This could be due to the fact that women with ASD are usually more socially adapted and show less ASD symptomatology. The peculiarities in sexual behaviors in ASD patients should be considered both for sexual education and in therapeutic approaches.

Masturbation and Partnered Sex: Substitutes or Complements?

Drawing upon a large, recent probability sample of American adults ages 18-60 (7648 men and 8090 women), we explored the association between sexual frequency and masturbation, evaluating the evidence for whether masturbation compensates for unavailable sex, complements (or augments) existing paired sexual activity, or bears little association with it. We found evidence supporting a compensatory relationship between masturbation and sexual frequency for men, and a complementary one among women, but each association was both modest and contingent on how content participants were with their self-reported frequency of sex. Among men and women, both partnered status and their sexual contentment were more obvious predictors of masturbation than was recent frequency of sex. We conclude that both hypotheses as commonly evaluated suffer from failing to account for the pivotal role of subjective sexual contentment in predicting masturbation.

Sexual diversity in the United States: Results from a nationally representative probability sample of adult women and men

In 2015, we conducted a cross-sectional, Internet-based, U.S. nationally representative probability survey of 2,021 adults (975 men, 1,046 women) focused on a broad range of sexual behaviors. Individuals invited to participate were from the GfK KnowledgePanel^®. The survey was titled the 2015 Sexual Exploration in America Study and survey completion took about 12 to 15 minutes. The survey was confidential and the researchers never had access to respondents’ identifiers. Respondents reported on demographic items, lifetime and recent sexual behaviors, and the appeal of 50+ sexual behaviors. Most (>80%) reported lifetime masturbation, vaginal sex, and oral sex. Lifetime anal sex was reported by 43% of men (insertive) and 37% of women (receptive). Common lifetime sexual behaviors included wearing sexy lingerie/underwear (75% women, 26% men), sending/receiving digital nude/semi-nude photos (54% women, 65% men), reading erotic stories (57% of participants), public sex (≥43%), role-playing (≥22%), tying/being tied up (≥20%), spanking (≥30%), and watching sexually explicit videos/DVDs (60% women, 82% men). Having engaged in threesomes (10% women, 18% men) and playful whipping (≥13%) were less common. Lifetime group sex, sex parties, taking a sexuality class/workshop, and going to BDSM parties were uncommon (each <8%). More Americans identified behaviors as “appealing” than had engaged in them. Romantic/affectionate behaviors were among those most commonly identified as appealing for both men and women. The appeal of particular behaviors was associated with greater odds that the individual had ever engaged in the behavior. This study contributes to our understanding of more diverse adult sexual behaviors than has previously been captured in U.S. nationally representative probability surveys. Implications for sexuality educators, clinicians, and individuals in the general population are discussed.

Fifty Shades of Stigma: Exploring the Health Care Experiences of Kink-Oriented Patients

INTRODUCTION

The term kink describes sexual behaviors and identities encompassing bondage, discipline, domination and submission, and sadism and masochism (collectively known as BDSM) and sexual fetishism. Individuals who engage in kink could be at risk for health complications because of their sexual behaviors, and they could be vulnerable to stigma in the health care setting. However, although previous research has addressed experiences in mental health care, very little research has detailed the medical care experiences of kink-oriented patients.

AIM

To broadly explore the health care experiences of kink-oriented patients using a community-engaged research approach.

METHODS

As part of the Kink Health Project, we gathered qualitative data from 115 kink-oriented San Francisco area residents using focus groups and interviews. Interview questions were generated in collaboration with a community advisory board. Data were analyzed using a thematic analysis approach.

MAIN OUTCOME MEASURES

Themes relating to kink-oriented patients' experience with health and healthcare.

RESULTS

Major themes included (i) kink and physical health, (ii) sociocultural aspects of kink orientation, (iii) the role of stigma in shaping health care interactions, (iv) coming out to health care providers, and (v) working toward a vision of kink-aware medical care. The study found that kink-oriented patients have genuine health care needs relating to their kink behaviors and social context. Most patients would prefer to be out to their health care providers so they can receive individualized care. However, fewer than half were out to their current provider, with anticipated stigma being the most common reason for avoiding disclosure. Patients are often concerned that clinicians will confuse their behaviors with intimate partner violence and they emphasized the consensual nature of their kink interactions.

CONCLUSION

Like other sexual minorities, kink-oriented patients have a desire to engage with their health care providers in meaningful discussions about their health risks, their identities, and their communities without fear of being judged. Additional research is needed to explore the experiences of kink-oriented patients in other areas of the country and internationally.

The Relation of Toxoplasma Infection and Sexual Attraction to Fear, Danger, Pain, and Submissiveness

Behavioral patterns, including sexual behavioral patterns, are usually understood as biological adaptations increasing the fitness of their carriers. Many parasites, so-called manipulators, are known to induce changes in the behavior of their hosts to increase their own fitness. Such changes are also induced by a parasite of cats, Toxoplasma gondii. The most remarkable change is the fatal attraction phenomenon, the switch of infected mice’s and rat’s native fear of the smell of cats toward an attraction to this smell. The stimuli that activate fear-related circuits in healthy rodents start to also activate sex-related circuits in the infected animals. An analogy of the fatal attraction phenomenon has also been observed in infected humans. Therefore, we tried to test a hypothesis that sexual arousal by fear-, violence-, and danger-related stimuli occurs more frequently in Toxoplasma-infected subjects. A cross-sectional cohort study performed on 36,564 subjects (5,087 Toxoplasma free and 741 Toxoplasma infected) showed that infected and noninfected subjects differ in their sexual behavior, fantasies, and preferences when age, health, and the size of the place where they spent childhood were controlled ( F(24, 3719) = 2.800, p < .0001). In agreement with our a priori hypothesis, infected subjects are more often aroused by their own fear, danger, and sexual submission although they practice more conventional sexual activities than Toxoplasma-free subjects. We suggest that the later changes can be related to a decrease in the personality trait of novelty seeking in infected subjects, which is potentially a side effect of increased concentration of dopamine in their brain.

Sensual, erotic, and sexual behaviors of women from the "kink" community

Unconventional sensual, erotic, and sexual behaviors (herein referred to as kink behaviors) investigated by academia are based largely on clinical and criminal cases, and most published, peer-reviewed, quantitative research on these behaviors is based almost exclusively on male participants. For this study, information was collected and analyzed from 1580 female participants recruited from the kink community, using a non-clinical and non-criminal sample. We explored and described the preferences and diversity of more than 126 sensual, erotic, and sexual behaviors found among these participants, along with recommendations for continued research. Gaining a better understanding of the breadth and depth of activities engaged in by female kink practitioners could benefit educators, counselors, therapists, medical doctors, and other professionals when interacting with members of the kink community.

Masturbation, paying for sex, and other sexual activities: the Second Australian Study of Health and Relationships

Background This study describes the prevalence of (solo) masturbation, paying for sex and a range of other sexual practices among Australians. Methods: A representative sample of 20 094 men and women aged 16–69 years (participation rate among eligible people, 66.2%) were recruited by landline and mobile phone random-digit dialling and computer-assisted telephone interviews in 2012–13. Results: Many respondents (men, 72%; women, 42%) had masturbated in the past year. Half (51%) of the men and 24% of women had masturbated in the past 4 weeks. In the past year, more than two-fifths of respondents (men, 63%; women, 20%) had looked at pornography in any medium. Approximately 15% of men and 21% of women had used a sex toy. Digital-anal stimulation with a partner was practised by 19% of men and 15% of women, and oral-anal stimulation by 7% of men and 4% of women. Sexual role playing or dressing up were engaged in by 7–8%. Online sex, swinging, group sex, BDSM (bondage and discipline, ‘sadomasochism’ or dominance and submission) and fisting (rectal or vaginal) were each engaged in by less than 3% of the sample. Seventeen per cent of men said they had ever paid for sex; 2% had done so in the past year. Conclusion: Most of the solo practices studied were engaged in by more men than women, but women were more likely to have used a sex toy. Autoerotic activities are both substitutes for partnered sex and additional sources of pleasure for people with sexual partners.

Consensual sadomasochistic sex (BDSM): the roots, the risks, and the distinctions between BDSM and violence

When practiced consensually, sadomasochistic sex is being increasingly accepted as an alternative sexuality. Here I suggest the possible evolutionary roots of the preferences, draw distinctions between violent, abusive and "healthy" practitioners' partnership, provide clear behavioural markers of the respective situations, and underline some specific problems connected to this sexual preference. Some of the problems are well-known in the community of its practitioners, although they have not yet been described in medical nor scientific sources.

Impaired masturbation-induced erections: a new cardiovascular risk factor for male subjects with sexual dysfunction

INTRODUCTION

Erectile dysfunction (ED) is considered an early surrogate marker of silent, or even overt, cardiovascular diseases (CVD). However, epidemiological studies take into account only sexual intercourse-related erections. Although autoeroticism is a very common practice, data on masturbation-induced erections as a possible predictor of major adverse cardiovascular events (MACE) are lacking.

AIM

To evaluate the clinical correlates of impaired masturbation-induced erections and to verify the importance of this sexual aspect in predicting MACE.

METHODS

A consecutive series of 4,031 male patients attending the Outpatient Clinic for sexual dysfunction for the first time was retrospectively studied. Among these subjects, 64% reported autoeroticism during the last 3 months, and only this subset was considered in the following analyses. In the longitudinal study, 862 subjects reporting autoeroticism were enrolled.

MAIN OUTCOME MEASURES

Several clinical, biochemical, and instrumental (Prostaglandin E1 [PGE1 ] test and penile color Doppler ultrasound) parameters were studied.

RESULTS

Subjects with an impaired erection during masturbation (46% of those reporting autoeroticism) had more often a positive personal or family history of CVD, a higher risk of reduced intercourse- and sleep-related erections, hypoactive sexual desire and perceived reduced ejaculate volume, and impaired PGE1 test response. Prolactin levels were lower in those having impaired erection during masturbation. In the longitudinal study, unadjusted incidence of MACE was significantly associated with impaired masturbation-induced erections. When dividing the population according to the median age and diagnosis of diabetes, the association between impaired masturbation-induced erections and incidence of MACE was maintained only in the youngest (<55 years old) and in nondiabetic subjects, even after adjusting for confounders (hazard ratio [HR] = 3.348 [1.085-10.335], P = 0.032 and HR = 2.108 [1.002-4.433], P = 0.049; respectively).

CONCLUSION

This study indicates that, in subjects with male sexual dysfunction, evaluating an often neglected sexual parameter, such as masturbation-induced erections, can provide further insights on forthcoming MACE in particular in "low risk" subjects.

Sex toy use by gay and bisexual men in the United States

Recent studies have documented that vibrators are an important part of the sexual repertoires of both men and women and have demonstrated positive sexual health outcomes among individuals who use such products. However, little is known about the use of other sexual enhancement products, particularly among gay and bisexually identified men. This study sought to document the extent to which gay and bisexually identified men report using sex toys and the sexual and relational situations within which they used them. Data were collected via an internet-based survey from 25,294 gay and bisexually identified men throughout the U.S. recruited from an Internet site popular among men seeking social or sexual interactions with other men. A majority (78.5%) of gay and bisexually identified men reported having used at least one type of sex toy, including dildos (62.1%), non-vibrating cock rings (51.9%), vibrators (49.6%), butt plugs (34.0%), masturbation sleeves (27.9%), and anal beads or balls (19.3%). Among users, toys such as dildos or butt plugs were commonly inserted into one's own anus during masturbation (95.7%, n = 11,781) and insertion into their partners anus (72.0% n = 4,197) during partnered sexual activities. These data suggest that sex toy use is common among gay and bisexual men during both solo and partnered sexual activities and considered by these men as enhancing the quality of their sexual experiences.

Time for a strategic research response to anal cancer

Anal cancer was until recently regarded as a rare cancer of little consequence. The articles in this special edition of Sexual Health clearly demonstrate that anal cancer is increasing in incidence and, in some populations, it has become an urgent public health priority. In this summary paper, we will review the data presented in this issue and elsewhere on the magnitude of the issue, the means of prevention and treatment, and suggest a way forward.

Autoerotic death: incidence and age of victims--a population-based study

Review of the Australian National Coronial Information System and the Swedish National Forensic Database was undertaken over a 7-year period from 2001 to 2007 for all cases where death had been attributed to autoerotic death or sexual asphyxia. In Australia, there were 44 cases (M:F = 42:2) with the majority of victims aged >30 years (77%)-a yearly national rate of approximately 0.3/million. In Sweden, there were nine cases (M:F = 9:0) with the majority of cases aged <30 years (55%)-a yearly national rate of approximately 0.14/million. The usual male predominance was present in both populations, although the Australian victims were older than is usually reported. Lethal sexual asphyxia is uncommon in both the Australian and Swedish populations, with a lower rate than has been cited for North America. Whether this is because of different kinds of paraphilic activities in different populations or of differences in methods of central data collection is uncertain.

The varied nature of women's sexuality: unresolved issues and a theoretical approach

During the 20th century there were clear indications that the socio-cultural suppression of women's sexuality had lessened, revealing a marked variability of women's sexual expression. In this article we review the recent literature to explore explanations for this variability. It is clear that we know little about the nature of sexual desire, and in particular, what it is that is desired. There is also now substantial evidence that vaginal response, as measured by vaginal pulse amplitude, is a relatively automatic response to perception of sexual stimuli, regardless of whether these stimuli are perceived positively or result in subjective arousal. This is considered as a possible mechanism that allows vaginal intercourse without pain, even when the woman is not sexually aroused. The roles of androgens and estrogen in women's sexuality remain uncertain. The evidence is, however, consistent with there being a testosterone-dependent component of women's sexuality that is more important for some women than others. Finally, a new theoretical model is presented that aims to resolve these uncertainties and that proposes different types of women's sexuality. Once we have a better understanding of "normal" female sexuality, in its various forms, our ability to develop effective treatments for women's sexual problems should improve.

Characteristics of vibrator use by gay and bisexually identified men in the United States

INTRODUCTION

Recent reports indicate that vibrator use during solo and partnered sexual activities is common among heterosexual men and women in the United States. However, little research has comprehensively assessed vibrator use among gay and bisexually identified men.

AIMS

This study sought to document the extent to which gay and bisexually identified men report using vibrators, the sexual and relational situations within which they use them, and how men use vibrators on their own and their partners' bodies.

METHODS

Data were collected from 25,294 gay and bisexually identified men from 50 U.S. states and from the District of Columbia via an internet-based survey.

MAIN OUTCOME MEASURE

Measures included sociodemographics, health-related indicators, sexual behaviors, and those related to recent and past use of vibrators during solo and partnered sexual interactions with other men.

RESULTS

Approximately half (49.8%) of gay and bisexually identified men reported having used vibrators. Most men who had used a vibrator in the past reported use during masturbation (86.2%). When used during partnered interactions, vibrators were incorporated into foreplay (65.9%) and intercourse (59.4%). Men reported frequent insertion of vibrators into the anus or rectum when using them during masturbation (87.3%), which was also common during partnered interactions (∼60%), but varied slightly for casual and relationship sex partners. For both masturbation and partnered interactions, men overwhelmingly endorsed the extent to which vibrator use contributed to sexual arousal, orgasm, and pleasure.

CONCLUSIONS

Vibrator use during both solo and partnered sexual acts was common among the gay and bisexually identified men in this sample and was described by men as adding to the quality of their sexual experiences.

Unconventional sexual behaviors and their associations with physical, mental and sexual health parameters: a study in 18 large Brazilian cities

OBJECTIVE

There have been many studies investigating paraphilias and sexual compulsion, but thus far little data about prevalence of unusual sexual practices that are subthreshold for these diagnoses. The associations between unconventional sexual behavior and sociodemographic and health parameters were investigated.

METHOD

A cross-sectional study of 7,022 individuals (45.4% of women) was carried out using a self-administered questionnaire that compared individuals carrying at least one reference of unconventional sexual behavior (group 1) with individuals without such reference (group 2).

RESULTS

Women's mean age was 35.0 vs. 35.9 years (p < 0.05) and men's mean age was 36.5 vs. 37.8 years (p < 0.05) being lower in group 1 than in group 2, respectively. More men (52.3%) than women (30.4%) (p < 0.001) presented unconventional sexual behavior. Fetishism (13.4%) and voyeuristic behavior (13.0%) were more frequent. Unconventional sexual behavior was associated with male gender, single or separated marital status, black or mulatto race, elementary and high school educational level, history of posttraumatic stress disorder treatment, alcohol dependence, emergency contraception, difficulty at the beginning of sexual life, sexual violence, bisexuality, and performance of anal or oral intercourse.

CONCLUSION

Unconventional sexual behaviors are important because they are associated with poorer health status and lower educational levels.

The DSM diagnostic criteria for sexual masochism

I reviewed the empirical literature for 1900-2008 on the paraphilia of Sexual Masochism for the Sexual and Gender Identity Disorders Work Group for the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The results of this review were tabulated into a general summary of the criticisms relevant to the DSM diagnosis of Sexual Masochism, the assessment of Sexual Masochism utilizing the DSM in samples drawn from forensic populations, and the assessment of Sexual Masochism using the DSM in non-forensic populations. I concluded that the diagnosis of Sexual Masochism should be retained, that minimal modifications of the wording of this diagnosis were warranted, and that there was a need for the development of dimensional and structured diagnostic instruments. It should be noted that this summary reflects my original literature review. Subsequently, interactions with other members of the workgroup and advisors have resulted in modification of these initial suggestions.

Sexual activities, sexual and life satisfaction, and successful aging in women

INTRODUCTION

Sexuality for women at all ages is a vital aspect of life satisfaction and is based upon continuing growth, development, and adaptation. The successful aging model includes physical, mental/emotional, and social well-being. There is no known published literature on the topic of sexual activities of older women and its implications on life and sexual satisfaction.

AIM

To investigate the sexual activities of older women in Israel, their levels of sexual satisfaction and life satisfaction, and to examine the relationship between the level of sexual activities, sexual satisfaction, and life satisfaction.

MAIN OUTCOME MEASURE

Components of the Derogatis Sexual Functioning Inventory, and the Life Satisfaction Index.

METHODS

A descriptive, correlational study guided by the theory of "successful aging" by Havighurst (1961) was conducted using a convenience sample of 127 women who attended a menopause clinic for routine and follow up care.

RESULTS

The research findings described older women as being involved in varied, though limited, sexual activities. There was no significant relationship discovered between the number of sexual activities and age. The level of sexual satisfaction of the studied sample was found to be above the mean score. Most of the women reported good sexual/intimate communication with their partners. Women were not satisfied with the limited variety in their sex life. Women reported a high level of life satisfaction. Ultimately, a positive significant correlation was discovered between sexual satisfaction and level of current sexual activity, and between sexual satisfaction and life satisfaction.

CONCLUSIONS

Older women are interested in continuing their sexual activities. It is a component of life satisfaction. The desire for sexual variety suggested an important area for patient education. Couple communication was deemed a priority. Health providers should include sexual health issues in their discussions with clients of all ages.

Development and validation of the attitudes about sadomasochism scale

This article describes the development and validation of a new measure, the Attitudes about Sadomasochism Scale (ASMS). Exploratory factor analysis with 213 participants yielded four subscales (Socially Wrong, Violence, Lack of Tolerance, and Real Life). Confirmatory factor analysis with a different sample (n = 258) indicated that this four-factor model fit the data well. Validation analyses using all 471 participants showed that the ASMS positively correlated with other measures of social and sexual conservatism (right-wing authoritarianism, attitudes about lesbians and gay men, sexual conservatism, rape myth acceptance). However, a multiple regression analysis showed that the majority of the variance in the ASMS was not explained by the four measures of conservatism, indicating that the ASMS measures a unique attitudinal construct. Further validation analyses revealed that participants who had prior knowledge about sadomasochism (SM), participants who have engaged in SM, and participants who knew a friend involved in SM all endorsed more positive attitudes on the ASMS. Thus, this study presents a reliable and valid measure of stereotypical and prejudicial attitudes about individuals involved in these nontraditional sexual practices.

Sexuality and the menopause

Sexuality is innate within all women to a greater or lesser extent, and is affected by a number of extrinsic factors that occur in the menopausal transition. Assessing hormone status is difficult as evidence exists that sex hormones may differ between ethnic groups, and that bio-assays may be insensitive at lower testosterone levels. Data are available on the prevalence of female sexual dysfunction, but results from cross-sectional studies differ from those of longitudinal studies. The original traditional models of human sexual response have been challenged, and new models have been defined which show more complex interaction between intrinsic and extrinsic factors. Definitions of sexual dysfunction have been redefined. There are a limited number of randomized, placebo-controlled trials of drugs to improve sexual function. These include sildenafil citrate, tibolone and hormone replacement therapy. Randomized controlled trials on testosterone replacement in naturally and/or surgically menopausal patients with female sexual dysfunction have been criticized for a high placebo response rate and short duration. This chapter seeks to put sexuality into perspective and to define both function and dysfunction.