Many people practice kink as part of their sex life, yet health care practitioners are rarely given specific training or information about this often misunderstood aspect of sexuality.
This article focuses on creating an inclusive environment for patients to discuss all aspects of their sexuality, and offers specific suggestions on how to talk about and assess patients for kink activity.
What is kink?
Kink is a form of sex play that involves power, sensation, and/or fetish. Other terms for this kind of play include BDSM, fetish, leather, kinky sex, ‘the scene’ or ‘the lifestyle’. Kink can include bondage, role play, spanking, caning, flogging, and many more types of sensation and power play.
People of all genders, orientations and backgrounds practice kink. It is a normal, healthy variant of sexual behaviour, and there is no evidence to suggest that people who practice kink are more psychologically troubled than their non-kinky peers.[1,2]
Some people may try kink occasionally for fun or experimentation. For others, it is their primary form of sexual expression. Some people choose to have relationships where certain aspects of kink, such as power dynamics, form a major part of their sexual and non-sexual interactions. Others practice kink casually or in committed relationships. There are kink communities where people meet socially, and may engage in public play together. These communities help provide a structure for safety, accountability, education and connection.
Why you should know if your patient practices kink
The portrayal of kink in pop culture is inaccurate and insufficient for providing professional clinical care. Clinicians, particularly those working in sexual health, have an important role to play in helping patients understand how their individual health profile may affect their kink activities.
By providing safety and harm reduction information, and exploring ways to modify activities to accommodate medical conditions, clinicians can help patients to prevent or limit kink-related injuries while still embracing their own sexuality.
Inclusive clinic environments
Creating an environment that is open and nonjudgmental will help your patient feel safer coming to you with questions and concerns. It may also increase the likelihood that a patient will seek timely care for unintended kink-associated injuries or complications.
The messages your patients receive in the clinic waiting room (like information about safer sex) can indicate how safe it is for them to discuss their sexual health concerns with you.
Talking about kink and sex
Kink remains a misunderstood and stigmatized activity. Patients may be concerned about being judged or seen as victims of abuse, especially if they have visible bruises, cuts or other marks on their body. While kink is a normal, healthy activity, your patient may have questions about safety and health that pertain to kink.
All different kinds of people explore and practice kink. By keeping your language open and avoiding assumptions, you can signal to people that you are open to discussing their interests and concerns.
Here is an example of how to frame questions that are inclusive of many types of sexual behaviour, including kink.
“The next few questions are to help me identify what screening tests to offer you based on your sexual activities. People can have all kinds of intimate contact with each other, so please let me know if I have missed anything, or if you would like any additional information.”
- Are you sexually active? This includes any kind of activity where there is skin-to-skin contact between genitals, mouths and/or anuses, or contact with body fluids like blood, semen, vaginal or anal fluids.
- Do you have oral, vaginal or anal sex? Are you the giver, receiver or both?
- Do any of your partners ejaculate into the back of your throat, or the inside of your genitals or anus?
- Do you use sex toys with your partners? If yes, what kinds do you use? Do you share them?
- Do you participate in any other activities where you have skin-to-skin contact with genitals, or where you come in contact with blood or genital fluids?
- Do you have any questions about other kinds of sexual activity that we have not yet discussed?
- Do you have questions about any other kinds of sexual practices?
People participate in kink for many reasons, including connection, desire for pleasurable and/or intense sensations, intimacy, creativity, stress relief, or simply because they enjoy it.
Clinicians have an important role to play in supporting the health and well-being of their kinky patients. Intentional use of language and inclusive clinical resources can indicate to patients that they can safely discuss sensitive topics. This creates opportunities for sharing information, discussing harm reduction options, exploring activity modifications to accommodate medical conditions, and receiving care for an accidental injury.
- CATIE – BDSM Safer Kinky Sex Brochure
- Book: Bound to be Free by Charles Moser and JJ Madeson
- Book: The New Bottoming Book by Dossie Easton and Janet W. Hardy
- Book: The New Topping Book by Dossie Easton
- Wismeijer AAJand M van Assen. 2013. Psychological characteristics of BDSM practitioners. Journal of Sexual Medicine10:1943-1952.
- Richter J, de Visser RO, Rissel CE, Grulich A and A Smith. 2008. Demographic and Psychosocial Features of Participants in Bondage and Discipline, “Sadomasochism” or Dominance and Submission (BDSM): Data from a National Survey. Journal of Sexual Medicine 5(7):1660-1668.