The professional initiative is yours
Patients are unlikely to disclose their kinky- or BDSM-life until they know it’s safe to talk to you about this. So it is important to take the professional initiative yourself to talk about sex, kink or BDSM when you think it is professionally appropriate.
Studies report that the population that is -or has been in the past- involved in BDSM-activities ranges from 5 to 25% of the population (Jay Wiseman, SM 101: A Realistic Introduction, Greenery Press, 1996 – Richters et al, Sex in Australia: Autoerotic, esoteric and other sexual practices engaged in by a representative sample of adults. Australian and New Zealand journal of public health. 2003), with even higher percentages reporting fantasies or an interest in these activities.
It differs from rural or city practices but overall estimates of at least 10% are realistic.
So whether you know it or not, you will have patients who are into practicing BDSM.
So we advise to think about initiating a non-judgmental discussion on sexuality. Patients are way more likely to be honest about their practices, and open to your professional advice as a when you do!
Talking to kinksters
Workshops like these to help (beginning) Kink Aware Professionals working through the
2 possible feelings that create a Y-fork in the road of client-contact. To help you ask relevant questions, but beware of questions designed to satisfy your personal curiosity (professional curiosity can be appropriate), nor vent your personal dislikes.
Do ask for the patient’s (medical/psychological/financial) concerns or questions about their play.
Non-monogamy
Kink and BDSM may make non-monogamy more likely (important in connection with the need for STD-checks and Safe sex-info and possible relational stresses).
Ask yourself: what’s the direction?:
- Is the role in BDSM a reason for non-monogamy?
- Are wishes towards BDSM a reason for non-monogamy (in a non-BDSM-relation)?
- A non-monogamous relation happens to give room for other (BDSM) contacts?
If known, use the patient’s own language to describe their identity, play and relationships (otherwise ask!)
Someone who calls herself a “bottom” may be really annoyed if you assume she’s a “submissive” or a “slave”. And be careful with using in-group terms (especially the reclaimed ones) even if the patient him/herself uses them (like “perv”, “fag”, “slut”, etc.)
Please do remember that a patient walks into your office with a lifetime of experiences that affect their fears, hopes, and expectations (i.e. information you don’t have, misinformation, worries from stories they’ve heard from other people)
Suggested Phrases could be:
Begin with something like:
“Sexual health is important to overall health; therefore I always ask patients about it. If it’s ok with you, I’ll ask you a few questions about sexual matters now.”
The Topping-Cake-metaphor
In thinking about kinky relations it is good to remember the cake-metaphor (West, 2010) “no topping stays in place without a good cake” (pun is intended).
In BDSM- and kinky relations more is possible than in ‘normal’ life. Topping with power-imbalance needs equality to carry those kicks. Underneath any BDSM relation are always the rules of our biology, our societal equality and relational aspects like respect, trust, work, health, kids, taxes.
“I know that my patients participate in a wide variety of sexual practices, including oral, anal, vaginal intercourse, the use of sex toys. That they do role play, do bondage, like BDSM, like intense sensation, or do other activities with their partners or others that add to their quality of life… Different activities have different (health) risks and implications for how I can best care for you as your . What types of sexual activity do you participate in?”
and finish with something like:
“Are there any sexual activities you might engage in, about which you have questions or health questions for me?”
Then have an open-minded and non-judgemental conversation…
Common Practitioner Pitfalls
The main practitioner pitfalls are:
- Reaction to bruises and lesions:
- Not asking about marks or bruises
- Filing an abuse report on every mark you see
- Assumptions about kinksters
- Assuming all BDSM is always abuse
- Assuming BDSM can never be abusive
- Knowledge
- Making up answers that you do not really know to be the truth (present educated guesses as educated guesses)
- Referring all kinksters and BDSM-loving patients for psychological care while not having a clear (and communicated!) reason to suspect anxiety/depression etc other than the kink.
- Privacy: “Outing” a patient to anyone, anytime, anywhere (IRL or online, in or outside the family, in or outside treatment)
Questions screening for abusive (BDSM-)relationships
- Can you insist on safe sex practices?
- Can you enter a situation without fearing that you will be seriously harmed, or fearing that other participant(s) will be harmed seriously?
- Can you refuse to do certain (illegal) activities, and/or refuse to do activities that don’t match your fantasies?
- Is your relationship built on things like honesty, trust, and respect (i.a.w. underlying safety)?
- Are your needs, wants and your true limits respected in your relationship?
- Are you able to express your feelings of guilt or jealousy or unhappiness to your partner? And do those remarks create fruitful conversation?
- Can you function in everyday life? And can you choose to exercise self-determination with non-BDSM aspects like money, employment, health and other life decisions?
- Are you allowed to interact freely with others outside of your relationship? (both in and/or outside the BDSM community)
- Do you feel free to discuss -with anyone you choose- your (sexual/BDSM) practices and your feelings about that?
- Does BDSM-play only happen under the influence of drugs or alcohol?
SM versus ABUSE
| SM: Everyone involved in an SM scene is concerned about the needs, desires, and limits of all of the others (relational consent and compersion) | ABUSE: There is no concern to the needs, desires, and limits of the abused person. There is no consent and no compersion. |
| SM: The people in an SM scene are mostly careful to be sure that they are not impaired by alcohol or drug use during the scene. | ABUSE: Alcohol or drugs are often the onset of an episode of abuse. |
| SM: follows rules of play (homo ludens: borders, rules, fun) with underlying respect and responsibility. | ABUSE: rules nor respect is applicable. |
| SM: An SM scene is a controlled situation. | ABUSE: Abuse is an out-of-control situation! (alcohol?) |
| SM: Knowledgeable consent is given to the scene by all parties. | ABUSE: No consent is asked for or given or in anyway applicable. |
| SM: Negotiation often occurs before an SM scene to determine what will and will not happen in that scene. | ABUSE: Only the aggressor determines what happens. |
| SM: The ‘bottom’ has a safe-word that allows them to stop the scene at any time should they need to for physical or emotional reasons. | ABUSE: The person being abused cannot interfere in what is happening other than with aggression. |
| SM: After an SM scene, the people involved usually feel good or talk it over. | ABUSE: After an episode of abuse, the people involved will feel bad (hurt/empty/guilty) and generally don’t really discuss proceedings. |
Some reasons why BDSM-adepts visit a doctor
- Lesions like cuts (knifeplay, ripped needleplay weavings),
- burns (waxplay with f.i. bee wax),
- infections (-infected- brandings),
- contorted joints (bondage and falls),
- stress because of relationship problems (partner vanilla, partner on other axis of BDSM),
- STD’s (unprotected sex f.i. during sexual degradation),
- fissures vaginal-anal (fisting, unlubed anal sex),
- nerve damage (pressure from shibari -bondage-),
- penisses getting cought in all kind of things (i.e. viagra, kamagra?)
- welts and bruises (hardly ever primary reason for visit but may still be visible when visiting for other health problems)
- …amongst others…
This text is copyrighted (West-coaching, 2010) and used within the
“Kink Aware Professionality Training”
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