A Preliminary Exploratory Factor Analysis of the BDSM Counselor Competency Scale

BDSM practitioners represent a large sexual minority group often overlooked, misunderstood, and unnecessarily pathologized by mental health clinicians. Although developing cultural competence for diverse and marginalized populations is widely understood to be a core component of delivering efficacious therapeutic services that can counteract these stigmatizing mental healthcare experiences, no measures currently exist that assess clinicians' self-reported competence to work with BDSM practitioners. Previous measurement work has been done to establish self-report competency scales for clinicians working with other sexual and gender minority groups, but no such scales exist for working with BDSM practitioners. In the current study, we adapted a version of the Sexual Orientation Counselor Competency Scale (SOCCS) to measure clinicians' self-reported competence to work with BDSM practitioners and did a preliminary exploratory factor analysis of the new scale (n = 124). After an initial 24-item administration, principal axis factoring of our final 17-item solution revealed two latent factors (attitudes and skills/knowledge) consistent with the 2013 SOCCS and the theoretical constructs of cultural competency. The BDSM Counselor Competency Scale (BDSM-CCS) can help clinicians, practices, agencies, and training programs track self-reported cultural competence with the BDSM population. Future research directions for scale development and clinical and training applications are discussed.

The Psychology of Kink: A Cross-Sectional Survey Investigating the Association Between Adult Attachment Style and BDSM-Related Identity Choice in China

BDSM is a type of sexual preference that includes bondage and discipline, dominance and submission, and sadism and masochism. Research has identified three specific power exchange roles in the practice of BDSM: dominance, submission, and switch. It has also been suggested that attachment style potentially influences BDSM interests. This study investigated the potential roles of attachment style in driving BDSM identity. A questionnaire was completed by a cross-sectional Chinese sample (n = 3310, age range 18-30 years), including 1856 BDSM practitioners (436 men, 1420 women). To assess attachment style, the questionnaire included a Chinese translation of the Adult Attachment Scale as well as items surveying BDSM interests. Compared to non-BDSM practitioners, attachment styles were not significantly different from BDSM practitioners. However, practitioners with different BDSM identities showed a significant difference in their attachment styles. Secure and avoidant attachment styles were associated with dominance, whereas submissiveness recorded high average scores of separation anxiety in both males and females. BDSM identities based on gender revealed that 60.5% of female practitioners assumed the role of submissiveness and this group recorded the highest average scores of separation anxiety among all groups. These results show that BDSM identity is related to attachment style. However, the results did not support the hypothesis that attachment styles potentially drive BDSM identities. Further research is needed to explore other psychological processes that drive BDSM identities in order to provide guidance for BDSM practitioners in choosing suitable identities, thereby helping practitioners to choose suitable identity partners and avoid negative experiences during BDSM participation.

"Comforting, Reassuring, and…Hot": A Qualitative Exploration of Engaging in Bondage, Discipline, Domination, Submission, Sadism and (Sado)masochism and Kink from the Perspective of Autistic Adults

Background

There is a lack of research on autistic intimacy; however, a small body of research suggests that bondage, discipline, domination, submission, sadism and (sado)masochism (BDSM)/kink may be appealing to autistic people. We aimed at exploring how engagement in BDSM/kink related to autistic identity, using a phenomenological approach.

Methods

We recruited six autistic adults through purposive sampling on social media. All participants took part in a one-to-one spoken interview about their engagement in BDSM/kink and how it related to their sense of identity.

Results

We used interpretative phenomenological analysis to analyze the data and found three key themes. Theme 1, "Practicing safe 'sex'" highlighted how the clear communication and explicit focus on consent present in BDSM/kink facilitated a feeling of safety. Theme 2, "So many ways to touch and be touched" was focused on the sensory draw of BDSM/kink, and how it provided exciting ways to explore sensory joy (and sometimes revulsion). Theme 3, "Subverting (neuro)normativity" showed how autistic people can find pleasure in intimate practices that transgress normative expectations.

Conclusion

Our findings highlighted the importance of exploring the perceptions of autistic adults in relation to their own intimate practices. Autistic intimacy is an emerging area of research, with very little focus on lived experience. Although engagement in BDSM/kink may appear niche, our findings suggest that there are aspects which are inherently appealing to autistic people. These findings can be used to destigmatize both autistic intimacy and engagement in alternative intimate practices more broadly.

Sexual Consent Norms in a Sexually Diverse Sample

Sexual consent has received increased attention in mainstream media, educational, and political settings since the rise of the #MeToo movement in 2017. However, long before #MeToo, sexual consent has been a core practice among people who engage in Bondage and Discipline, Dominance and Submission, Sadism, and Masochism (BDSM). This study examined sexual consent norms among a sexually diverse sample, including people who practice BDSM (n = 116), people who identify with another sexual minority group, such as swingers and sex workers (n = 114), and people who did not identify with a sexual minority group, termed sexual majority group members (n = 158). Explicit consent for both BDSM- and non-BDSM-related activities was rated as more common (descriptively normative) among people who were a member of the BDSM community compared to majority participants. Further, BDSM participants rated consent discussions as less sexually disruptive compared to majority participants. We found no significant group differences in the extent to which people thought sexual consent should be discussed. We also discuss findings from an open-ended question asking participants to recall a recent sexual experience with a new partner. This study demonstrates variability in consent norms between groups and points to the potential to shift sexual consent behaviors among majority participants.

Fetters and the Design of Bondage Objects in Britain During the 1970s and 1980s

This article examines the development of male bondage in Britain during the 1970s and 1980s through an examination of products designed by Jim Stewart, who founded the company Fetters in 1976. Through research using primary written sources, interviews with early customers, users and business partners, and the objects themselves, this paper situates Fetters designs within the broader infrastructures that were essential for the development of the material culture of male BDSM. The research finds that the primary contacts and inspiration came from outside of the emergent gay leather scene, in particular the cult of Houdini and publications that facilitated collecting of esoteric objects. Furthermore, military culture is shown to have influenced the design and mediation of bondage objects in a way that was fundamental to their design and functioning. This analysis therefore highlights some tensions surrounding cultural aspects of sexual identity that were negotiated through the design and development of objects produced at Fetters.

"It's Their Consent You Have to Wait For": Intimate Partner Violence and BDSM Among Gender and Sexual Minority Youth

Gender and sexual minoritized (GSM) youth are more likely than their cisgender heterosexual peers to experience intimate partner violence (IPV) and practice bondage and discipline, domination and submission, sadism, and masochism (BDSM). Although IPV and BDSM are vastly different phenomena, superficial similarities (e.g., violent behaviors) can lead to misidentification in both practice and research. This study explores how GSM youth (a) experience and understand the differences between IPV and BDSM and (b) report consensual violent and controlling behaviors when answering items on IPV measures. Nine demographically diverse GSM youth (mean age 21.2) were drawn from a GSM youth-serving organization in the Northeast United States. Participants were interviewed about their experiences with IPV, BDSM, and consent. Participants also were asked to describe the process of completing two standardized measures of IPV. Interviews were coded using conventional and directed content analysis. Eight of nine participants reported IPV victimization, and seven reported BDSM interest or experiences. Four themes emerged: (a) GSM youth experience a spectrum of IPV victimization, often related to their gender and sexual identity; (b) interest in BDSM does not imply an acceptance of IPV; (c) GSM youth have a nuanced understanding of consent and strategies to communicate consent with their partners; and (d) Consent is the organizing framework by which GSM youth distinguish IPV from BDSM. Participants reported various degrees of certainty that they would include BDSM behaviors when answering questions about violent behaviors. Findings underscore the importance of conceptually and operationally differentiating IPV and BDSM. Programs that serve GSM youth should address IPV victimization, offer sex-positive education regarding healthy relationships and BDSM, and assist GSM youth in differentiating abusive behaviors from consensual BDSM. Standardized measures that do not conflate BDSM with IPV are crucial for studying IPV among GSM youth.

Esophageal rupture through extreme sadomasochistic practice

We report the case of a woman in her thirties who suffered an esophageal rupture while participating in extreme sadomasochistic practices. After herself seeking help in a hospital for complaints alleged to be from a fall, she was initially diagnosed with several broken ribs and a pneumothorax. The cause of the pneumothorax was later discovered to be an esophageal rupture. When confronted with this atypical injury for a fall, the woman admitted to have accidentally swallowed an inflatable gag, which her partner had afterwards inflated. In addition to the esophageal rupture, the patient also had numerous other externally visible injuries of various ages, reportedly also from sadomasochistic acts. Although an in-depth police investigation was conducted and a "slave contract" was found, the woman's consent to the extreme sexual practices performed by her life partner could not be substantiated conclusively. The man was convicted for intentional infliction of serious as well as dangerous bodily injury and sentenced to a long term in prison.

Kink-Oriented People and Exogenous Oppressions: Understanding Mental Health and Related Service Use in a Rural Context

Rural, kink-oriented people experience much exogenous oppression and yet related research is scarce. This study examined the risk and protective factors of kink-oriented rural Tasmanian Australians with preexisting mental health conditions and help-seeking barriers and facilitators. Participants completed either an online survey (n = 42), an interview (n = 10), or both. Thematic analysis and descriptive statistics were used to analyze the qualitative and quantitative data, respectively. Participants aged 18 to 61 were gender and sexually diverse and better educated but had more lifetime suicide attempts than the general public. Despite the increasing normalization of kink, 90.5% of participants have never seen a kink-aware mental health professional (MHP) and nearly 83.0% did not disclose to an MHP for fear of stigma or discrimination. Self-awareness, resilience, social support and kink improved participants' mental health. Tailored support from trained MHP is vital to improve the mental health of kink-oriented people in rural areas.

"Classifying D/s Profiles Without Prior Assumptions: An Application of Cluster Analysis to Social Data"

Dominant/submissive role-play (D/s) is associated with specialized roles including Mistress, Master, Slave, Switch, Sadist, and Masochist. The current study uses cluster analysis to provide empirical evidence that no binary opposition or single spectrum constitutes a workable typology of individuals based on their affinities for these roles. The optimality of a particular choice of clustering scheme, including the number of clusters, is established using a replication technique which is presented in detail. A large number (n = 236,353) of individualized results (profiles) generated by the BDSM Test, a popular anonymous web survey, were analyzed. We hypothesize a two-dimensional typology of D/s profiles as the inferential result of our cluster analyses.

Paraphilic Interests Versus Behaviors: Factors that Distinguish Individuals Who Act on Paraphilic Interests From Individuals Who Refrain

Little is known about distinct factors linked with acting on paraphilic interests or refraining from engaging in paraphilic behaviors. Participants from Canada and the United States (N = 744), aged 19-42 years (M = 29.2; SD = 3.18), were recruited through Amazon's Mechanical Turk. Participants completed questionnaires about their paraphilic interests and behaviors, as well as potential key factors linked to behavioral engagement (i.e., perceptions of consent, sexual excitation/inhibition, impulsivity, moral disengagement, empathy). Results indicated that higher moral disengagement and impulsivity, lower sexual control (i.e., high sexual excitation, low sexual inhibition), and maladaptive understandings of consent were best able to differentiate individuals who reported highly stigmatized (e.g., hebephilia, pedophilia, coprophilia) or Bondage and Dicipline, Dominance and Submission, Sadism and Masochism(BDSM)/Fetish paraphilic interests and engagement in the paraphilic behaviours associated with these interests relative to individuals who did not report such paraphilic interests or behaviors. Moreover, higher moral disengagement, impulsivity, and maladaptive perceptions of consent were best able to differentiate non-consensual paraphilic interests and behaviours (e.g., voyeurism, exhibitionism) compared to individuals who did not report these paraphilic interests or behaviours. These results provide future directions for the exploration of mechanisms that may contribute to engagement in paraphilic behaviors and may be targets for intervention aimed at preventing engagement in potentially harmful paraphilias.

An exploration of marks/injuries related to BDSM sexual experiences

Background

Despite its growing prevalence, BDSM practice (bondage, discipline, dominance, submission, and sadomasochism) is still stigmatized, and little is known about the physical marks and injuries that individuals sustain from consensual BDSM-related activities.

Aim

In this exploratory study, we examined BDSM sexual experiences and the physical marks and injuries resulting from these experiences in a convenience sample of 513 US adults.

Methods

We examined the extent to which individuals at various stages of BDSM exploration engage with different types of BDSM and kink behaviors, along with the frequency with which they communicate about, inflict, and receive physical marks from these activities.

Outcomes

Our main outcome measures were intentional and unintentional marks sustained from BDSM-related activities, BDSM experiences, and the use of safe words.

Results

Results revealed that BDSM marks and injuries are common and quite varied (from small scratches to very large bruises) and unintentional and intentional marks differ in terms of typical size, place on body, and severity of injury. Additionally, BDSM experience is positively associated with the use of safe words and marking behaviors.

Clinical Translation

Disclosure of marks and injuries, intentional and unintentional, may be improved if health care providers are aware of, and make efforts to reduce stigma surrounding, BDSM and rough sex activity.

Strengths and Limitations

The findings of this study must be interpreted with acknowledgment of the limitations that it was a survey study with a convenience sample. However, as one of the few studies exploring the marks and injuries sustained from BDSM activities, the exploration of intentional and unintentional marks sustained provides a critical starting point for future examination of BDSM consequences that intersect with health care and the law.

Conclusion

Marks and injuries from BDSM-related activities are common, and despite the greater use of safe words, practitioners with more BDSM experience inflict more marks than those with less BDSM experience.

Commodified BDSM Services: Professional Dominatrices' Views on Their Work and Its Criminalization

In this article, we report research participants' experiences providing professional bondage, discipline, sadism, masochism (BDSM), and other fetish services in Canada. Like many sexual service providers, professional dominatrices often argue that their work challenges patriarchal and oppressive systems of sexual and gender conformity. These women assert that Canadians misunderstand the range of activities that fall under "BDSM" and the dynamics of power within the provider/client relationship. As a result, misrepresentations and inaccuracies form the basis of Canadian laws, which open professional BDSM practitioners to criminalization and remove provider and client autonomy to consent. The 35 professional dominatrices who participated in our mixed-method study challenge this narrow interpretation of their work, suggesting that Canadian law denying bodily autonomy in this context fails to reflect the realities of professional BDSM. Rather than protection from violence, the mischaracterization of the services as criminal in nature serves to perpetuate marginalization, increase vulnerability to exploitation, and maintain stigmatization of non-normative sexualities.

Sexual diversity on college campuses: using a BDSM framework to discuss consent

Sexual assault in higher education is a continuing concern. At the same time, college students are engaging in a range of consensual sexual behaviors that could appear to be sexual violence. Sexuality education on college campuses should address the spectrum of sexual behaviors and college health professionals and administrators need to be able to distinguish consensual rough sex from sexual violence. Common consent negotiations in BDSM (bondage and discipline, dominance and submission, sadism and masochism) contexts may serve as an appropriate model for acquiring consent. This viewpoint article aims to (1) review the increased participation of college students in diverse sexual behaviors, and (2) introduce the consent process of BDSM as a framework for college health professionals to discuss consent for other sexual behaviors.

Understanding BDSM practices from practitioners' perspective

OBJECTIVES

The aim of the research was to study the narrative of BDSM practitioners (sadism and masochism - S/M, bondage and discipline - B&D) and to attempt to describe how they interpret and define their practices and what significance they have in their life.

METHODS

Qualitative methodology - grounded theory - has been used in the study. The sample consisted of 12 individuals aged 20-49 who identified with BDSM practices. The data have been collected through intensive interviews with participants.

RESULTS

Based on the language analysis of the interviews, researchers established categories related to identity and the definition of BDSM. Subsequently, the initial model of the process of defining one's own sexuality in BDSM practicing individuals was proposed.

CONCLUSIONS

The research showed stages of the process of defining and accepting their sexuality in BDSM practicing individuals and multifaceted identification with their BDSM roles. The initial stage of the development of identification with BDSM was gender identity and sexual orientation. The participants defined their sexuality by either the identification with their roles in BDSM practices (not only as a form of sexual activity, but also in every-day life) or assuming such roles temporarily. It seems that defining their identity by the persons practicing BDSM is not an either-or between "identity" or a "role", but can be seen as continuum.

Agonistic approaches to sexuality: A critical analysis of the conservative mindset

Why do so many people attack sexualities they do not desire and which do not harm them independently of their negative emotions? This is a question to conservative audiences whose anxious reactions this study aims to explain. I introduce seven principles to clarify the situation. The Foundational Principle sketches the basic normative rules. The Hyperbolic Principle recognizes the ever-present exaggeration of sex narratives. According to the Imaginary Principle, extreme imaginings will become too painful to bear. The Principle of de se Reading of Sexual Thought explains contagious emotions and vicarious arousal. The Principle of Motivation argues that sexual images are intrinsically arousing and thus prima facie motivating. According to the Principle of Safety, an unacceptable sexual desire feels unsafe and risky. The Exclusionary Principle says, if a person fails to recognize a given sexual desire, she rejects it. This is the principle that characterizes a conservative reaction to unaccepted sexuality. These negative socio-psychological facts have not attracted adequate attention in sexuality studies. Yet, anxious conservative audiences have the political power to jeopardize liberal policy formation, sex education, and LGBT/BDSM lifestyles. The method of this study is conceptual and philosophical. Its premises and result should lead to empirical verification. At the same time, I suggest a more sophisticated conceptual and linguistic framework for advancing the critical discussion of moral tradition, scientific sexuality studies, and diagnostic art.

Current biopsychosocial science on understanding kink

The field of kink (or BDSM) studies has grown significantly in recent years, with several areas of study being initiated. This paper summarizes the current state of kink research, including prevalence rates; marginalization and stigma; key biological, psychological, and social research findings; clinical issues; and recommendations for further research. Theoretical frameworks, such as minority stress, serious leisure, sexual orientation, personal growth, and sensation-seeking theories appear to be useful frameworks outside of approaches that assume psychopathology as an etiological factor. Studies find the following results: higher levels of sensation-seeking; kink activities generating states of flow and transient hypofrontality; notable levels of gender, sexual orientation, and relationship style diversity in kink samples; and higher levels of minority stress-related suicidality.

Findings From a Community Survey of Individuals Who Engage in Pup Play

This study presents findings from a community survey on pup play. Pup play is a kink activity and a form of role play that is growing in popularity internationally, and gaining increasing attention in sexology, yet prior research on pup play has almost entirely employed qualitative methods and primarily involved gay and bisexual men. Using survey data of 733 pup play participants primarily from the US, but also internationally, this study reports on the demographics of participants, how they engage in pup play, its social and sexual elements, and how it relates to social identity and mental health. Unique pup names and identifying with breeds of dogs were used to foster a sense of individuality within pup play, while the majority of participants owned and wore gear when engaging in pup play. We also found significant associations between being younger and identifying as a pup. Most participants reported that pup play improved their mental health. Binary logistic regression analyses indicated that having a mental health diagnosis was associated with identifying with a more social style of pup play and self-reporting the mental health benefits of pup play. We find that the conceptualization of pup play in the existing literature to be accurate to this international sample and highlight areas where further research is needed, alongside limitations of the study.

Frequency, Method, Intensity, and Health Sequelae of Sexual Choking Among U.S. Undergraduate and Graduate Students

Although sexual choking is now prevalent, little is known about how people engage in choking in terms of frequency, intensity, method, or potential health sequelae. In a campus-representative survey of undergraduate and graduate students, we aimed to: (1) describe the prevalence of ever having choked/been choked as part of sex; (2) examine the characteristics of choking one's sexual partners (e.g., age at first experience, number of partners, frequency, intensity, method); (3) examine the characteristics of having been choked during sex; and (4) assess immediate responses of having been choked including the extent to which frequency and method (e.g., hand, ligature, limb) of having been choked predicts the range of responses endorsed by participants. A total of 4254 randomly sampled students (2668 undergraduate, 1576 graduate) completed a confidential online survey during Spring 2021. The mean age of first choking/being choked was about 19, with more undergraduates than graduate students reporting first choking/being choked in adolescence. Women and transgender/gender non-binary participants were significantly more likely to have been choked than men. Participants more often reported the use of hands compared to limbs or ligature. Common responses to being choked were pleasurable sensations/euphoria (81.7%), a head rush (43.8%), feeling like they could not breathe (43.0%), difficulty swallowing (38.9%), unable to speak (37.6%), and watery eyes (37.2%). About 15% had noticed neck bruising and 3% had lost consciousness from being choked. Greater frequency and intensity of being choked was associated with reports of more physical responses as was use of limb (arm, leg) or ligature.

BDSM Proclivity Among College Students

Bondage/discipline, dominance/submission, and sadism/masochism (BDSM) proclivity among college students is poorly characterized, in part because existing measures of BDSM proclivity highlight the consensual nature of BDSM and are appropriate for use with non-community members (e.g., those who may not understand BDSM jargon). The current study introduces such a measure, the BDSM Proclivity Scale, which characterizes BDSM proclivity among college students and evaluates relations of BDSM proclivity with other sexual attitudes and behaviors. College students (n = 552) completed measures of BDSM proclivity, sociosexual attitudes and behaviors, rape-supportive attitudes, lifetime sexual partners, and consent-seeking behavior. Two factors mapping onto attitudes and experiences related to BDSM were identified and cross-validated. Average endorsements of BDSM attitudes and experiences on a 7-point Likert scale (1 = strong disagreement, 7 = strong agreement) were 5.61 and 4.44, respectively. Structural models revealed that lifetime sexual contact and gender significantly positively correlated with BDSM attitudes and experiences, sociosexual attitudes positively correlated with BDSM attitudes, and rape-supportive attitudes positively correlated with BDSM experiences. Consent-seeking was unrelated to BDSM experiences or attitudes. College student BDSM proclivity was evident for both attitudes and experiences, highlighting the need to characterize the development of BDSM proclivity and its correlates, the sources of students' knowledge, and the nature of students' experiences. The observed associations between BDSM proclivity and relevant sexual attitudes and behaviors support its construct validity and suggest that BDSM proclivity may prove to be an important addition to the broader constructs assessed in sexual attitudinal and behavioral domains.

Castration for Pleasure: Exploring Extreme Castration Ideations in Fiction

The Eunuch Archive (EA) is an online community which includes individuals who read and write sexual fantasies with themes related to castration and eunuchs. Here we analyzed the 100 stories rated highest by EA readers among the >8800 currently posted. Our goal was to gain insights into commonalities within, and specifics of, castration sexual fantasies. Simply stated, we want to know what the authors (and readers) fantasize about and why. The most popular EA stories link sexual gratification and romantic partnership with genital abuse. They are characterized by the absence of consent for genital ablations and multiple SM-related paraphilias. Many stories feature attraction to, and ablation of, the genitals of pubescent or adolescent males. Some EA members have acted on their interests and been voluntarily castrated. Others wish to be. The most popular stories in the EA collection typically link the sacrifice via SM abuse to securing a permanent sexual partnership. The idea of sacrificing one's genitals to build dyadic adhesion has been noted before in individuals with extreme castration ideations. Here we identify the common features of sexualized fantasies that are popular among individuals with exceptional interest in castration.

Kink in an English Field: The Drinking, Drug use and Sexual Practices of English Festival-Goers Who Engage in Kink

Little is known about the other leisure activities of people who engage in kink, including sexual practices and the use of alcohol and other drugs. This article examines the drinking, illicit drug use and sexual practices of people who engage in kink from a novel sample of attendees at an English festival. Of 966 respondents, 64 reported having engaged in kink within the past 12 months. We provide evidence of these respondents' self-reported demographic characteristics, alcohol and other drug use in their lifetime and within the past 12 months, as well as other sexual practices they engaged in. This study illustrates the value of accessing participants through in situ festival fieldwork to understand kink practices, and helps us move beyond notions of clustered risky activities toward a leisure studies approach to understanding the practices of people who engage in kink.

Perceptions of and stigma toward BDSM practitioners

Despite a recent increase in academic attention, little is known about how the general population perceives BDSM practitioners. Though the gay/lesbian community has undergone de-medicalization and de-stigmatization over time, the same process for BDSM practitioners is in its infancy. Past research suggests that BDSM practitioners do expect to be stigmatized by others, especially in the healthcare system; however, little is known about how the general population currently perceives and stigmatizes the BDSM community. In the current study, we found that the general population (N = 257) does stigmatize BDSM practitioners more than the gay/lesbian population, and both are stigmatized more than a low-stigma comparison group (people in romantic relationships), F(2, 253) = 21.70, p < .001,η 2 = 0.15. These findings help to inform mental healthcare providers and the general population about BDSM practitioners, with the goal of inspiring additional research and activism aimed at combating misinformation and reducing stigma toward this population.

Challenge at the Intersection of Race and Kink: Racial Discrimination, Fetishization, and Inclusivity Within the BDSM (Bondage-Discipline, Dominance-Submission, and Sadism-Masochism) Community

The bondage-discipline, dominance-submission, and sadism-masochism (BDSM) community has achieved diversity with respect to gender identity and sexual orientation yet does so to a lesser extent with respect to race and ethnicity. A total of 398 BDSM practitioners recruited in 2018 and 2019 from BDSM conferences located within the Southern, Midwestern, and Western regions of the U.S., as well as online, completed surveys asking about racial and ethnic discrimination, fetishization, and inclusivity. People of color were 16 times more likely than non-people of color to feel discriminated against at BDSM events and 17 times more likely to feel fetishized. Qualitative results included troubling stories of overt racism and offensive racial slurs, and examples of microaggressions, feelings of isolation, and feelings of being dismissed. The results suggest that organizations can increase inclusivity by understanding the unique costs faced by people of color with an awareness that these costs might be invisible to non-people of color, diversifying positions of authority and leadership, and teaching well-meaning members what types of behaviors could create a hostile environment.

Interpersonal Risk Factors, Sexual and Gender Minority Status, and Suicidal Ideation: Is BDSM Disclosure Protective?

Suicidal ideation is elevated among individuals who engage in BDSM practices and those with sexual and gender minority (SGM) identities. There is limited research on the intersectionality of these identities and how they relate to suicidal ideation, especially within a theoretical framework of suicide risk, such as the interpersonal theory of suicide. Thus, we tested the indirect relation between BDSM disclosure and suicidal ideation through thwarted belongingness and perceived burdensomeness, as well as the moderating role of SGM identity on these indirect associations. Participants were 125 (M_age = 28.27 years; 64% cisgender men) individuals recruited via online BDSM-related forums who endorsed BDSM involvement and recent suicidal ideation. Results indicated significant moderated mediation, such that BDSM disclosure was indirectly negatively related to suicidal ideation through lower thwarted belongingness, but not perceived burdensomeness, among SGM individuals. This was due to the significant relation between BDSM disclosure and thwarted belongingness. There were no significant moderated mediation or indirect effects related to perceived burdensomeness. We also provide supplemental analyses with positive ideation (i.e., positive thoughts toward life) as the criterion variable. In conclusion, BDSM disclosure appears to be protective against suicidal ideation through thwarted belongingness but only for SGM individuals. This work furthers our understanding of the impact of intersecting marginalized identities on suicide risk and resilience. Implications, limitations, and future directions are further discussed.

"It Was Scary, But Then It Was Kind of Exciting": Young Women's Experiences with Choking During Sex

Choking/strangulation during sex is prevalent among young adults, with one study finding that 58% of women college students had ever been choked during sex. However, no qualitative study has examined women's experiences with choking/strangulation during sex outside of intimate partner violence. The purpose of our qualitative interview study was to investigate women's experiences with choking and/or being choked during partnered sex. Through in-depth interviews with 24 undergraduate and graduate women students ages 18 to 33, we sought to understand how women communicate about choking, their learning about and initiation into choking, their feelings about being choked and choking others, as well as consent and safety practices used in relation to choking. We found that women had first learned about choking through diverse sources including pornography, erotic stories, magazines, social media, friends, and partners. While all 24 women had been choked during sex, only 13 of 24 had ever choked a partner. They described having engaged in choking with men as well as women and with committed as well as more casual partner types. Participants described consensual and non-consensual choking experiences. While many women enjoyed choking, others did it largely to please their sexual partner. Women described different methods and intensities of having been choked. Although very few had ever sought out information on safety practices or risk reduction, and only some had established safe words or safe gestures with partners, participants consistently expressed a belief that the ways in which they and their partner(s) engaged in choking were safe.

Pathways and Patterns of Entrance into BDSM

Prior limited research on entrance into BDSM divided paths of entry into external or internal factors (Yosta & Hunter, 2012), while research on age at entry into BDSM has not considered variation by BDSM role identity, gender, sexual orientation, and other demographic differences. In this mixed-methods exploratory study, we contribute to this literature by collecting and analyzing qualitative interviews with 96 self-described practitioners of BDSM to more fully describe distinct pathways into BDSM, adding nuance to prior descriptions of entry. We also collected and analyzed surveys with 2,017 self-described practitioners of BDSM to examine patterns of age at entry into BDSM practices and fantasies, and selection into older or younger age at practice and age at fantasy by BDSM role identity, gender, sexual orientation, and other demographic characteristics. Interview respondents told "constructionist sexual stories" describing introductions to BDSM via popular culture including pornography and other media, the Internet, or a sexual partner that awaked an inherent interest, along with "essentialist sexual stories" which described self-discovery solely attributed to an inherent personality characteristic. Survey data revealed that age at fantasy and onset of behavior varied by social-environmental factors. Pathways and patterns into BDSM behavior and fantasies therefore reflect a combination of idiosyncratic interests, exposure to ideas via the media or partners, and stratified social norms and opportunities related to sexual behavior.

BDSM, Non-Monogamy, Consent, and Stigma Navigation: Narrative Experiences

With the rise in popularity of media pieces depicting alternative sexual/relationship preferences, there has been a rise in interest in kink and BDSM (Sprott & Berkey, 2015), which corresponds with research suggesting that approximately 20% of Americans have been in a consensually non-monogamous relationship (Haupert et al., 2016). Despite this growing popularity, these populations are often stigmatized and misunderstood (Bettinger, 2002). The present study examined the self-reported experiences of individuals who have participated in kink, BDSM, non-monogamy, and/or polyamory. Specifically, the study used qualitative methodology to examine narratives of discrimination, harassment, coming out, being outed, consent violations, and/or sexual assault in a BDSM or non-monogamous encounter. Participants consisted of 67 adults who completed an online survey conducted by the National Coalition for Sexual Freedom and were asked to provide narratives of their experience. Data were analyzed using a modified consensual qualitative research methodology (CQR-M; Spangler et al., 2012). Results indicated 11 categories falling into three domains: navigating incidents (consent issues, negotiation of scenes or relationships, identity/beliefs about coming out, and reporting), contributing factors (role of social media/media, exacerbating factors, and beliefs about the community), and response/prevention (outcome of incident, emotions felt, lessons learned from incident by the participant, and what would be helpful from the community). This study contributes to our understanding of the experiences in this community and elucidates strategies that can be used to intervene and advocate for these populations, including education of the general public and deliberate community support.

The Biology of BDSM: A Systematic Review

INTRODUCTION

BDSM is an abbreviation used to reference the concepts of bondage and discipline, dominance and submission, sadism and masochism, enacted by power exchanges between consensual partners. In recent years, attention has shifted from the idea of BDSM as a pathological and tabooed niche practice towards viewing BDSM as a healthy form of intimacy.

AIM

This systematic review brings together all existing literature on the biology of BDSM and places it in a broader biological context.

METHODS

A systematic search was conducted on PubMed, Web of Science and PsycARTICLES, of which 10 articles are included and discussed in this systematic review.

RESULTS

There is evidence for cortisol changes in submissives as a result of a BDSM interaction, suggesting involvement of the physiological stress system. Endocannabinoid changes implicate the pleasure and reward system. In dominants, this biologically measured pleasure seemed to be dependent on power play rather than pain play. Testosterone and oxytocin are also implicated in BDSM, though their role is less evident. Research into brain region activity patterns related to BDSM interest suggests a role for the parietal operculum and ventral striatum in the context of the pleasure and reward system, the primary and secondary somatosensory cortex in the context of pain perception, empathy-related circuits such as the anterior insula, anterior midcingulate cortex and sensorimotor cortex and the left frontal cortex in the context of social and sexual interactions. Pain thresholds are shown to be higher in submissive individuals and a BDSM interaction may cause pain thresholds to rise in submissives as well.

CONCLUSION

BDSM interactions are complex and influenced by several psychological, social and biological processes. Though research is limited, there is emerging evidence for an interaction between several biological systems involved in these types of interests and activities. This means there is an important role for future research to replicate and supplement current results.

Rates of Injury and Healthcare Utilization for Kink-Identified Patients

BACKGROUND

Kink-involved people engage in atypical erotic activities such as bondage, rough sex, and other fetish activities that might risk injury or medical complication. To date, however, no one has examined the rate of injury or healthcare utilization for people who engage in these activities.

AIM

To describe the type and rate of injuries from kink activities, and the use of healthcare by kink-involved people, including how many people disclose their involvement in kink when seeking care.

METHODS

A survey of 1,398 kink-involved or kink-identified people, using a convenience sampling method.

OUTCOMES

The study is the first to report on rates of injury and disclosure of kink involvement to care providers using a large community sample of kink-involved people.

RESULTS

A high number of participants did not disclose their kink behavior to their physical healthcare clinician (58.3%) or to their mental healthcare clinician (49.6%). Past experiences of kink-related injuries were relatively common (13.5%), as was the number of people who reported delaying or avoiding healthcare because of anticipated or perceived stigma for kink involvement (19.0%).

CLINICAL TRANSLATION

The findings of the current study point to the need for clinicians to address barriers to culturally competent care for kink-involved people. Anticipated stigma leads to non-disclosure of kink involvement and delay in seeking care, thereby creating barriers to health and well-being.

STRENGTHS & LIMITATIONS

Strengths include a sample size large enough to examine regression models to predict disclosure to care providers, and lifetime rates of injury from kink activities overall. Limitations include the use of a convenience sampling method and self-report survey design, which affect the generalizability of the results.

CONCLUSION

The patterns of anticipated stigma, delay or avoidance of care, and concealment of kink and/or BDSM involvement fit the Minority Stress Model, and we argue that kink-identified people should be considered a sexual minority for the purposes of healthcare. Sprott RA, Randall A, Smith K et al. Rates of Injury and Healthcare Utilization for Kink-Identified Patients. J Sex Med 2021;18:1721-1734.

Findommes, Cybermediated Sex Work, and Rinsing

INTRODUCTION

Financial domination involves the payment of cash or gifts from a wish list by a money slave to a money mistress, financial dominatrix, or findomme. Boundaries for findommes working through webcam and video-call services may be more fluid than via text-based modes since the domme engages in more visible displays, and modification of language, voice, and feelings to fulfil the fantasy for a client. We explore the nature of findomme work and its relationship to BDSM to understand how the interaction progresses and how the boundaries, of reasonable and permissible behaviour which affect both incoming and outgoing interactions between people, are maintained.

METHODS

The study was in two stages. The first stage was a survey of online findommes (n = 56) in UK and the USA. For the second stage, we explored the experience of findommes (n = 195) on money-slavery websites and social media feeds using netnography as an observation method with cisgender male, female, and transgender participants.

RESULTS

Our analysis reveals how findomme interaction progresses from text-based interaction to virtual face-to-face and voice communication. We show financial domination to be on a continuum from being a lifestyle choice in the BDSM community that reaps financial benefits to a purely economic and legitimate form of commercial labour. Although financial domination clearly elicits sexual arousal for clients, the relationship can also be exclusively psychological and focus on the relinquishing of control to a money mistress for a prescribed period.

CONCLUSION

The findings also show how personal boundaries are negotiated and enhance understanding of how the microculture of findomming interacts with other microcultures. By demystifying the process of financial domination, we clarify its relationship with other microcultures and add to the growing body of literature that destigmatizes consensual erotic labour.

IMPLICATIONS

These findings show how online support, in a decriminalised environment, enabled new and 'instadommes' to set and maintain healthy boundaries for enhanced physical and psychological well-being, and the research provides valuable insight into sex work that is safely carried out in online spaces by a large number of participants so adding to the growing body of work on decriminalization.

Sexual Violence and Trauma in Childhood: A Case Report Based on Strategic Counseling

Children and adolescents are too often victims of sexual abuse and harassment. According to the World Health Organization (WHO), approximately 150 million girls and 73 million children <18 have been victims of violence and sexual exploitation during their childhood. Data show that females are more likely to be a victim of abuse and violence than males (20% vs. 5–10%). Such abuses lead to long-term psychophysical and relational consequences and victims are often afraid of asking for support from both parents and professionals. This case report shows the story of a 17-year-old adolescent, Sara, involved by her mother in a strategic counseling process, to solve BDSM-type sexual addiction (slavery and discipline, domination and submission, sadism and masochism), self-aggressive behavior, and alcohol abuse issues. The strategic counseling process is structured in 15 sessions and was based on problem-solving techniques and corrective behavioral strategies. During the sessions, it emerged that Sara had been a victim of sexual violence at the age of 6 and that she had never talked about the rape with anyone. At the age of 12, she began to experience social anxiety and shame, feelings that led her to use alcohol and seek violent sexual partners and bondage relationships. During the counseling sessions, Sara elaborated on her trauma, becoming more aware of her resources and her desires, and she learned to manage the sense of guilt and shame associated with the violence suffered, through alternative strategies. At the end of the process, Sara normalized her relationship with sex and alcohol, regaining her identity.

Consensual Non-Monogamy Among Kink-Identified Adults: Characteristics, Relationship Experiences, and Unique Motivations for Polyamory and Open Relationships

People who engage in both kink and consensual non-monogamy (CNM) have received little attention in research. The present article reports on the characteristics, relationship experiences, and unique motivations for engaging in CNM of kinky and consensually non-monogamous individuals using data from two U.S. samples-one large, national (N = 690) quantitative survey, and one qualitative study (N = 70) of adults in Northern California. The results describe the prevalence of universal (e.g., jealousy, sexual desire discrepancy) and population-specific relationship experiences (e.g., kink interest discrepancy, "coming out" about relationship structure). Findings indicate that discrepancies in desire for kink are a common relationship experience for kink-CNM individuals and that managing kink interests is an important motivation for CNM in this particular population. Implications for future research and clinical practice with kinky and consensually non-monogamous individuals are discussed.

The Psychology of Kink: A Cross-Sectional Survey Study Investigating the Roles of Sensation Seeking and Coping Style in BDSM-Related Interests

Despite the gaining popularity in mainstream media of the phenomenon that is BDSM, empirical research on the motives and underlying psychological mechanisms driving BDSM practitioners is scarce. The current study focused on the potential driving roles of sensation seeking and coping styles in BDSM-related interests and behavior. A cross-sectional survey questionnaire was completed by 256 Dutch-speaking BDSM practitioners (110 men, 135 women, 7 gender fluid, 2 genderless, 1 other not specified), 1 missing (this participant did not answer the question regarding gender, but did answer all other survey items) and a matched control group lacking any BDSM interest recruited from the general Belgian population (N = 300; 135 men, 158 women, 4 gender fluid, 3 genderless). The questionnaire consisted of several items surveying different BDSM identities and interest levels of BDSM-related activities, an adapted version of the Dutch Sensation Seeking Scale, and items querying seven coping styles. Compared to controls, BDSM practitioners reported significantly higher levels of sensation seeking for all dimensions (experience seeking, thrill seeking, and distraction seeking), as well as the use of more active coping skills such as problem solving and taking action. Gender differentiated which specific coping skills were being used with women seeking out more emotional support and comfort and reaching out more for help and advice in both the BDSM and control group, and men taking more action and seeking distraction in leisure. About 40% of the practitioners reported using BDSM itself as a coping strategy. Further research is needed to explore the link between coping and sexuality in general, and to other psychological processes that drive BDSM interests in order to destigmatize and normalize consensual BDSM-related activities within the general population.

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.

Kinky Sex Gone Wrong: Legal Prosecutions Concerning Consent, Age Play, and Death via BDSM

This commentary begins by describing the author's research and expert witness practice serving sex and gender minorities, especially practitioners of BDSM/kinky sex. Then, it reviews the three most common reasons that BDSM is legally prosecuted. First, consent: was this assault, rape, and/or kidnapping, or was it consensual kinky sex that either got out of hand or is now being strategically employed to punish the other partner? Second, age play: was this adult trying to have sex with children or was he (and it is virtually always men) intending to age play with an adult who is pretending to be an adolescent? Third, death by kinky sex: was this a person who murdered their lover or was this an accidental death? Finally, this article concludes with recommendations for kinksters who wish to assure consent and safe play, and for litigators involved in the prosecution of kinky sex.

Beyond Pain: A Study on the Variance of Pain Thresholds Within BDSM Interactions in Dominants and Submissives

BACKGROUND

BDSM is an acronym describing bondage and discipline, dominance and submission, and sadism and masochism. Afflicting or receiving pain is usually an important part of the BDSM interaction.

AIM

This research will focus on better understanding the aspect of pain within a BDSM interaction.

METHODS

Submissive and dominant counterparts of 35 couples were recruited to participate in a BDSM interaction, of which 34 dominants and 33 submissives were included in the analyses. A non-BDSM interested control group (n = 27) was included to control for social interaction, of which 24 were included in the analyses.

OUTCOMES

This research investigates the differences in (i) baseline pain thresholds, (ii) the impact of a BDSM interaction on those thresholds, and (iii) threshold moderating factors like pain cognition between submissive and dominant BDSM participants and control individuals.

RESULTS

BDSM practitioners have a higher pain threshold overall and a BSDM interaction will result in a temporary elevation of pain thresholds for submissives. Additionally, pain thresholds in dominants will be dependent upon their fear of pain and tendency to catastrophize pain and submissives will experience less fear of pain than the control group.

CLINICAL IMPLICATIONS

By further enhancing our understanding of the mechanisms behind a BDSM interaction in this way, we aspire to relieve the stigma these practitioners still endure.

STRENGTHS & LIMITATIONS

This is one of the first studies of its kind with a large sample size compared to similar research, which makes it a significant contribution to the field. It must be mentioned that there is a possible selection bias because recruitment was only done through the Flemish BDSM community and specifically those who visit clubs. Additionally, pain threshold remains a subjective measurement, which must be taken into account.

CONCLUSION

This study helps shed further light on the biological processes behind a BDSM interaction through pain threshold measurements. Wuyts E, De Neef N, Coppens V, et al. Beyond Pain: A Study on the Variance of Pain Thresholds Within BDSM Interactions in Dominants and Submissives. J Sex Med 2021;18:556-564.

Fatal strangulation during consensual BDSM activity: three case reports

Autoerotic accidents are well-known occurrences in forensic casework. Reports about unintentional deaths in a sexual context involving other persons are much rarer. Three cases of fatal incidents related to asphyxiophilia during consensual BDSM activity are reported. Two men died while visiting a dominatrix, the third one in the presence of a male casual sexual partner. Paraphernalia associated with BDSM/fetishism were found at the scene in all cases. Autopsy findings were compatible with death by strangulation. The cases are compared with published autoerotic accidents and similar unintentional deaths involving other individuals. The difficulties concerning the forensic assessment and reconstruction of the cases are discussed.

The Role of Consent in the Context of BDSM

Consent represents a central focus in the controversial realm of BDSM-an overlapping acronym referring to the practices of Bondage and Discipline, Dominance and Submission, and Sadism and Masochism. Many authors have argued that the hallmark feature that distinguishes BDSM activity from abuse and psychopathology is the presence of mutual informed consent of all those involved. This review examines the relevant literature on consent in BDSM, including discussions on safety precautions, consent violations, North American laws pertaining to BDSM practice, and the role of the BDSM community with respect to education and etiquette surrounding consent. Practical information relevant to professionals who work toward the prevention of sexual exploitation and abuse is provided. The explicit approach to consent practiced by those in the BDSM community is proposed as a model for discussions around consent in clinical and educational contexts. Criteria for distinguishing abuse from BDSM and identifying abuse within BDSM relationships are outlined. It is our hope to demystify the consent process and add to the growing body of literature that destigmatizes consensual BDSM practices.

Describing the Nature and Correlates of Health Service Providers' Competency Working With Sexual and Gender Minority Patients: A Systematic Review

Disparities in the health services delivered to sexual and gender minority (SGM) individuals are widespread across health service disciplines. Many health service providers do not have the knowledge, comfort, or skills necessary to provide health services to SGM individuals. The objective of the current systematic review was to review the correlates of competency (defined as knowledge, attitude, and skill) that health service providers possess for working with SGM individuals. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was utilized to guide search and reporting strategies. PsycInfo/PsycArticles, PubMed/Medline, and Google Scholar databases were searched to find studies that addressed health service providers' competency working with SGM individuals. There were 31 studies included in the review. Approximately half of the studies utilized the full definition of competency (knowledge, attitude, and skill). The most common competency assessed was knowledge, and the least common was skill. The majority of the studies addressed health service providers in the social sciences. Health service education needs to emphasize competency working with SGM individuals. Of particular importance is developing skill sets, as many providers reported that they did not have the skills necessary to provide culturally competent health services to SGM individuals.

Between Pleasure and Pain: A Pilot Study on the Biological Mechanisms Associated With BDSM Interactions in Dominants and Submissives

BACKGROUND

BDSM is an abbreviation used to reference the concepts of bondage and discipline, dominance and submission, sadism, and masochism, enacted by power exchanges between consensual partners.

AIM

To shed light upon the rewarding biological mechanisms associated with BDSM interactions.

METHODS

A group of 35 BDSM couples (dominant and submissive counterparts) were recruited and tested during a BDSM interaction, with an additional control group of 27 non-BDSM interested people tested in a normal social interaction.

OUTCOMES

We compared the evolution of the stress and reward hormone levels of cortisol, beta-endorphins, and endocannabinoids (2AG and anandamide) in a group of BDSM practitioners before and after an active BDSM interaction with the levels in control individuals.

RESULTS

We showed that submissives showed increases in cortisol and endocannabinoid levels due to the BDSM interaction, with dominants only showing increased endocannabinoid levels when the BDSM interaction was associated with power play.

CLINICAL IMPLICATIONS

This study effectively provides a link between behavior that many think of as aberrant on one hand, and biological pleasure experience on the other, in the hope that it may relieve some of the stigma these practitioners still endure.

STRENGTHS & LIMITATIONS

It is one of the first and largest studies of its kind, but is still limited in sample size and only represents a specific population of Flemish BDSM practitioners.

CONCLUSION

Even though this is one of the first studies of its kind, we can conclude that there is a clear indication for increased pleasure in submissives when looking at biological effects of a BDSM interaction, which was related to the increases in experienced stress. Wuyts E, De Neef N, Coppens V, et al. Between Pleasure and Pain: A Pilot Study on the Biological Mechanisms Associated With BDSM Interactions in Dominants and Submissives. J Sex Med 2020;17:784-792.

Non-Natural Death Associated with Sexual Activity: Results of a 25-Year Medicolegal Postmortem Study

INTRODUCTION

Non-natural deaths associated with sexual activity may occur either with or without the involvement of other persons.

AIM

The present study provides an overview of cases of non-natural death related to sexual activities as well as recommendations of how to handle these cases and to identify potentially dangerous pleasure-enhancing techniques.

METHODS

This medicolegal, postmortem, retrospective, and prospective study is based on data of autopsies performed at the Institute of Legal Medicine at University Hospital, Goethe University, Frankfurt, Germany.

MAIN OUTCOME MEASURE

Identification of circumstances, sexual practices, and gender distribution of cases of non-natural death in this context.

RESULTS

Between 1993 and 2017 (25 years), 16,437 medicolegal autopsies were performed, of which 74 cases (43 males, 31 females) of non-natural death were found to relate to sexual activities (0.45%). One female and 21 males had died in the course of autoerotic practices (group I, n = 22). Nine males and 14 females had performed sexual practices with mutual consent (group II, n = 23), and 13 males and 16 females without mutual consent (group III, n = 29). The average age in group I was 45.4 years; in group II, 40.6 years; and in group III, 39.2 years. Most of the deceased were found in their own apartments. Forms of stimulation included vaginal, anal, and oral intercourse; insertion of foreign bodies; use of chemical substances; and tools for respiratory depression/hypoxia. Three cases of death occurred during sexual activities involving bondage and discipline, sadism, and masochism (BDSM). Death due to strangulation was the main cause in group I, whereas intoxications were predominant in group II. Sharp force (eg, knife) was mainly responsible for death in group III. Anogenital injuries were documented in all groups in approximately equal percentages.

CLINICAL IMPLICATIONS

The cases presented show a high variety of circumstances in which non-natural death connected to sexual activity may occur.

STRENGTHS & LIMITATIONS

This study presents a large postmortem collection of non-natural death cases with associated sexual activity. As the main limiting factor, it must be stated that mutual consent for a sexual practice or consumption of substances was presumed based on the information provided and a lack of evidence against this assumption.

CONCLUSION

In cases of death associated with sexual activity, medical staff should perform thorough unbiased examinations and documentations. Strangulation and the consumption of stimulants should be classified as life-threatening, pleasure-enhancing techniques. Patients and young people should be informed about these risks. Bunzel L, Koelzer SC, Zedler B, et al. Non-Natural Death Associated with Sexual Activity: Results of a 25-Year Medicolegal Postmortem Study. J Sex Med 2019;16:1547-1556.

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.

BDSM, becoming and the flows of desire

Based on a five-year qualitative ethnographic study of Bondage and Discipline/Dominance and Submission/Sadism and Masochism (BDSM) in Sweden, this paper examines the process of becoming among BDSM practitioners. In-depth interviews were completed with 29 self-defined BDSM practitioners, and their accounts were analysed using thematic analysis. Focusing on the Deleuzian concept of becoming, BDSM is understood as a dynamic and collective phenomenon closely connected to fantasies, memories and longing, and enabled through flows of desire. Practising BDSM can be understood as a process of increasing expansion, creation and connection, in which desire is seen not as something we lack or need but rather as a process of striving and self-enhancement. Exploring the becoming process more fully can provide a better understanding as to why some people choose to practise BDSM.

Prevalence rates, reporting, and psychosocial correlates of stalking victimization: results from a three-sample cross-sectional study

PURPOSE

Public health and criminal justice stalking victimization data collection efforts are plagued by subjective definitions and lack of known psychosocial correlates. The present study assesses the question of stalking victimization prevalence among three groups. Psychosocial risk and protective factors associated with stalking victimization experiences were assessed.

METHODS

Archival data (n = 2159) were drawn from a three-sample (i.e., U.S. nationwide sexual diversity special interest group, college student, and general population adult) cross-sectional survey of victimization, sexuality, and health.

RESULTS

The range of endorsement of stalking-related victimization experiences was 13.0-47.9%. Reported perpetrators were both commonly known and unknown persons to the victim. Participants disclosed the victimization primarily to nobody or a family member/friend. Bivariate correlates of stalking victimization were female gender, Associates/Bachelor-level education, bisexual or other sexual orientation minority status, hypertension, diabetes, older age, higher weekly drug use, elevated trait aggression, higher cognitive reappraisal skills, lower rape myth acceptance, and elevated psychiatric symptoms. Logistic regression results showed the strongest factors in identifying elevated stalking victimization risk were: older age, elevated aggression, higher cognitive reappraisal skills, lesser low self-control, increased symptoms of suicidality and PTSD re-experiencing, and female and other gender minority status.

CONCLUSIONS

Behavioral approaches to epidemiological and criminal justice stalking victimization are recommended. Victimization under reporting to healthcare and legal professionals were observed. Further research and prevention programming is needed to capitalize on data concerning personality and coping skills, sexual diversity, and trauma-related psychiatric symptoms.

An Exploration of the Experience of Harm in the Bondage/Discipline/Sadomasochism Community

This study sought to gain insight into the attitudes, beliefs, and values that shape bondage/discipline/sadomasochism (BDSM) activities and to explore the degree and consequences of unintended or non-negotiated harms, including physical, emotional, and sexual violence. A qualitative approach, consisting of 22 semistructured interviews and over 150 hours of observations of BDSM events and activities, was used to develop an in-depth exploration of the lived experiences of participants. Thematic analysis was employed to elucidate the ways in which participants define and in some cases experience harm. Findings suggest that individuals construct rational identities that emphasize safe practices and managing harm; however; there are instances where "boundary slippage" occurs. Implications for understanding the dynamics as well as the potential dangers of "consensual" violence are discussed.

Empathy in female submissive BDSM practitioners

The practice of bondage/discipline, dominance/submission, sadism/masochism (BDSM) sometimes is associated with giving and receiving pain. It remains unresolved how BDSM practitioners perceive the pain of other people. This study investigated whether and how the BDSM experience affects human empathy. Experiment 1 measured trait empathy and subjective empathic responses in BDSM practitioners and control respondents. The results revealed lower trait empathy scores and subjective pain intensity ratings in the female submissive group (Subs) compared to controls. Experiment 2 measured participants' neural responses to others' suffering by recording event-related potentials (ERPs) from female Subs and controls while viewing painful and neutral expressions. We found that the differential amplitudes between painful and neutral expressions in the frontal N1 (92-112ms), frontal P2 (132-172ms) and central late LPP (700-1000ms) were reduced in the submissive group versus the control group. These findings suggest that being in the submissive role during BDSM practice weakens female individuals' empathic responses to others' suffering at both the behavioral and neural levels.

Embodiment and Humiliation Moderation of Neural Responses to Others' Suffering in Female Submissive BDSM Practitioners

Giving and receiving pain are common in the practice of BDSM (bondage-discipline, dominance-submission, and sadism-masochism). Playing a submissive role during BDSM practice weakens both the behavioral and neural empathic responses of female individuals to others' suffering, suggesting that long-term BDSM experience affects BDSM practitioners' empathic ability. This study further investigates whether physical restriction during BDSM practice also modulates individuals' neural responses to others' suffering. We measured neural responses to others' suffering by recording event-related potentials (ERPs) in female submissives while they viewed painful and neutral expressions in sexual sadistic/general social contexts under ball gag Blocking and Relaxed conditions. The neural responses recorded during 92-112 ms (N1), 132-172 ms (P2), 200-340 ms (N2), early late positive potential (LPP, 400-600 ms), and late LPP (700-1,000 ms) were included in the analyses. Compared to the relaxed condition, when a ball gag was used to prevent facial muscle movement and facial mimicry, the N1, early LPP, and late LPP responses neural responses to others' suffering were inhibited. The moderation effect of ball gag blocking on the N1 and early LPP amplitudes was positively correlated with the subjective feelings of facial muscle stillness, and the blocking moderation effect on the late LPP amplitudes was positively correlated with subjective feelings of humiliation. This study is the first neuropsychological investigation of the transient BDSM-related physical restriction effects on BDSM practitioners. These findings suggest that physical restriction (via a ball gag) during BDSM practices increases the wearer's facial muscle stillness and sense of humiliation. This physical restriction inhibits both early automatic responses and late controlled processes in response to the suffering of others.

Examining the Lesbian, Gay, and Bisexual Identity Scale Among Members of an Alternative Sexuality Special Interest Group

The present study contributes to a growing body of literature developing psychometrically and theoretically grounded measures of sexual orientation minority identity. We tested psychometric properties and construct validity of a 27-item measure, the Lesbian, Gay, and Bisexual Identity Scale (LGBIS). The sample consisted of 475 adult (178 male, 237 female, 16 male-to-female, 14 female-to-male, and 30 gender queer persons) members of a special interest group, the National Coalition for Sexual Freedom. Participants completed a health needs questionnaire. Prominent findings included (1) confirmatory factor-analytic, internal consistency, and inter-correlation patterns support two LGBIS factor structures; (2) men, compared primarily to women, reported elevated scores on Acceptance Concerns, Concealment Motivation, Difficulty Process, and Negative Identity; (3) queer-identifying persons tended to report low Concealment Motivation, and high Identity Affirmation and Identity Centrality scores; (4) experimenting/fluid-identifying individuals tended toward higher Identity Uncertainty and Negative Identity, and lower Identity Centrality scores; (5) LGB community involvement was negatively associated with Concealment Motivation, Identity Uncertainty, and Negative Identity, and positively associated with Identity Superiority, Identity Affirmation, and Identity Centrality scores; and (6) Acceptance Concerns, Identity Uncertainty, and Internalized Homonegativity displayed significant positive associations with such mental health symptoms as general anxiety and posttraumatic stress. The LGBIS represents a useful approach to evaluating sexual orientation minority identity. Implications for identity theory, research, and practice are provided.

"Sex in a Relationship" versus "Sex During a One-Night Stand": The Link Between Mental Representations of Consensual Sexuality, Mating Strategies, and Sexual Experience in Heterosexual Women and Men

Sexual scripts, that is, the mental representations of sexual behavior, are highly influenced by mating strategies and sexual experience. The relationship between these factors and sexual scripts is, however, poorly understood. Therefore, we assessed how long-term (e.g., "sex in a relationship") and short-term (e.g., "one-night stand") strategies, as well as experience with highly scripted sexual practices (BDSM: bondage-discipline, dominance-submission, sadism-masochism), influence verbalized sexual script composition and detailedness. To this end, 204 heterosexual men and women generated both a "sex in a relationship" and a "one-night stand" script. Regarding mating strategies, both men and women generated shorter "sex in a relationship" scripts than "one-night stand" scripts, due to a shorter approach (flirting) phase. In addition, in the "sex in a relationship" script, women generated longer foreplay phases than men. Regarding sexual experience, in the "sex in a relationship" script, individuals with high-BDSM experience generated longer foreplay phases than individuals with middle- or low-BDSM experience. This pattern was reversed in the "one-night stand" script. These results provide empirical support for interactions between mating strategies and individual experience with regard to the mental representations of sexual activity and gender behavior. Understanding this relationship may enable us to better predict sexual encounters and may help to prevent conflicting or abusive situations.