Editing BDSM (section)

== Psychology ==
Research indicates that there is no evidence that a preference for BDSM is a consequence of childhood abuse.<ref name="a2">{{Cite journal|title=Demographic and Psychosocial Features of Participants in Bondage and Discipline, "Sadomasochism" or Dominance and Submission (BDSM): Data from a National Survey |url=http://www.niu.edu/user/tj0bjs1/bdsm/Richters,%20de%20Visser,%20Rissel,%20Grulich,%20&%20Smith%20(2008).pdf |journal=The Journal of Sexual Medicine |date=1 July 2008 |issn=1743-6109 |pages=1660–1668 |volume=5 |issue=#7 |doi=10.1111/j.1743-6109.2008.00795.x |first1=Juliet |last1=Richters |first2=Richard O. |last2=De Visser |first3=Chris E. |last3=Rissel |first4=Andrew E. |last4=Grulich |first5=Anthony M.A. |last5=Smith |pmid=18331257 |url-status=dead |archive-url=https://web.archive.org/web/20161020021649/http://www.niu.edu/user/tj0bjs1/bdsm/Richters%2C%20de%20Visser%2C%20Rissel%2C%20Grulich%2C%20%26%20Smith%20%282008%29.pdf |archive-date=20 October 2016 }}</ref> Some reports suggest that people abused as children may have more BDSM injuries and have difficulty with safe words being recognized as meaning stop the previously consensual behaviour;<ref>{{Cite journal|last=Jozifkova|first=Eva|date=11 August 2013|title=Consensual Sadomasochistic Sex (BDSM): The Roots, the Risks, and the Distinctions Between BDSM and Violence|journal=Current Psychiatry Reports|language=en|volume=15|issue=#9|pages=392|doi=10.1007/s11920-013-0392-1|pmid=23933978|s2cid=29054687|issn=1523-3812}}</ref> thus, it is possible that people choosing BDSM as part of their lifestyle, who also were previously abused, may have had more police or hospital reports of injuries. In one study of three online surveys, many transgender adults remarked that BDSM influenced their individual experience of gender.<ref>{{Cite journal|last1=Cook-Daniels|first1=Loree|last2=Munson|first2=Michael|date=5 May 2010|title=Sexual Violence, Elder Abuse, and Sexuality of Transgender Adults, Age 50+: Results of Three Surveys|journal=Journal of GLBT Family Studies|volume=6|issue=#2|pages=142–177|doi=10.1080/15504281003705238|issn=1550-428X|s2cid=57665777}}</ref>

Joseph Merlino, author and psychiatry adviser to the ''[[New York Daily News]]'', said in an interview that a sadomasochistic relationship, as long as it is consensual, is not a psychological problem:
{{Blockquote|It's a problem only if it is getting that individual into difficulties, if he or she is not happy with it, or it's causing problems in their personal or professional lives. If it's not, I'm not seeing that as a problem. But assuming that it did, what I would wonder about is what is his or her biology that would cause a tendency toward a problem, and dynamically, what were the experiences this individual had that led him or her toward one of the ends of the spectrum.<ref>[[n:Dr. Joseph Merlino on sexuality, insanity, Freud, fetishes and apathy#Gender identity and Heteronormativity|Interview with Dr. Joseph Merlino]], David Shankbone, ''[[Wikinews]]'', October 5, 2007.</ref>}}

Some psychologists agree that experiences during early [[Psychosexual development|sexual development]] can have a profound effect on the character of sexuality later in life. Sadomasochistic desires, however, seem to form at a variety of ages. Some individuals report having had them before puberty, while others do not discover them until well into adulthood. According to one study, the majority of male sadomasochists (53%) developed their interest before the age of 15, while the majority of females (78%) developed their interest afterward (Breslow, Evans, and Langley 1985). The prevalence of sadomasochism within the general population is unknown. Despite female sadists being less visible than males, some surveys have resulted in comparable amounts of sadistic fantasies between females and males.<ref name="Fedoroff640">{{harvnb|Fedoroff|2008|p=640}}: "...surveys have found no difference in frequency of sadistic fantasies in men and women."</ref> The results of such studies demonstrate that one's sex does not determine preference for sadism.<ref name="Fedoroff644">{{harvnb|Fedoroff|2008|p=644}}: "This review indicates that sexual sadism, as currently defined, is a heterogeneous phenomenon."</ref>

Following a phenomenological study of nine individuals involved in sexual masochistic sessions who regarded pain as central to their experience,<ref>Kurt, H., & Ronel, N. (in print). Addicted to Pain. International Journal of Offender Therapy and Comparative Criminology.</ref> sexual masochism was described as an addiction-like tendency, with several features resembling that of drug addiction: craving, intoxication, tolerance and withdrawal. It was also demonstrated how the first masochistic experience is placed on a pedestal, with subsequent use aiming at retrieving this lost sensation, much as described in the descriptive literature on addiction.

=== Prevalence ===
[[File:Man flogged at xxxotica.jpg|thumb|[[Flogging]] of a bound man by a [[dominatrix]] at the [[Exxxotica]] adult event at the [[Jersey Shore]], [[New Jersey]], U.S.]]
[[File:David Shankbone interviews two dominatices about strange client requests.ogg|thumb|Two professional dominatrices interviewed by David Shankbone about the psychological aspects of some of their stranger requests<ref>[[n:BDSM as business: Interviews with Dominatrixes]]—full transcript.</ref>]]
BDSM occurs among people of all genders and sexual orientations, and in varied occurrences and intensities.<ref>{{Cite journal |last1=Brown |first1=Ashley |last2=Barker |first2=Edward D. |last3=Rahman |first3=Qazi |date=2020 |title=A Systematic Scoping Review of the Prevalence, Etiological, Psychological, and Interpersonal Factors Associated with BDSM |journal=The Journal of Sex Research |volume=57 |issue=6 |pages=781–811 |doi=10.1080/00224499.2019.1665619 |pmid=31617765 |s2cid=204740964 |doi-access=free }}</ref><ref>Breslow et al. ''On the Prevalence and Roles of Females in the Sadomasochistic Subculture: Report of an Empirical Study''. Archives of Sexual Behavior 14/1985, P. 303–17. In Thomas S. Weinberg: ''S&M: Studies in Dominance and Submission'', (ed.), Prometheus Books, New York, 1995 {{ISBN|978-0-87975-978-0}}</ref><ref>[[Gloria Brame|Gloria G. Brame]], [http://www.gloria-brame.com/therapy/kinkoverview.html BDSM/Fetish Sex: Overview and Study] {{webarchive|url=https://web.archive.org/web/20071221063236/http://www.gloria-brame.com/therapy/kinkoverview.html |date=21 December 2007 }}. Retrieved on 9 November 2008.</ref> The spectrum ranges from couples with no connections to the subculture outside of their bedrooms or homes, without any awareness of the concept of BDSM, playing "tie-me-up-games", to public scenes on [[Saint Andrew's Cross (BDSM)|St. Andrew's crosses]] at large events such as the [[Folsom Street Fair]] in [[San Francisco, California|San Francisco]]. Estimation on the overall percentage of BDSM-related sexual behaviour varies.<ref name="a3" >{{cite journal | last1 = Kolmes | first1 = K. | last2 = Stock | first2 = W. | last3 = Moser | first3 = C. | year = 2006 | title = Investigating bias in psychotherapy with BDSM clients | journal = Journal of Homosexuality | volume = 50 | issue = #2–3| pages = 301–324 | doi=10.1300/j082v50n02_15| pmid = 16803769 | s2cid = 21097726 }}</ref>

[[Alfred Kinsey]] stated in his 1953 nonfiction book ''Sexual Behavior in the Human Female'' that 12% of females and 22% of males reported having an erotic response to a sadomasochistic story.<ref name="sbhf677">''Sexual Behavior in the Human Female'', pp. 677-678</ref> In that book erotic responses to being bitten were given as:<ref name="sbhf677"/>
{| class="wikitable"
|- style="border-bottom:2px solid black;"
! Erotic responses
! By females
! By males
|-
! Definite and/or frequent
| 26%
| 26%
|-
! Some response
| 29%
| 24%
|-
! Never
| 45%
| 50%
|- style="border-top:2px solid black;"
|+
! Number of cases
| 2200
| 567
|}

A non-representative survey on the sexual behaviour of American students published in 1997 and based on questionnaires had a response rate of about 8–9%. Its results showed 15% of homosexual and bisexual males, 21% of lesbian and female bisexual students, 11% of heterosexual males and 9% of female heterosexual students committed to BDSM related fantasies.<ref name="elliott" /> In all groups the level of practical BDSM experiences were around 6%. Within the group of openly lesbian and bisexual females, the quote was significantly higher, at 21%. Independent of their sexual orientation, about 12% of all questioned students, 16% of lesbians and female bisexuals and 8% of heterosexual males articulated an interest in spanking. Experience with this sexual behaviour was indicated by 30% of male heterosexuals, 33% of female bisexuals and lesbians, and 24% of the male gay and bisexual men and female heterosexual women.<ref name="elliott" /> Even though this study was not considered representative, other surveys indicate similar dimensions in differing target groups.<ref>Brokmann, Angela: ''Macht und Erotik'', 1996, Sexologisches Institut e. V. Hamburg, Hamburg (German)</ref><ref>Person, Ethel S. / Terestman, Nettie / Myers, Wayne A. / Goldberg, Eugene L. / Salvadori, Carol: "Gender differences in sexual behaviors and fantasies in a college population", 1989, in: ''Journal of Sex and Marital Therapy'', Bd. 15, No. 3, 1989, P. 187–198</ref><ref>Breslow, Norman: ''[https://archive.today/20120918113125/http://www.sexuality.org/l/nb/nbres.html SM Research Report, v1.1]'', 1999</ref>

A representative study done from 2001 to 2002 in Australia found that 1.8% of sexually active people (2.2% men, 1.3% women but no significant sex difference) had engaged in BDSM activity in the previous year. Of the entire sample, 1.8% of men and 1.3% of women had been involved in BDSM. BDSM activity was significantly more likely among bisexuals and homosexuals of both sexes. But among men in general, there was no relationship effect of age, education, language spoken at home or relationship status. Among women, in this study, activity was most common for those between 16 and 19 years of age and least likely for females over 50 years. Activity was also significantly more likely for women who had a regular partner they did not live with, but was not significantly related with speaking a language other than English or education.<ref name="a2" />

Another representative study, published in 1999 by the German Institut für rationale Psychologie, found that about 2/3 of the interviewed women stated a desire to be at the mercy of their sexual partners from time to time. 69% admitted to fantasies dealing with sexual submissiveness, 42% stated interest in explicit BDSM techniques, 25% in bondage.<ref>Arne Hoffmann, ''Lexikon der Tabubrüche'', Schwarzkopf&Schwarzkopf, 2003, {{ISBN|978-3-89602-517-3}} (German)</ref> A 1976 study in the general US population suggests three per cent have had positive experiences with Bondage or master-slave roleplaying. Overall 12% of the interviewed females and 18% of the males were willing to try it.<ref>"What's Really Happening on Campus", ''Playboy'' October 1976, S. 128–131, 160–164, 169. (see Charles Moser / Eugene E. Levitt: "An Exploratory-Descriptive Study of a Sadomasochistically Oriented Sample", in ''Journal of Sex Research'', Vol. 23, 1987, P. 322-337.)</ref><ref>Thomas S. Weinberg (Ed.): ''S&M: Studies in Dominance and Submission'', Prometheus Books, New York 1995, {{ISBN|978-0-87975-978-0}}</ref> A 1990 [[Kinsey Institute]] report stated that 5% to 10% of Americans occasionally engage in sexual activities related to BDSM, 11% of men and 17% of women reported trying bondage.<ref>Walter Lowe: ''The Playboy Readers' Sex Survey''. 1983.</ref><ref>Based on the 1983 "Playboy Readers Sex Survey" by Walter Lowe. [http://www.kinseyinstitute.org/resources/FAQ.html#bdsm kinseyinstitute.org] {{Webarchive|url=https://web.archive.org/web/20120420205301/http://www.kinseyinstitute.org/resources/FAQ.html#bdsm |date=20 April 2012 }}</ref> Some elements of BDSM have been popularized through increased media coverage since the middle 1990s. Thus both black leather clothing, sexual jewelry such as chains and dominance roleplay appear increasingly outside of BDSM contexts.

According to yet another survey of 317,000 people in 41 countries, about 20% of the surveyed have at least used masks, blindfolds or other bondage utilities once, and 5% explicitly connected themselves with BDSM.<ref name="Durex">Durex Global Sex Survey 2005, P.15 Online [http://www.durex.com/cm/gss2005results.asp Durex Global Sex Survey 2005] {{webarchive |url=https://web.archive.org/web/20090315002702/http://www.durex.com/cm/gss2005results.asp |date=15 March 2009 }}</ref> In 2004, 19% mentioned spanking as one of their practices and 22% confirmed the use of blindfolds or handcuffs.<ref name="Durex"/>

A 1985 study found 52 out of 182 female respondents (28%) were involved in sadomasochistic activities.<ref>Breslow, N., Evans, L., and Langley, J. (1985). "On the prevalence and roles of females in the sadomasochistic subculture: Report Of an empirical study". Arch. Sex. Behav. 14: 303-317.</ref>

;Recent surveys
A 2009 study on two separate samples of male undergraduate students in [[Canada]] found that 62 to 65%, depending on the sample, had entertained sadistic fantasies, and 22 to 39% engaged in sadistic behaviours during sex. The figures were 62 and 52% for bondage fantasies, and 14 to 23% for bondage behaviours.<ref>{{cite journal |title=Inferring Sexually Deviant Behavior From Corresponding Fantasies|year=2009|author1=Kevin M. Williams |author2=Barry S. Cooper |author3=Teresa M. Howell |author4=John C. Yuille |author5=Delroy L. Paulhus |s2cid=33364099|journal=Criminal Justice and Behavior|issue=#2|volume=36|pages=198–222|doi=10.1177/0093854808327277}}</ref> A 2014 study involving a mixed sample of Canadian college students and online volunteers, both male and female, reported that 19% of male samples and 10% of female samples rated the sadistic scenarios described in a questionnaire as being at least "slightly arousing" on a scale that ranged from "very repulsive" to "very arousing";<ref name=dawson>{{cite journal |title=Paraphilic Interests: An Examination of Sex Differences in a Nonclinical Sample|year=2014|author1=Samantha J. Dawson |author2=Brittany A. Bannerman |author3=Martin L. Lalumière |s2cid=541989|name-list-style=amp |journal=Sexual Abuse: A Journal of Research and Treatment|volume=28|issue=#1|pages=1–26|doi=10.1177/1079063214525645|pmid=24633420}}</ref> the difference was statistically significant.<ref name=dawson /> The corresponding figures for the masochistic scenarios were 15% for male students and 17% for female students, a non-significant difference.<ref name=dawson /> In a 2011 study on 367 middle-aged and elderly men recruited from the broader community in [[Berlin]], 21.8% of the men self-reported sadistic fantasies and 15.5% sadistic behaviors;<ref name=ahlers>{{cite journal |title=How unusual are the contents of paraphilias? Paraphilia-associated sexual arousal patterns in a community-based sample of men|year=2011|vauthors=Ahlers CJ, Schaefer GA, Mundt IA, Roll S, Englert H, Willich SN, Beier KM |journal=Journal of Sexual Medicine|issue=#5|volume=8|pages=1362–70|doi=10.1111/j.1743-6109.2009.01597.x|pmid=19929918}}</ref> 24.8% self-reported any such fantasy and/or behavior.<ref name=ahlers /> The corresponding figures for self-reported masochism were 15.8% for fantasy, 12.3% for behaviour, and 18.5% for fantasy and/or behaviour.<ref name=ahlers /> In a 2008 study on gay men in [[Puerto Rico]], 14.8% of the over 425 community volunteers reported any sadistic fantasy, desire or behaviour in their lifetime; the corresponding figure for masochism was 15.7%.<ref>{{cite report|title=Doctoral dissertation: Paraphilias among gay men in Puerto Rico|year=2008|author=Edward H. Fankhanel|url=http://www.esextherapy.com/dissertations/Edward%20H%20Fankhanel%20M.A.%20Ed.D.%20%20Paraphilias%20Among%20Gay%20Men%20in%20Puerto%20Rico.pdf|publisher=The American Academy of Clinical Sexologists|access-date=13 April 2015|archive-url=https://web.archive.org/web/20150322140811/http://www.esextherapy.com/dissertations/Edward%20H%20Fankhanel%20M.A.%20Ed.D.%20%20Paraphilias%20Among%20Gay%20Men%20in%20Puerto%20Rico.pdf|archive-date=22 March 2015|url-status=dead}}</ref> A 2017 cross-sectional representative survey among the general Belgian population demonstrated a substantial prevalence of BDSM fantasies and activities; 12.5% of the population performed one of more BDSM-practices on a regular basis.<ref>{{cite journal |title=Fifty Shades of Belgian Gray: The Prevalence of BDSM-Related Fantasies and Activities in the General Population|year=2017|author1=Lien Holvoet |author2=Wim Huys |author3=Violette Coppens |author4=Jantien Seeuws |author5=Kris Goethals |author6=Manuel Morrens |journal=Journal of Sexual Medicine|issue=#14|volume=9|pages=1152–1159|doi=10.1016/j.jsxm.2017.07.003 |pmid=28781214|hdl=10067/1450920151162165141|hdl-access=free}}</ref>

{| class="wikitable sortable" border="1"; style="text-align:center; width:80%"
|-
!Lifetime BDSM behaviors among North American medical students<ref>{{cite journal|title=The Impact of Sexual Orientation on Sexuality and Sexual Practices in North American Medical Students|year=2010|doi=10.1111/j.1743-6109.2010.01794.x|pmid=20384941|pmc=3607668|journal=[[Journal of Sexual Medicine]]|volume=7|issue=7|pages=2391–2400|last1=Breyer|first1=Benjamin N.|last2=Smith|first2=James F.|last3=Eisenberg|first3=Michael L.|last4=Ando|first4=Kathryn A.|last5=Rowen|first5=Tami S.|last6=Shindel|first6=Alan W.}}</ref>
!Straight men
!Gay men
!Bisexual men
!Straight women
!Gay women
!Bisexual women
|-
|Has been restrained for pleasure
|12%
|20%
|13%
|19%
|38%
|55%
|-
|Has restrained someone else for pleasure
|17.5%
|17%
|13%
|13%
|36%
|51%
|-
|Has received pain for pleasure
|4%
|6.5%
|18%
|8%
|10%
|36%
|-
|Has inflicted pain for pleasure
|5%
|6%
|9%
|4%
|6.5%
|26%
|}

Recent surveys on the spread of BDSM fantasies and practices show strong variations in the range of their results.<ref name="Fakten">{{cite web |title=Nackte Fakten – Statistik für Zahlenfetischisten |language=de |access-date=9 November 2008 |url=http://www.datenschlag.org/txt/statistik.html |archive-url=https://web.archive.org/web/20081208192334/http://www.datenschlag.org/txt/statistik.html |archive-date=8 December 2008 |url-status=dead }}</ref> Researchers believe that 5 to 25 per cent of the population practices sexual behaviour related to pain or dominance and submission. The population with related fantasies is believed to be even larger.<ref name="Fakten"/>

=== Medical categorization ===
{{See also|Sexual sadism disorder|Sexual masochism disorder}}
Reflecting changes in [[social norm]]s, modern medical opinion is now moving away from regarding BDSM activities as medical disorders, unless they are nonconsensual or involve significant distress or harm.

In 1995, Denmark became the first [[European Union]] country to have completely removed [[sadomasochism]] from its national classification of diseases. This was followed by Sweden in 2009, Norway in 2010, Finland in 2011, and Iceland in 2015.<ref>{{cite web|url=http://www.revisef65.org/Sweden.html|title=Fetish and SM diagnoses deleted in Sweden|publisher=ReviseF65|date=17 November 2008|access-date=4 March 2010|archive-url=https://web.archive.org/web/20091227102407/http://www.revisef65.org/Sweden.html|archive-date=27 December 2009|url-status=dead}}</ref><ref>{{cite web|url=http://www.revisef65.org/friskmelding_eng.html|title=SM and fetish off the Norwegian sick list|publisher=[[ReviseF65]]|date=6 February 2010|access-date=4 March 2010|archive-url=https://web.archive.org/web/20100206222549/http://www.revisef65.org/friskmelding_eng.html|archive-date=6 February 2010|url-status=dead}}</ref><ref>{{cite web|url=http://www.revisef65.org/finland_eng.html|title=Finland joins Nordic sexual reform|publisher=[[ReviseF65]]|date=13 May 2011|access-date=7 June 2011|archive-url=https://web.archive.org/web/20110621034733/http://www.revisef65.org/finland_eng.html|archive-date=21 June 2011|url-status=dead|df=dmy-all}}</ref><ref>{{Cite web|url=https://revisef65.net/2018/11/17/iceland/|title=Iceland removes Sadomasochism as a diagnosis|date=17 November 2018|website=Revise F65|access-date=26 December 2018|archive-date=27 December 2018|archive-url=https://web.archive.org/web/20181227040705/https://revisef65.net/2018/11/17/iceland/|url-status=live}}</ref>

==== DSM ====
In the past, the [[Diagnostic and Statistical Manual of Mental Disorders]] (DSM), the [[American Psychiatric Association]]'s manual, defined some BDSM activities as sexual disorders.<ref name=Gerson2015>{{Cite news|url=https://www.theatlantic.com/health/archive/2015/01/bdsm-versus-the-dsm/384138/|title=BDSM Versus the DSM|last=Gerson|first=Merissa Nathan|date=2015-01-13|work=The Atlantic|access-date=2018-07-13|language=en-US|archive-url=https://web.archive.org/web/20180713141700/https://www.theatlantic.com/health/archive/2015/01/bdsm-versus-the-dsm/384138/|archive-date=13 July 2018|url-status=live}}</ref> Following campaigns from advocacy organizations including the [[National Coalition for Sexual Freedom]],<ref name=Gerson2015/> the current version of the DSM, [[DSM-5]], excludes consensual BDSM from diagnosis when the sexual interests cause no harm or distress.<ref>{{Cite web|url=http://www.dsm5.org/Documents/Paraphilic%20Disorders%20Fact%20Sheet.pdf |title=Paraphilic Disorders |date=2013 |website=dsm5.org |publisher=American Psychiatric Association |access-date=26 August 2016 |url-status=dead |archive-url=https://web.archive.org/web/20160724010712/https://www.dsm5.org/Documents/Paraphilic%20Disorders%20Fact%20Sheet.pdf |archive-date=24 July 2016 |df=dmy }}</ref>

==== ICD ====
The [[World Health Organization]]'s [[International Classification of Diseases]] (ICD) has changed in regard to BDSM in recent years.

In Europe, an organization called [[:de:ReviseF65]] worked to remove sadomasochism from the ICD.<ref>{{cite journal |vauthors=Reiersøl O, Skeid S |title=The ICD diagnoses of fetishism and sadomasochism |journal=Journal of Homosexuality |volume=50 |issue=#2–3 |pages=243–62 |year=2006 |pmid=16803767 |doi=10.1300/J082v50n02_12 |s2cid=7120928 }}</ref>

On 18 June 2018, the WHO ([[World Health Organization]]) published [[ICD-11]], in which sadomasochism, together with [[Sexual fetishism|fetishism]] and fetishistic transvestism ([[cross-dressing]] for sexual pleasure) are now removed as psychiatric diagnoses. Moreover, discrimination against fetish-having and BDSM individuals is considered inconsistent with human rights principles endorsed by the United Nations and The World Health Organization.<ref name=":ICD1" />

The classifications of sexual disorders reflect contemporary sexual norms and have moved from a model of pathologization or criminalization of non-reproductive sexual behaviors to a model that reflects sexual well-being and pathologizes the absence or limitation of consent in sexual relations.<ref name=":ICD1">{{Cite journal|last1=Krueger|first1=Richard B.|last2=Reed|first2=Geoffrey M.|last3=First|first3=Michael B.|last4=Marais|first4=Adele|last5=Kismodi|first5=Eszter|last6=Briken|first6=Peer|date=2017|title=Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11)|journal=Archives of Sexual Behavior|volume=46|issue=5|pages=1529–1545|doi=10.1007/s10508-017-0944-2|issn=0004-0002|pmc=5487931|pmid=28210933}}</ref><ref>{{Cite journal|last=Giami|first=Alain|date=2 May 2015|title=Between DSM and ICD: Paraphilias and the Transformation of Sexual Norms|journal=Archives of Sexual Behavior|volume=44|issue=5|pages=1127–1138|doi=10.1007/s10508-015-0549-6|pmid=25933671|s2cid=21614140|issn=0004-0002}}</ref>

=== Visibility ===
[[File:BDSM Company on Taiwan Pride 2005.jpg|thumb|BDSM activists at Taiwan [[gay pride|Pride]] 2005, [[Taipei]]]]
[[File:Folsom Street Fair IMG 6259 (cropped).jpg|thumb|A [[sulky]] cart drawn by a pony-girl, an example of [[petplay]] at the [[Folsom Street Fair|Folsom Parade]], 2012. She is wearing a [[Gag (BDSM)#Bit|bit gag]] and a [[Collar (BDSM)|neck collar]], to which are attached a ''[[ring of O]]'' and a [[leash]]. Bells are hung from her [[Nipple piercing|pierced nipples]]. All these symbols indicate she is [[Sexual roleplay|roleplaying]] a '[[Sexual slavery (BDSM)|pet slave]]'.]]
[[File:Kink porn shoot 09.jpg|thumb|A [[bondage pornography]] shoot in the U.S., 2011]]

Some people who are interested in or curious about BDSM decide to tell others. Depending upon a survey's participants, about 5 to 25 per cent of the US population show affinity to the subject.<ref name="elliott">Elliott, Leland / Brantley, Cynthia, ''Sex on Campus'', 1997, Random House, New York</ref><ref>Janus, Samuel S. / Janus, Cynthia L., 1994 ''The Janus Report on Sexual Behavior'', Wiley, New York, {{ISBN|978-0-471-01614-4}}</ref> Other than a few artists and writers,<ref>{{Cite news |first=Jillian|last=Keenan|title=Finding the Courage to Reveal a Fetish|url=https://www.nytimes.com/2012/11/11/fashion/modern-love-a-spanking-fetish-is-not-revealed-easily.html|website=The New York Times|date=9 November 2012|access-date=13 August 2016|archive-url=https://web.archive.org/web/20160623212231/http://www.nytimes.com/2012/11/11/fashion/modern-love-a-spanking-fetish-is-not-revealed-easily.html|archive-date=23 June 2016|url-status=live}}</ref> practically no celebrities are publicly known as sadomasochists.

Public knowledge of one's BDSM lifestyle can have detrimental vocational and social effects for sadomasochists. Many face severe professional consequences<ref>{{Cite journal|first=Jillian|last=Keenan|title=Can You Really Be Fired for Being Kinky? Absolutely|url=http://www.slate.com/blogs/outward/2014/10/28/the_jian_ghomeshi_case_echoes_many_kinksters_worst_fears_being_outed_and.html|journal=Slate|date=28 October 2014|access-date=13 August 2016|archive-url=https://web.archive.org/web/20160813225416/http://www.slate.com/blogs/outward/2014/10/28/the_jian_ghomeshi_case_echoes_many_kinksters_worst_fears_being_outed_and.html|archive-date=13 August 2016|url-status=live}}</ref> or [[social rejection]] if they are exposed, either voluntarily or involuntarily, as sadomasochists.

Within feminist circles, the discussion is split roughly into two camps: some who see BDSM as an aspect or reflection of oppression (for example, [[Alice Schwarzer]]) and, on the other side, pro-BDSM feminists, often grouped under the banner of [[sex-positive feminism]] (see [[Samois]]); both of them can be traced back to the 1970s.<ref>Alice Schwarzer: "Weiblicher Masochismus ist Kollaboration!" from ''EMMA Heft 2'', 1991</ref> Some feminists have criticized BDSM for eroticizing power and violence and reinforcing [[misogyny]]. They argue that women who engage in BDSM are making a choice that is ultimately bad for women.<ref>Alice Schwarzer, ''EMMA Heft 2'', 1991</ref> Feminist defenders of BDSM argue that consensual BDSM activities are enjoyed by many women and validate the sexual inclinations of these women.<ref>[http://bdsmreport.org/bdsm-and-feminism-an-insiders-view/ BDSM and Feminism: An Insider's View by Tammy Jo Eckhart] {{webarchive|url=https://web.archive.org/web/20150529111714/http://bdsmreport.org/bdsm-and-feminism-an-insiders-view/ |date=29 May 2015 }}, May 2011</ref> They argue that there is no connection between consensual [[Kink (sexuality)|kinky]] activities and [[sex crimes]], and that feminists should not attack other women's sexual desires as being "anti-feminist". They also state that the main point of feminism is to give an individual woman free choices in her life; which includes her sexual desire. While some feminists suggest connections between consensual BDSM [[Scene (BDSM)|scenes]] and non-consensual rape and [[sexual assault]], other sex-positive ones find the notion insulting to women.<ref>[[Gayle Rubin]]: ''Thinking Sex: Notes for a Radical Theory of the Politics of Sexuality''. In Carole S. Vance (Ed.), ''Pleasure and Danger: exploring female sexuality'', pp. 267–319. Routledge & Kegan Paul, Boston 1984. {{ISBN|978-0-04-440867-3}}</ref><ref>[[Wendy McElroy]]: ''A Woman's Right to Pornography''. Saint Martin's Press 1997, {{ISBN|978-0-312-15245-1}}</ref>

Roles are not fixed to [[gender]], but personal preferences. The dominant partner in a heterosexual relationship may be the woman rather than the man, or BDSM may be part of male/male or female/female sexual relationships. Finally, some people [[Switch (BDSM)|switch]], taking either a dominant or submissive role on different occasions. Several studies investigating the possibility of a correlation between BDSM pornography and the violence against women also indicate a lack of correlation. In 1991, a lateral survey came to the conclusion that between 1964 and 1984, despite the increase in amount and availability of sadomasochistic pornography in the U.S., Germany, Denmark and Sweden, there is no correlation with the national number of rapes to be found.<ref>[[Berl Kutchinsky]], "Pornography and Rape: Theory and Practice?" in: ''International Journal of Law and Psychiatry'', Vol. 14, 1991, P. 47–66</ref>

[[Operation Spanner]] in the U.K. proves that BDSM practitioners still run the risk of being [[Social stigma|stigmatized]] as criminals. In 2003, the media coverage of [[Jack McGeorge]] showed that simply participating and working in BDSM support groups poses risks to one's job, even in countries where no law restricts it.<ref>{{Cite news |title=Pleasure, Pain, and Saddam Hussein |url=http://www.slate.com/id/2074821/ |periodical=[[Slate.com]] |first1=Timothy |last1=Noah |date=3 December 2002 |access-date=9 November 2008 | archive-url= https://web.archive.org/web/20081123071440/http://www.slate.com/id/2074821/| archive-date= 23 November 2008 | url-status=live}}</ref> Here a clear difference can be seen to the situation of homosexuality.{{Clarify|date=January 2015}} The psychological strain appearing in some individual cases is normally neither articulated nor acknowledged in public. Nevertheless, it leads to a difficult psychological situation in which the person concerned can be exposed to high levels of emotional stress.<ref name="moser">[[Charles Allen Moser|Charles Moser]], in ''Journal of Social Work and Human Sexuality'' 1988, (7;1, S.43–56)</ref>

In the stages of "self-awareness", he or she realizes their desires related to BDSM scenarios or decides to be open for such. Some authors call this ''internal coming-out''. Two separate surveys on this topic independently came to the conclusion that 58 per cent and 67 per cent of the sample respectively, had realized their disposition before their 19th birthday. Other surveys on this topic show comparable results.<ref>[[Andreas Spengler|Spengler, Andreas]]: ''Sadomasochisten und ihre Subkulturen'', Campus Verlag, 1979, Frankfurt am Main / New York (German)</ref><ref>{{cite web|url=http://www.datenschlag.org/umfrage/dpb1_ergebnisse.html|title=Datenschlag Peinliche Befragung I - Alte Fragen neu gestellt Ergebnisse|website=Datenschlag survey|language=de|access-date=28 November 2016|archive-url=https://web.archive.org/web/20160725102732/http://www.datenschlag.org/umfrage/dpb1_ergebnisse.html|archive-date=25 July 2016|url-status=dead}}</ref> Independent of age, coming-out can potentially result in a difficult life crisis, sometimes leading to thoughts or acts of suicide. While homosexuals have created support networks in the last decades, sadomasochistic support networks are just starting to develop in most countries. In German-speaking countries they are only moderately more developed.<ref>Eva Daschek und Axel Konrad: ''Empirische Untersuchung über den Zusammenhang zwischen ausgewählten Faktoren und inklinierendem sexuellem Sadomasochismus'', online [http://www.schlagabtausch-hd.de/sm-studie.php sm-study] {{webarchive |url=https://web.archive.org/web/20071122135714/http://www.schlagabtausch-hd.de/sm-studie.php |date=22 November 2007 }} (German)</ref> The Internet is the prime contact point for support groups today, allowing for local and international networking. In the U.S., [[National Coalition for Sexual Freedom#Kink Aware Professionals|Kink Aware Professionals]] (KAP) a privately funded, non-profit service provides the community with referrals to psychotherapeutic, medical, and legal professionals who are knowledgeable about and sensitive to the BDSM, fetish, and leather community.<ref>{{cite web|url=http://www.ncsfreedom.org/kap/index.php?option=com_keyword&id=270|title=ncsfreedom.org|access-date=6 October 2014|url-status=dead|archive-url=https://web.archive.org/web/20100611150428/http://www.ncsfreedom.org/kap/index.php?option=com_keyword&id=270|archive-date=11 June 2010|df=dmy-all}}</ref> In the U.S. and the U.K., the [[Woodhull Freedom Foundation & Federation]], [[National Coalition for Sexual Freedom]] (NCSF) and Sexual Freedom Coalition (SFC) have emerged to represent the interests of sadomasochists. The German [[Bundesvereinigung Sadomasochismus]] is committed to the same aim of providing information and driving press relations. In 1996, the website and mailing list Datenschlag went online in German and English providing the largest [[bibliography]], as well as one of the most extensive historical collections of sources related to BDSM.

=== Social (non-medical) research ===
Richters et al. (2008) found that people who engaged in BDSM were more likely to have experienced a wider range of sexual practices (e.g., [[Oral sex|oral]] or [[anal sex]], more than one partner, [[group sex]], [[phone sex]], viewed [[pornography]], used a [[sex toy]], [[fisting]], etc.). They were, however, not any more likely to have been coerced, unhappy, anxious, or experiencing [[Sexual dysfunction|sexual difficulties]]. On the contrary, men who had engaged in BDSM scored lower on a psychological distress scale than men who did not.<ref name="a2" />

There have been few studies on the psychological aspects of BDSM using modern scientific standards. Psychotherapist [[Charles Allen Moser|Charles Moser]] has said there is no evidence for the theory that BDSM has common symptoms or any common psychopathology, emphasizing that there is no evidence that BDSM practitioners have any special psychiatric other problems based on their sexual preferences.<ref name="moser" />

Problems sometimes occur with self-classification. During the phase of the "coming-out", self-questioning related to one's own "normality" is common. According to Moser, the discovery of BDSM preferences ''can'' result in fear of the current non-BDSM relationship's destruction. This, combined with the fear of discrimination in everyday life, leads in some cases to a double life which can be highly burdensome. At the same time, the denial of BDSM preferences can induce stress and dissatisfaction with one's own "vanilla"-lifestyle, feeding the apprehension of finding no partner. Moser states that BDSM practitioners having problems finding BDSM partners would probably have problems in finding a non-BDSM partner as well. The wish to remove BDSM preferences is another possible reason for psychological problems since it is not possible in most cases. Finally, the scientist states that BDSM practitioners seldom commit violent crimes. From his point of view, crimes of BDSM practitioners usually have no connection with the BDSM components existing in their life. Moser's study comes to the conclusion that there is no scientific evidence, which could give reason to refuse members of this group work- or safety certificates, adoption possibilities, custody or other social rights or privileges. The Swiss psychoanalyst Fritz Morgenthaler shares a similar perspective in his book, ''Homosexuality, Heterosexuality, Perversion'' (1988). He states that possible problems result not necessarily from the non-normative behavior, but in most cases primarily from the real or feared reactions of the social environment towards their own preferences.<ref>Fritz Morgenthaler: ''Homosexuality, Heterosexuality, Perversion'', Analytic, April 1988, {{ISBN|978-0-88163-060-2}}</ref> In 1940 psychoanalyst [[Theodor Reik]] reached implicitly the same conclusion in his standard work ''Aus Leiden Freuden. Masochismus und Gesellschaft''.<ref>Theodor Reik: ''Aus Leiden Freuden. Masochismus und Gesellschaft'', Fischer, 1983, {{ISBN|978-3-596-26768-2}} (German)</ref>

Moser's results are further supported by a 2008 Australian study by Richters ''et al.'' on the demographic and psychosocial features of BDSM participants. The study found that BDSM practitioners were no more likely to have experienced sexual assault than the control group, and were not more likely to feel unhappy or anxious. The BDSM males reported higher levels of psychological well-being than the controls. It was concluded that "BDSM is simply a sexual interest or subculture attractive to a minority, not a pathological symptom of past abuse or difficulty with 'normal' sex."<ref>{{cite journal | last1 = Richters | first1 = J. | last2 = De Visser | first2 = R. O. | last3 = Rissel | first3 = C. E. | last4 = Grulich | first4 = A. E. | last5 = Smith | first5 = A. | year = 2008 | title = Demographic and psychosocial features of participants in bondage and discipline, "sadomasochism" or dominance and submission (BDSM): Data from a national survey | journal = The Journal of Sexual Medicine | volume = 5 | issue = #7| pages = 1660–1668 | doi=10.1111/j.1743-6109.2008.00795.x | pmid=18331257}}</ref>

=== Gender differences in research ===
{{See also|Feminist views on BDSM}}
Several recent studies have been conducted on the gender differences and personality traits of BDSM practitioners. Wismeijer and van Assen (2013) found that "the association of BDSM role and gender was strong and significant" with only 8% of women in the study being dominant compared to 75% being submissive.;<ref>{{cite journal | last1 = Wismeijer | first1 = Andreas | last2 = van Assen | first2 = Marcel | year = 2013 | title = Psychological Characteristics of BDSM Practitioners | journal = The Journal of Sexual Medicine | volume = 10 | issue = #8| pages = 1943–1952 | doi = 10.1111/jsm.12192 | pmid = 23679066 }}</ref> Hébert and Weaver (2014) found that 9% of women in their study were dominant compared to 88% submissive;<ref>{{cite journal | last1 = Hébert | first1 = Ali | last2 = Weaver | first2 = Angela | year = 2014 | title = An examination of personality characteristics associated with BDSM orientations | journal = The Canadian Journal of Human Sexuality | volume = 24 | issue = #1| pages = 49–62 | doi = 10.3138/cjhs.2467 | s2cid = 143570286 }}</ref> Weierstall1 and Giebel (2017) likewise found a significant difference, with 19% of women in the study as dominant compared to 74% as submissive, and a study from Andrea Duarte Silva (2015) indicated that 61.7% of females who are active in BDSM expressed a preference for a submissive role, 25.7% consider themselves a switch, while 12.6% prefer the dominant role. In contrast, 46.6% of men prefer the submissive role, 24% consider themselves to be switches and 29.5% prefer the dominant role.<ref>{{cite thesis |title=Through Pain, More Gain? - A Survey into the Psychosocial Benefits of Sadomasochism |year=2015 |last1=Silva |first1=Andrea Duarte |pages=41 |url=https://www.duo.uio.no/handle/10852/48652 |access-date=26 February 2021 |archive-date=3 March 2021 |archive-url=https://web.archive.org/web/20210303222125/https://www.duo.uio.no/handle/10852/48652 |url-status=live }}</ref> They concluded that "men more often display an engagement in dominant practices, whereas females take on the submissive part. This result is inline with a recent study about mate preferences that has shown that women have a generally higher preference for a dominant partner than men do (Giebel, Moran, Schawohl, & Weierstall, 2015). Women also prefer dominant men, and even men who are aggressive, for a short-term relationship and for the purpose of sexual intercourse (Giebel, Weierstall, Schauer, & Elbert, 2013)".<ref>{{cite journal | last1 = Weierstall | first1 = Roland | last2 = Giebel | first2 = Gilda | year = 2017 | title = The Sadomasochism Checklist: A Tool for the Assessment of Sadomasochistic Behavior | journal = Archives of Sexual Behavior | volume = 46 | issue = #3| pages = 735–745 | doi = 10.1007/s10508-016-0789-0 | pmid = 27488306 | doi-access = free }}</ref> Similarly, studies on sexual fantasy differences between men and women show the latter prefer submissive and passive fantasies over dominant and active ones, with rape and force being common.<ref>{{cite journal | last1 = Wilson | first1 = Glenn | year = 2010 | title = The Sex Fantasy Questionnaire: An update | journal = Sexual and Relationship Therapy | volume = 25 | issue = #1| pages = 68–72 | doi = 10.1080/14681990903505799 | s2cid = 144679434 }}</ref>

==== Gender differences in masochistic scripts ====
[[File:Female whipping two women.jpg|thumb|170px|A whipping scene where both dominant and submissives are female, Paris, 1930]]

One common belief of BDSM and [[Kink (sexuality)|kink]] is that women are more likely to take on masochistic roles than men. [[Roy Baumeister]] (2010) had more male masochists in his study than female, and fewer male dominants than female. The lack of statistical significance in these gender differences suggests that no assumptions should be made regarding gender and masochistic roles in BDSM. One explanation why we might think otherwise lies in our social and cultural ideals about [[femininity]]; masochism may emphasize certain stereotypically feminine elements through activities like [[Feminization (activity)|feminization]] of men and ultra-feminine clothing for women. But such tendencies of the submissive masochistic role should not be interpreted as a connection between it and the stereotypical female role—many masochistic scripts do not include any of these tendencies.<ref name="a4" >{{cite journal | last1 = Baumeister | first1 = R. F. | year = 1988 | title = Gender differences in masochistic scripts | journal = Journal of Sex Research | volume = 25 | issue = #4| pages = 478–499 | doi=10.1080/00224498809551477}}</ref>

Baumeister found that masochistic males experienced greater: severity of pain, frequency of humiliation (status-loss, degrading, oral), partner infidelity, active participation by other persons, and [[cross-dressing]]. Trends also suggested that male masochism included more bondage and oral sex than female (though the data was not significant). Female masochists, on the other hand, experienced greater: frequency in pain, pain as punishment for 'misdeeds' in the relationship context, display humiliation, genital intercourse, and presence of non-participating audiences. The exclusiveness of dominant males in a heterosexual relationship happens because, historically, men in power preferred multiple partners. Finally, Baumeister observes a contrast between the 'intense sensation' focus of male masochism to a more 'meaning and emotion' centred female masochistic script.<ref name="a4" />

Prior argues that although some of these women may appear to be engaging in traditional subordinate or submissive roles, BDSM allows women in both dominant and submissive roles to express and experience personal power through their sexual identities. In a study that she conducted in 2013, she found that the majority of the women she interviewed identified as bottom, [[Female submission|submissive]], captive, or slave/[[Sexual slavery (BDSM)|sex slave]]. In turn, Prior was able to answer whether or not these women found an incongruity between their sexual identities and feminist identity. Her research found that these women saw little to no incongruity, and in fact felt that their feminist identity supported identities of submissive and slave. For them, these are sexually and emotionally fulfilling roles and identities that, in some cases, feed other aspects of their lives. Prior contends that third wave feminism provides a space for women in BDSM communities to express their sexual identities fully, even when those identities seem counter-intuitive to the ideals of feminism. Furthermore, women who do identify as submissive, sexually or otherwise, find a space within BDSM where they can fully express themselves as integrated, well-balanced, and powerful women.<ref>{{cite journal|last1=Prior|first1=Emily|title=Women's Perspectives of BDSM Power Exchange|journal=Electronic Journal of Human Sexuality|date=2013|volume=16|url=http://go.galegroup.com/ps/i.do?id=GALE%7CA365455101&v=2.1&it=r&p=AONE&sw=w&asid=c799ed9c2682c1c57c56ec8c16af7e4d|access-date=4 March 2015|archive-date=25 January 2022|archive-url=https://web.archive.org/web/20220125033351/https://go.gale.com/ps/i.do?id=GALE%7CA365455101&v=2.1&it=r&p=AONE&sw=w&asid=c799ed9c2682c1c57c56ec8c16af7e4d&userGroupName=anon%7Ece315a29|url-status=live}}</ref>

==== Women in S/M culture ====
Levitt, Moser, and Jamison's 1994 study provides a general, if outdated, description of characteristics of women in the sadomasochistic (S/M) subculture. They state that women in S/M tend to have higher education, become more aware of their desires as young adults, are less likely to be married than the general population. The researchers found the majority of females identified as heterosexual and submissive, a substantial minority were versatile—able to switch between dominant and submissive roles—and a smaller minority identified with the dominant role exclusively. Oral sex, bondage and master-slave script were among the most popular activities, while feces/watersports were the least popular.<ref>{{cite journal | last1 = Levitt | first1 = E. E. | last2 = Moser | first2 = C. | last3 = Jamison | first3 = K. V. | year = 1994 | title = The prevalence and some attributes of females in the sadomasochistic subculture: A second report | journal = Archives of Sexual Behavior | volume = 23 | issue = #4| pages = 465–473 | doi=10.1007/bf01541410 | pmid=7993186| s2cid = 28743901 }}</ref>

=== Orientation observances in research ===
BDSM is considered by some of its practitioners to be a sexual orientation.<ref>Jillian Keenan, [http://www.slate.com/blogs/outward/2014/08/18/is_kink_a_sexual_orientation.html] {{Webarchive|url=https://web.archive.org/web/20141111130050/http://www.slate.com/blogs/outward/2014/08/18/is_kink_a_sexual_orientation.html|date=11 November 2014}}, ''Slate'', 18 August 2014</ref> The BDSM and [[Kink (sexuality)|kink]] scene is more often seen as a diverse pansexual community. Often this is a non-judgmental community where gender, sexuality, orientation, preferences are accepted as is or worked at to become something a person can be happy with.<ref>Weiss, M. D. (2006). Working at play: BDSM sexuality in the San Francisco Bay area. Anthropologica, 229-245.</ref> In research, studies have focused on bisexuality and its parallels with BDSM, as well as gay-straight differences between practitioners.

==== Asexuality  ====
It has been suggested that some [[asexuality|asexual]] people have found a language for navigating relationships through BDSM.<ref>{{cite journal |last1=Jolene Sloan |first1=Lorca  |date=2015-02-27 |title=Ace of (BDSM) clubs: Building asexual relationships through BDSM practice |url=https://doi.org/10.1177/1363460714550907 |journal=Sexualities  |volume= 18|issue=5–6 |pages=548–563 |doi=10.1177/1363460714550907  |access-date=2024-08-28}}</ref>

==== Bisexuality ====
In Steve Lenius' original 2001 paper, he explored the acceptance of [[bisexuality]] in a supposedly [[Pansexuality|pansexual]] BDSM community. The reasoning behind this is that 'coming-out' had become primarily the territory of the gay and lesbian, with bisexuals feeling the push to be one or the other (and being right only half the time either way). What he found in 2001, was that people in BDSM were open to discussion about the topic of bisexuality and pansexuality and all controversies they bring to the table, but personal biases and issues stood in the way of actively using such labels. A decade later, Lenius (2011) looks back on his study and considers if anything has changed. He concluded that the standing of bisexuals in the BDSM and [[Kink (sexuality)|kink]] community was unchanged, and believed that positive shifts in attitude were moderated by society's changing views towards different sexualities and orientations. But Lenius (2011) does emphasize that the pansexual promoting BDSM community helped advance greater acceptance of alternative sexualities.<ref>{{cite journal | last1 = Lenius | first1 = S | year = 2001 | title = Bisexuals and BDSM | journal = [[Journal of Bisexuality]] | volume = 1 | issue = #4| pages = 69–78 | doi=10.1300/j159v01n04_06| s2cid = 142599575 }}</ref><ref>{{cite journal | last1 = Lenius | first1 = S | year = 2011 | title = A Reflection on "Bisexuals and BDSM: Bisexual People in a Pansexual Community"—Ten Years Later (and a Preview of the Next Sexual Revolution) | journal = [[Journal of Bisexuality]] | volume = 11 | issue = #4| pages = 420–425 | doi=10.1080/15299716.2011.620466| s2cid = 143156292 }}</ref>

Brandy Lin Simula (2012), on the other hand, argues that BDSM actively resists gender-conforming and identified three different types of BDSM bisexuality: [[Gender bender|gender-switching]], gender-based styles (taking on a different gendered style depending on the gender of partner when playing), and rejection of gender (resisting the idea that gender matters in their play partners). Simula (2012) explains that practitioners of BDSM routinely challenge our concepts of sexuality by pushing the limits on pre-existing ideas of sexual orientation and gender norms. For some, BDSM and kink provides a platform in creating identities that are fluid, ever-changing.<ref>{{cite journal | last1 = Simula | first1 = B. L. | year = 2012 | title = Does Bisexuality 'Undo' Gender? Gender, Sexuality, and Bisexual Behavior Among BDSM Participants | journal = [[Journal of Bisexuality]] | volume = 12 | issue = #4| pages = 484–506 | doi=10.1080/15299716.2012.729430| s2cid = 144476771 }}</ref>

==== Comparison between gay and straight men in S/M ====
Demographically, Nordling et al.'s (2006) study found no differences in age, but 43% of gay male respondents compared to 29% of straight males had university-level education. The gay men also had higher incomes than the general population and tended to work in [[white-collar worker|white-collar]] jobs while straight men tended toward [[blue-collar]] ones. Because there were not enough female respondents (22), no conclusions could be drawn from them.

Sexually speaking, the same 2006 study by Nordling et al. found that gay males were aware of their S/M preferences and took part in them at an earlier age, preferring [[Leather subculture|leather]], [[anal sex]], [[rimming]], [[dildo]]s and special equipment or uniform scenes. In contrast, straight men preferred verbal humiliation, mask and blindfolds, [[Gag (BDSM)|gags]], [[Latex and PVC fetishism|rubber/latex]] outfits, [[caning]], [[vaginal sex]], [[straitjacket]]s, and [[cross-dressing]] among other activities. From the questionnaire, researchers were able to identify four separate sexual themes: [[Hypermasculinity|hyper-masculinity]], giving and receiving pain, physical restriction (i.e. bondage), and psychological humiliation. Gay men preferred activities that tended towards hyper-masculinity while straight men showed greater preference for humiliation, significantly higher [[Domination (BDSM)|master]]/[[Femdom|madame-slave]] role play at ≈84%. Though there were not enough female respondents to draw a similar conclusion with, the fact that there is a difference in gay and straight men suggests strongly that S/M (and BDSM in general) can not be considered a homogenous phenomenon. As Nordling et al. (2006) puts it, "People who identify as sadomasochists mean different things by these identifications." (54)<ref>{{cite journal | last1 = Nordling | first1 = N. | last2 = Sandnabba | first2 = N. K. | last3 = Santtila | first3 = P. | last4 = Alison | first4 = L. | year = 2006 | title = Differences and similarities between gay and straight individuals involved in the sadomasochistic subculture | journal = Journal of Homosexuality | volume = 50 | issue = #2–3| pages = 41–57 | doi=10.1300/j082v50n02_03| pmid = 16803758 | s2cid = 25370996 }}</ref>

=== History of psychotherapy and current recommendations ===
Psychiatry has an insensitive history in the area of BDSM. There have been many involvements by institutions of political power to marginalize subgroups and sexual minorities.<ref name="a3" /> Mental health professionals have a long history of holding negative assumptions and stereotypes about the BDSM community. Beginning with the [[Diagnostic and Statistical Manual of Mental Disorders|DSM]]-II, Sexual Sadism and Sexual Masochism were listed as sexually deviant behaviours. Sadism and masochism were also found in the personality disorder section.<ref>American Psychiatric Association. (1968). ''Diagnostic and statistical manual of mental disorders'' (2nd ed.). Washington, DC: American Psychiatric Association.</ref> This negative assumption has not changed significantly which is evident in the continued inclusion of Sexual Sadism and Sexual Masochism as [[paraphilia]]s in the [[DSM-IV-TR]].<ref>American Psychiatric Association. (2000). ''Diagnostic and statistical manual of mental disorders'' (4th ed. rev.). Washington, DC: American Psychiatric Association.</ref> The [[DSM-5|DSM-V]], however, has depathologized the language around [[paraphilia]]s in a way that signifies "the [[American Psychiatric Association|APA]]’s intent to not demand treatment for healthy consenting adult sexual expression".<ref>{{Cite web|url=https://ncsfreedom.org/press/blog/item/the-dsm-5-says-kink-is-ok.html|title=NCSF Blog|website=ncsfreedom.org|access-date=5 April 2016|url-status=dead|archive-url=https://web.archive.org/web/20160422123917/https://ncsfreedom.org/press/blog/item/the-dsm-5-says-kink-is-ok.html|archive-date=22 April 2016|df=dmy-all}}</ref> Still, biases and misinformation can result in pathologizing and unintentional harm to clients who identify as sadists and/or masochists and medical professionals who have been trained under older editions of the DSM can be slow to change in their ways of clinical practice.

According to Kolmes et al. (2006), major themes of biased and inadequate care to BDSM clients are:
* Considering BDSM to be unhealthy
* Requiring a client to give up BDSM activities in order to continue in treatment
* Confusing BDSM with abuse
* Having to educate the therapist about BDSM
* Assuming that BDSM interests are indicative of past family/spousal abuse
* Therapists misrepresenting their expertise by stating that they are BDSM-positive when they lack knowledge of BDSM practices

These same researchers suggested that therapists should be open to learning more about BDSM, to show comfort in talking about BDSM issues, and to understand and promote "safe, sane, consensual" BDSM.<ref name="a3" />

There has also been research which suggests BDSM can be a beneficial way for victims of sexual assault to deal with their trauma, most notably by Corie Hammers, but this work is limited in scope and, to date, has not undergone empirical testing as a treatment.{{Citation needed|date=January 2019}}

=== Clinical issues ===
Nichols (2006) compiled some common clinical issues: countertransference, non-disclosure, coming out, partner/families, and bleed-through.<ref name="a1" >{{cite journal | last1 = Nichols | first1 = M | year = 2006 | title = Psychotherapeutic issues with "kinky" clients: Clinical problems, yours and theirs | journal = Journal of Homosexuality | volume = 50 | issue = #2–3| pages = 281–300 | doi=10.1300/j082v50n02_14| pmid = 16803768 | s2cid = 37706751 }}</ref>

[[Countertransference]] is a common problem in clinical settings. Despite having no evidence, therapists may find themselves believing that their client's pathology is "self-evident". Therapists may feel intense disgust and aversive reactions. Feelings of countertransference can interfere with therapy. Another common problem is when clients conceal their sexual preferences from their therapists. This can compromise any therapy. To avoid non-disclosure, therapists are encouraged to communicate their openness in indirect ways with literature and artworks in the waiting room. Therapists can also deliberately bring up BDSM topics during the course of therapy. With less informed therapists, sometimes they over-focus on clients' sexuality which detracts from original issues such as family relationships, depression, etc. A special subgroup that needs counselling is the "newbie". Individuals just coming out might have internalized shame, fear, and self-hatred about their sexual preferences. Therapists need to provide acceptance, care, and model positive attitude; providing reassurance, [[psychoeducation]], and [[bibliotherapy]] for these clients is crucial. The average age when BDSM individuals realize their sexual preference is around 26 years.<ref name="a3" /> Many people hide their sexuality until they can no longer contain their desires. However, they may have married or had children by this point.{{Citation needed|date=January 2019}}