Diverse sexual practices, including BDSM (Bondage, Discipline, Dominance, Submission, Sadism, and Masochism), are more common than many realize. Studies show that over 30% of people have engaged in kink-related activities, and many have fantasies involving elements like bondage or power exchange. Central to BDSM is consent, with participants agreeing on activities beforehand to ensure safety and mutual enjoyment. However, some BDSM activities may carry risks, such as bruises or cuts, similar to injuries that can occur during non-BDSM sexual activities.

Despite the emphasis on consent, individuals in the BDSM community often face stigma and discrimination in healthcare settings. Many healthcare providers lack training in addressing diverse sexual practices, which can lead to assumptions, discomfort, or avoidance of discussing sexual health. This creates barriers for BDSM practitioners, who may fear being judged, misunderstood, or even reported for injuries stemming from consensual activities.

A recent study explored how these challenges impact BDSM practitioners’ communication with healthcare providers, including their willingness to disclose BDSM-related injuries or seek care. Understanding these barriers is crucial for improving healthcare equity and fostering nonjudgmental, informed care for all patients, regardless of their sexual practices.

This study explored the experiences of BDSM practitioners with healthcare providers, focusing on stigma, discrimination, injury disclosure, and medical mistrust. Participants were recruited online through platforms like FetLife, Reddit, and Instagram, as well as the National Coalition for Sexual Freedom newsletter. Eligibility required participants to be 18 or older, part of the BDSM community, and comfortable reading English. A total of 301 individuals, mostly white and male, participated, with ages ranging from 18 to 78 years. Most reported engaging in BDSM activities weekly or more.

Participants answered surveys about demographics, BDSM roles, medical mistrust, discrimination, and injuries. Nearly half (48.1%) reported avoiding asking questions about sexual health during healthcare appointments due to concerns about judgment. About 29% felt discriminated against by healthcare staff for being part of the kink community, and 24% said providers disapproved of their practices. Additionally, about 32% admitted to hiding injuries, and 21% wanted to discuss issues but refrained due to fear of judgment or discrimination.

Experiences of discrimination were common, with 38% reporting at least one instance related to their kink identity. Non-white participants experienced significantly higher rates of discrimination compared to white participants. These experiences, combined with high levels of medical mistrust, led many to avoid seeking care for injuries that could benefit from medical intervention. While most injuries from BDSM play were minor and did not require treatment, more serious issues like infections, nerve damage, or trauma were sometimes ignored due to mistrust.

The results of the study highlighted the need for improved healthcare training to address stigma, foster trust, and provide inclusive care for diverse sexual practices. Understanding the context of BDSM-related injuries, whether intentional or accidental, could help providers deliver equitable care. Increasing provider knowledge and sensitivity about kink behaviors is critical for building trust and addressing the unique healthcare needs of this community, which in turn could improve overall health outcomes. Future research should explore these issues further, particularly among diverse racial groups and geographic regions, to develop culturally competent healthcare practices.

References:

• Jansen, K. L., Fried, A. L., Goetz, C., & Kang, S. (2024). Mistrust and missed opportunities: BDSM practitioner experiences in healthcare. The Journal of Sexual Medicine, 21(11), 1047–1053. https://doi.org/10.1093/jsxmed/qdae125