Kinky and in Need of Healthcare 

This post is going to touch on some uncomfortable and even taboo subjects. I will debunk some myths about and provide guidance around what it is like to go to the doctor as a member of the “kink” community. 

Kinks can be sexual or they can be non-sexual. Essentially, they are acts that deviate from normative behaviors and involve persons who have unconventional tastes and preferences. 

Going to the doctor under regular circumstances can be intimidating. Not everyone is comfortable discussing bodily functions or sexual and reproductive health. The atmosphere can feel very clinical. The questions may feel probing and cause embarrassment. 

For those who come to a doctor’s office with bruises or other marks resulting from consensual sex involving some forms of kink, a doctor’s office can be more than intimidating -- it can seem completely unapproachable. 

Before I dive in, let’s begin with a few brief definitions and clarifications so that we are all on the same page: 

What is BDSM? BDSM stands for Bondage/Discipline, Dominance/Submission, and Sadism/Masochism. BDSM is an umbrella term for which there is a range of definitions. BDSM can be defined broadly as a variety of often erotic practices or roleplaying involving bondage, discipline, dominance and submission, sadomasochism, and other related interpersonal dynamics.

Are BDSM and kink safe? Are BDSM and kink abuse? The short answers are: yes and no, respectively. It may come as a surprise, but a study from Northern Illinois University revealed that those involved in BDSM are more consent-minded when it comes to sex acts and less likely to conform to behaviors associated with rape culture. According to this research, practitioners of BDSM displayed “significantly lower levels of benevolent sexism, rape myth acceptance, and victim-blaming.” 

What is the difference between BDSM/Kink and Abuse? The answer: Consent. Abuse is never consensual whereas acts that fall under the umbrella of BDSM or kink must be consensual. 

Seeking medical care as someone in a kinky relationship dynamic can add a layer of complication to a typical doctor’s visit -- especially if you are the one with visible marks (e.g. bruises, cuts, welts). But, your relationship dynamics should not prevent you from getting the care you need. 

I spoke to a member of the kink community in North Carolina, as well as a Planned Parenthood provider and physician. I wanted to reconcile the valid concerns of both parties. 

The myth I heard that inspired this piece was that BDSM, even though it is consensual, is considered abuse by the medical community and therefore, must be reported. This is simply false. But the concern is clearly born from a mix of misinformation, rumors, and reality. 

Two important questions should be asked: 

• What can kinky patients do to quell their provider’s concerns? 

• What can providers do to put their patients at ease and demonstrate nonjudgement? 

From a patient perspective: The most important thing to do as a kinky person visiting a medical provider is to advocate for yourself. I am fully aware that this puts a huge burden on the patient. There is simply no getting around the fact that as the patient, you will have to ask questions, advocate for your needs, and even potentially educate your provider. 

Questions from the National Coalition for Sexual Freedom, such as the following, are key to establishing where your provider stands and how prepared they are to provide for you and your health needs:

• Are you familiar with alternative forms of sexual expression, and BDSM in particular? 

• Do you understand that BDSM and related activities can be done consensually for fun and erotic satisfaction, and are not abusive activities? 

• If I come to you with a health issue unrelated to my choice of sexual interactions, would you be able to be objective about those health issues and not assume they are related to BDSM and related activities? 

• If I were to ask questions about health safety, medical risks of certain activities, etc., would you feel comfortable discussing them without any sense of judgment or disapproval? 

• I enjoy rough sex and often have bruises and marks. I do not want you to misinterpret them as abuse or assault. Can you deal with that? 

• I often have questions about sexually transmitted infections and sexual health. Are you comfortable with those areas? 

• Is your practice LGBTQ+ friendly? 

Asking these questions might be difficult, but it is the first step in not only establishing an understanding between you and your provider, but it also helps the two of you establish boundaries. In that same vein, make sure those boundaries are clear with your provider by self-advocating with statements such as the following: 

• You’re going to see that I have bruises on [insert part of body here], these are kink-related and received with my enthusiastic consent.  

• My sexual practices are safe, sane, and consensual.

• This visit does not pertain to kink. When my visit is kink related, I will be sure to ask you about it. Today, I am here for a general medical issue pertaining to X. 

• This visit does pertain to kink. Please let me know if, at any point, I can clarify what I’m talking about. 

Ultimately, your provider may not be familiar with BDSM. If you are not emotionally or mentally prepared to educate your provider, or sense that they will not be friendly, you should feel empowered to seek care elsewhere. The unfortunate truth is that not everyone will have the option of finding another provider. And without a doubt, it is exhausting having to explain kink to a new set of medical providers. If you have the ability to find other care, it is worth it to develop a good rapport with medical personnel you trust for your future medical needs. 

From a provider perspective: The most important thing to do as a provider with potentially kinky patients is to do some of your own research. Taking some of the burden of educating you off of your patients will help your patients feel comfortable and safe in your care. 

It can only help the patient-provider relationship to be able to address your patient’s kink with some basic knowledge and understanding of their activities. Asking your patient some of the following questions may help to establish that you respect their choices and intend to offer your medical expertise accordingly: 

• If you’re doing X type of play, do you know how best to stay safe? 

• What types of discussions do you have with your partner(s) about safety and consent? 

• Are there safety tips I can provide from a medical perspective? 

• When it comes to STDs, are you familiar with the increased risk that comes from certain types of kinky play? 

• Are you here today to discuss something related to kink? 

Understand that your patients may be nervous discussing sensitive topics with you. As with other sensitive conversations, putting your patients at ease when it comes to kink and your ability to treat them will make a world of difference. Statements such as the following go a long way in showing your patients that you are not judgmental: 

• I want you to know that I understand that BDSM and related activities, when performed with full consent, are not abuse. 

• I do not view BDSM and related activities as immoral or disgusting. 

• I do not view BDSM and related activities as a manifestation of a mental disorder. 

• I intend to treat you to the best of my medical expertise, just as I would any other patient. 

Ultimately, you may not be the best provider for this patient. If you are unsure of how to treat a patient who engages in kinky activities, it is important to be kind, nonjudgmental, and upfront. Providing your patient with a referral so that they can get their medical needs met is imperative. You should feel empowered to ask your patient if they are willing to educate you, but be on the lookout for cues that they are performing emotional labor or are uncomfortable doing so. The patient-provider relationship is a give-and-take; asking questions is okay, but only asking questions without doing your own research will likely limit the safety and trust of your patient. 

Ultimately...

Due to mandating reporting laws, there are times when providers are required to report abuse and other patient-related safety issues. If a health care provider is made aware of child or elder abuse, or any patient who is a threat to themselves or someone else, they are mandated to report the event and ensure safety

Thus, the number one rule for kinky people in the doctor’s office: Don’t lie. Do not risk your own health by withholding vital information from your provider. At the end of the day, your provider cannot help you and may even assume the worst if you are not upfront and honest with them.