1052

ORIGINAL RESEARCHPARAPHILIAS
Sexual Satisfaction and Distress in Sexual Functioning in a
Sample of the BDSM Community: A Comparison Study Between
BDSM and Non-BDSM Contexts
Patrcia Monteiro Pascoal, PhD,* Daniel Cardoso, MSc, and Rui Henriques, MSc
*Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal; Faculty of Psychology, University
of Lisbon, Lisbon, Portugal; iSex, Lusfona University, Lisbon, Portugal; CESNOVA, New University of Lisbon, Lisbon,
Portugal; CICANT, Lusfona University, Lisbon, Portugal
DOI: 10.1111/jsm.12835

ABSTRACT

Introduction. Little attention has been paid to distress in sexual functioning or the sexual satisfaction of people who
practice BDSM (Bondage and Discipline, Domination and Submission, Sadism and Masochism).
Aim. The purpose of this study was to describe sociodemographic characteristics and BDSM practices and compare
BDSM practitioners sexual outcomes (in BDSM and non-BDSM contexts).
Methods. A convenience sample of 68 respondents completed an online survey that used a participatory research
framework. Cronbachs alpha and average inter-item correlations assessed scale reliability, and the Wilcoxon paired
samples test compared the total scores between BDSM and non-BDSM contexts separately for men and women.
Open-ended questions about BDSM sexual practices were coded using a preexisting thematic tree.
Main Outcome Measures. We used self-reported demographic factors, including age at the onset of BDSM interest,
age at rst BDSM experience, and favorite and most frequent BDSM practices. The Global Measure of Sexual
Satisfaction measured the amount of sexual distress, including low desire, arousal, maintaining arousal, premature
orgasm, and anorgasmia.
Results. The participants had an average age of 33.15 years old and were highly educated and waited 6 years after
becoming interested in BDSM to act on their interests. The practices in which the participants most frequently
engaged did not coincide with the practices in which they were most interested and were overwhelmingly conducted
at home. Comparisons between genders in terms of distress in sexual functioning in BDSM and non-BDSM contexts
demonstrate that, with the exception of maintaining arousal, we found distress in sexual functioning to be statistically
the same in BDSM and non-BDSM contexts for women. For men, we found that distress in sexual functioning, with
the exception of premature orgasm and anorgasmia, was statistically signicantly lower in the BDSM context. There
were no differences in sexual satisfaction between BDSM and non-BDSM contexts for men or women.
Conclusion. Our ndings suggest that BDSM sexual activity should be addressed in clinical settings that account for
BDSM identities, practices, relationships, preferences, sexual satisfaction, and distress in sexual function for men and
women. Additional research needs are identied, such as the need to dene distressful sexual functioning experiences
and expand our understanding of the development of BDSM sexual identities. Pascoal PM, Cardoso D, and
Henriques R. Sexual satisfaction and distress in sexual functioning in a sample of the BDSM community: A
comparison study between BDSM and non-BDSM contexts. J Sex Med 2015;12:10521061.
Key Words. BDSM; Sexual Distress; Sexual Satisfaction; Gender Comparison; Sexual Function

Name of the department and institution to which the work should be attributed: Faculty of Psychology and Educational
Sciences, University of Porto, Porto, Portugal.
Sources of Support: None.

J Sex Med 2015;12:10521061

2015 International Society for Sexual Medicine

Sexual Distress in BDSM and Non-BDSM

Introduction

DSM (Bondage and Discipline, Dominance

and Submission, Sadism and Masochism) is a
recently coined acronym that evolved from the
terms SM, S/M, or S&M (Sadism and Masochism). BDSM practitioners (kinksters) share an
interest in and/or are sexually aroused by these
practices (also known as kinky sex). For several
decades, research has focused on SM as a pathological subculture indicator [1]. Research has
conated sexual arousal in the context of consensual domination interactions with arousal during
nonconsensual sex acts [2]. This confusion originates from old models of sexual behavior that continue to contribute to the stigmatization of and
prejudice against BDSM practitioners [3].
Researchers interest in sexual minorities
and subcultures has moved away from a criminal/
psychopathological perspective [46] that pathologizes nonconforming, nonheterosexual, nonmonogamous, and non-genital modes of sexual
expression [7] toward de-pathologizing nonnormative sexual practices [8]. This shift increases
kinksters visibility and awareness about their
characteristics and specicities [9] and broadens
clinical and research knowledge about BDSM
practitioners.
Recent empirical research indicates that BDSM
practitioners become aware of their interests as
early as age 15 and that they have negative experiences related to their disclosure of BDSM practices [10]. Research has shown that BDSM
practitioners are less neurotic, more extraverted,
more open to new experiences, more conscientious, less sensitive to rejection, and have higher
subjective well-being compared with non-BDSM
controls [11]. BDSM practitioners have normative
scores on standardized clinical psychopathology
and severe personality pathology measures [12]
but have higher-than-average levels of narcissism
and nonspecic dissociative symptoms.
A great diversity of sexual practices and behaviors can be labeled as BDSM. Although BDSM
sexual behaviors are interrelated, they can be
grouped into four distinct BDSM themes, which
have been described by Alison et al. [13]: the
administration and receipt of pain (e.g., skin branding, wax play, caning, and spanking); physical
restriction (e.g., with handcuffs, straitjackets, or
chains); humiliation (e.g., using spitting, submission, or gags); and hypermasculinity, which refers
to . . .behaviours that include enemas, catheters,
anal sting, and scatological practices and are

1053
sometimes described by respondents as displays
of masculinity and toughness (p. 2) [13]. These
categories are theoretically meaningful combinations related to patterns of BDSM behaviors that
are similar to the existence of partially cumulative
structures that can be likened to sexual scripts for
ordinary heterosexual sexual behaviour (p. 193)
[14] and allow researchers to categorize behavior
and conduct analyses and comparisons among
categories.
Regarding gender specicity, research by
Richters et al. and Santtila et al. [9,14] has consistently demonstrated that men are more likely than
women to respond erotically to BDSM themes
[15] and become involved in BDSM practices.
This nding may indicate a gender imbalance,
with more men than women becoming interested
in BDSM. In terms of sexual orientation, research
also indicates that gay, lesbian, and bisexual people
are more frequently involved in BDSM [16] than
heterosexuals are and that approximately onethird of lesbian and bisexual people have engaged
in BDSM activities [17]. Furthermore, gay men
more frequently engage in BDSM behaviors than
heterosexual men do [18]. One study used Alison
et al.s four categorizations of BDSM behaviors
and demonstrated an interaction between gender
and sexual orientation in preferred BDSM practices: Women and straight men preferred humiliation and gay men preferred hypermasculine
practices [18]. This nding indicates that the interaction between gender and sexual orientation may
be an important moderator in BDSM.
Although BDSM is visible in both mainstream
culture (e.g., the book Fifty Shades of Grey) and high
culture (e.g., the lm Nymphomaniac and Marquis
de Sades literary work), previous research has demonstrated that SM practitioners encounter prejudice from lay people [10] and health professionals
because of their sexual preferences [9,19,20].
One result of prejudice is the lack of research
focused on sexual functioning and the associated
sexual distress among BDSM practitioners.
Richters et al. [9] reported that kinky sex was associated with sexual difculties; however, the amount
of distress was not assessed, nor was it compared
with the distress experienced during non-BDSM
sexual activity. In other words, sexual distress was
not compared with the sexual problems and distress experienced by BDSM practitioners when
involved in sexual activity that is not considered
BDSM by them (non-BDSM context). Given the
power of the psychological sciences [21] in determining acceptable behavior, research that adopts a
J Sex Med 2015;12:10521061

1054
critical psychology framework [22] has consistently moved away from framing BDSM as a
pathology. Instead of operating within the
pathological/healthy dichotomy, critical psychology historically contextualizes and problematizes
the impact of cultural norms and values in determining what is considered pathological, opening
up the study of discriminated sexualities outside
the pathologizing framework. Nonetheless, people
can have problems with their sexual life and sexual
satisfaction regardless of their sexual practices
[19]. Thus, people should not believe that everything in their sexual life should be unproblematic
and thus avoid questioning the validity of their
sexual practices. Finally, research in sexual health
in general, including research with sexual minorities, should include important indicators of sexual
wellness, such as sexual satisfaction and sexual
functioning distress, without connecting these
indicators to the validity or orientation of their
sexual practices.
Current Study

The current study is conceptually and methodologically dened as participatory research, i.e.,
members from the studied community were
involved in and collaborated with the study
throughout the different phases of the research
process [23]. The authors approached members of
the BDSM community and discussed issues that
could be addressed through quantitative research.
The motivation for this study arose from a literature review that indicated that there was little
knowledge about sexual satisfaction and sexual
functioning distress among BDSM practitioners.
Our study aimed to:
1. Describe the sociodemographic, sexual orientation, and relationship characteristics of a
sample of self-identied BDSM practitioners.
2. Describe the mean age of the onset of BDSM
preferences, the mean age of onset of BDSM
practices, and the participants favorite and
most frequent BDSM activities.
3. Compare sexual outcomes separately for men
and women (i.e., sexual satisfaction and sexual
functioning distress) in BDSM and non-BDSM
contexts.
Method

Participants
Eligibility criteria included self-identifying as a
nonexclusive BDSM practitioner, being at or
J Sex Med 2015;12:10521061

Pascoal et al.
above the age of consent (18 years), and being a
Portuguese citizen living in Portugal.

Materials
General Questionnaire
This questionnaire included questions about
sociodemographic and health characteristics (e.g.,
age, perception of global health) and researchercreated questions about sexuality (e.g., perceived
sexual problems, level of distress related to sexual
problems).
BDSM Questionnaire
This researcher-created questionnaire was developed for the current study and included specic
questions about BDSM (age at rst sexual interest
in BDSM, age at onset of BDSM practices, favorite BDSM practices, and favorite settings for
BDSM practices).
Sexual Functioning Distress
To assess distress in sexual functioning, we used the
following procedure: Participants self-identied
sexual problems by reporting whether they had
experienced a sexual problem for at least 6 months
during the previous year. Sexual problems were
presented in table format and were based on the
traditional sexual response cycle and the Diagnostic
and Statistical Manual of Mental Disorders
4Text Revision (DSM-IV-TR) classication of
sexual dysfunction [24]. Sexual problems included
low sexual desire, difculty feeling aroused or
maintaining arousal, premature orgasm, and
anorgasmia. The participants were able to add
other sexual problem(s) that they experienced.
After they had identied their sexual problems, the
participants rated the level of distress associated
with this/these problem(s) from 0 (no distress) to 7
(a lot of distress). Participants who did not perceive
that they had a sexual problem were assigned a
distress level of 0 (no distress). This approach is
similar to online data collection approaches that
assess the distress associated with sexual problems
[25,26]. The sexual problems table was presented
twice during the survey: once in reference to nonBDSM contexts and once in reference to BDSM
contexts.
Sexual Satisfaction
To assess sexual satisfaction, we used the Global
Measure of Sexual Satisfaction (GMSEX), which is
aligned with the Interpersonal Exchange Model
of Sexual Satisfaction [27]. The participants rated
their current relationship using ve bipolar items
with responses on a seven-point Likert scale.

1055

Sexual Distress in BDSM and Non-BDSM

Higher scores indicate higher sexual satisfaction.
This scale has demonstrated good reliability and
validity in different studies [2830]. The scale was
developed for heterosexual couples in exclusive
dyadic relationships and has been validated in different Portuguese samples [31]. In the current
study, the wording in the instructions was adapted
so that the participants could rate their overall
current sexual satisfaction in non-BDSM and
BDSM contexts without reference to a specic
partner. For non-BDSM contexts, the Cronbachs
alpha was 0.97 and the average inter-item correlation was 0.74; for BDSM contexts, Cronbachs
alpha was 0.86 and the average inter-item correlation was 0.58.

Procedure
The primary researcher contacted the organizers
during The Gathering Party, which is an annual
event devoted to the BDSM community that occurs
in Lisbon and promotes BDSM-related live acts.
The researcher stated her interest in conducting an
exploratory scientic study of the Portuguese
BDSM community, and she approached the community in person to facilitate personal contacts and
the possibility of community engagement in the
project. She also stated that her intention was to
conduct a respectful survey that integrated the scientic literature and input provided by the BDSM
community. Community liaisons were reluctant to
participate because the BDSM community is very
sensitive to the voyeuristic interests of researchers and journalists that often end in the misuse of
participants personal information. After agreeing
to collaborate, a meeting was held in a caf chosen
by The Gathering Party organizers (PO), who were
also responsible for an online newsgroup and
listserv dedicated to the Portuguese BDSM community. The researchers presented their specic
goals to the PO and provided a draft of the questionnaire. The PO edited the questionnaire and
evaluated the relevance of the topics, the adequacy
of the language, and whether the questionnaire met
the communitys expressed needs regarding sexual
function and distress. Because of ongoing controversy within the Portuguese BDSM community
about the denition of a sadist, masochist, fetishist,
and switcher, closed- and open-ended questions
about BDSM identity were removed.
A provisional consent form was provided, and
issues regarding anonymity and condentiality
were claried and discussed. These were important
issues for the PO, who stated that they wanted to
protect their members privacy. The PO and the

researchers agreed that a web-based survey was the

best solution. A nal version of the survey was
agreed upon by both the PO and the researchers. A
website was developed on a secure server and was
regularly checked and updated for security, with its
back-end accessible only by the researchers. No IP
addresses were recorded. After pilot testing for
bugs, length, comprehensibility, and language
adequacy with a group of 15 people known to the
main researcher, a link with an invitation to participate in the study was sent to the PO. The PO sent
the link to their newsgroup and listserv, which
included a total of 532 members. The informed
consent form provided information about nonnancial compensation, condentiality, anonymity,
the name and e-mail address of the researcher, the
studys goals, and the inclusion criteria. Openended questions (e.g., What is your profession?)
allowed the researchers to exclude participants
whose answers contained mockery (e.g., Im your
mother) or showed lack of attention (e.g., My profession is 20 years old), which allowed the research
team to improve the studys validity. In the current
study, we found no answers that showed signs of
mockery or a lack of attention. The survey was
available online for one and a half months and was
closed after an entire week passed with no submissions. This study was conducted according to the
principles of the Declaration of Helsinki and was
approved by the scientic committee of the
involved institution.
Data Analysis

Quantitative data analysis procedures were performed using SPSS 19 (SPSS Inc., Chicago, IL,
USA). Cronbachs alpha was computed to assess
the GMSEXs reliability. To compare the total
levels of distress with each dimension of sexual
function (low desire, difculty feeling aroused or
maintaining arousal, premature orgasm, and
anorgasmia) for men and women in BDSM and
non-BDSM contexts, we used the Wilcoxon test
for paired samples (the nonparametric equivalent
of the paired samples t-test). Because we compared
the samples experiences in BDSM and nonBDSM contexts, two participants who selfidentied as exclusively BDSM practitioners were
excluded from the current study. All of the text
data that were entered as answers to open questions (e.g., those regarding preferred practices) are
presented verbatim with their frequencies and percentages to increase the visibility of the current
samples different expressions of BDSM activities.
J Sex Med 2015;12:10521061

1056
Table 1

Pascoal et al.
Samples sociodemographic characteristics

Education
9 years
12 years
University student
University degree
Residence
North
Center
Lisbon Metropolitan Area
Other
Relationship status
Marriage/civil union
Other situation
Sexual orientation
Heterosexual
Bisexual
Partnership status
Single people
Reports monogamous BDSM
and non-BDSM practice
Reports different partners for
BDSM and non-BDSM practices

Men
(n = 46 [%])

Women
(n = 22 [%])

1 (2.2)
8 (17.3)
13 (28.3)
24 (52.2)

1 (4.5)
3 (13.6)
12 (54.5)
6 (27.4)

3 (6.5)
8 (17.4)
32 (69.6)
3 (6.5)

8 (36.5)
1 (4.5)
12 (54.5)
1 (4.5)

24 (52.2)
22 (47.8)

15 (68.3)
7 (31.7)

39 (85)
7 (15)

9 (41)
13 (59)

1 (2)
23 (50)

1 (0.4)
17 (78.6)

22 (48)

5 (21)

BDSM = Bondage and Discipline, Domination and Submission, Sadism and

Masochism

samples preference for and interest in BDSM

began when the participants were young adults
and that it took an average of 6 years for them to
progress from interest in BDSM to actual involvement in BDSM practices.
The participants favorite BDSM practices, frequencies of BDSM practices, and favorite settings
for BDSM practices are presented in Tables 2, 3,
and 4. The tables highlight the diversity of the
practices that participants described as their favorite and most practiced. The results indicate that
most BDSM practices occur at home and that a
very small number of people engage in BDSM
activities in other settings. The participants
BDSM practices were grouped into the four
previously mentioned categories [14], and the
prevalence of the preferred and most frequently
practiced behaviors in each category is presented
in Table 5 for both men and women.

Table 2

Prevalence for each favorite practice*

Frequency (%)

To categorize the practices that the participants

referred to, we used a specic form of thematic
analysis [32]. For open-ended questions about
favorite practices, we conducted content coding
using an established thematic tree [14] that classied BDSM practices into the four categories
previously mentioned in this manuscript:
hypermasculinity, the administration and receipt of
pain, physical restriction, and humiliation.
Results

A total of 68 participants (average age = 33.15

years, standard deviation [SD] = 8.78, minmax = 1855) completed valid questionnaires. Of
these participants, 22 were women (average
age = 36.34 years, SD = 8.2, min-max = 2252) and
46 were men (average age = 35.09 years, SD = 8.4,
min-max = 2155). The samples sociodemographic characteristics are described in Table 1.
Our sample comprised nonexclusive BDSM
practitioners who had started to become aware of
their BDSM preferences approximately 11 years
prior to the time of the study (SD = 8.3, minmax = 033), i.e., when they were 22 years old, on
average. However, the participants rst participated in BDSM practices approximately 5 years
prior to the time of the study on average
(SD = 4.08, min-max = 030) at the average age of
28 years. This nding indicates that the current
J Sex Med 2015;12:10521061

Domination
Submission
Spanking
Bondage/being tied up
Humiliation
Boot/shoes worship (boot fetish,
boot licking)/foot fetish
Golden showers
Fisting
Discipline
Feminization
Role reversal
Trampling
Strap-on
Wax play
Body worship
Needle play
Handcuffs
Physical punishment
Whips/whipping
Ritual coprophagia
Cross-dressing
Spitting
D/s, 24/7, TPE, or Gorean
FemDom
Sexy outfit fetish
Fetishism
Forced feminization
Masochism
Medical play
Role play
Rubber
Light S&M
Slave
Tease and denial
Accessory using
Total

6 (9)
6 (9)
5 (7.5)
4 (6)
4 (6)
3 (4.5)
3 (4.5)
3 (4.5)
2 (3)
2 (3)
2 (3)
2 (3)
2 (3)
2 (3)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
67 (100)

*Ad verbatim translated from Portuguese

S&M = Sadism and Masochism; TPE = Total Power Exchange

1057

Sexual Distress in BDSM and Non-BDSM

Table 3

Most frequently performed practice*

Frequency (%)

Bondage/being tied up
Domination
Spanking
Submission
Boot /shoes worship (boot fetish,
boot licking)/foot fetish
Humiliation
Whips/whipping
Trampling
Full restraint
Shibari/bondage
Strap-on
Physical punishment
Golden showers
Dildos
D/s, 24/7, TPE, or Gorean
Choking
Feminization
Sexy outfit fetish
Fetishism
Fisting
Role reversal
Masochism
Medical play
Behavior conditioning
Rubber
Slave
Accessory using
Blindfolds
Water sports
Wax play
99
Total

Table 5 Categorization of practices according to Alison

et al.s categorization of BDSM behaviors for men (n = 46)
and women (n = 22)

10 (14.7)
6 (8.8)
6 (8.8)
5 (7.4)
4 (5.9)
4 (5.9)
3 (4.4)
3 (4.4)
2 (2.9)
2 (2.9)
2 (2.9)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)
2 (2.9)
68 (100)

*Ad verbatim translated from Portuguese

TPE = Total Power Exchange

The analysis of the data from the tables highlights the diversity of BDSM practices. It also
demonstrates that for both men and women, the
favored practices and practices that most frequently occur do not completely overlap. In
Table 6, we present the results of comparisons
between sexual functioning distress in BDSM and
non-BDSM contexts for women; Table 7 presents
the same results for men.
The results in Tables 6 and 7 indicate that the
men reported signicantly lower levels of distress

Men

Hypermasculinity
Inflicting pain
Humiliation
Physical restraining
Other
Total

Favorite

Favorite

Most
frequently
practiced

8 (17.4)
7 (15.2)
20 (43.5)
2 (4.3)
9 (19.6)
46 (100)

6 (13.0)
9 (19.6)
16 (34.8)
7 (15.2)
8 (14.3)
46 (100)

2 (9.1)
6 (27.3)
9 (40.9)
3 (13.6)
2 (9.1)
22 (100)

1 (4.5)
6 (27.3)
6 (27.3)
9 (40.9)
0 (0)
66 (100)

BDSM = Bondage and Discipline, Domination and Submission, Sadism and

Masochism

related to sexual desire. Feeling aroused, maintaining arousal, and orgasm inhibition did not signicantly differ in BDSM contexts and non-BDSM
contexts for the men. The women reported lower
distress related to maintaining arousal in BDSM
contexts compared with non-BDSM contexts.
Sexual satisfaction was statistically equivalent in
both BDSM and non-BDSM contexts for the men
and the women.

Table 6 Comparison of womens levels of distress in

sexual dysfunction in BDSM and non-BDSM contexts
(n = 22)

Low desire
Difficulties to feel aroused
Maintenance of arousal
Premature orgasm
Inhibition of orgasm
Anorgasmia
GMSEX

BDSM = Bondage and Discipline, Domination and Submission, Sadism and

Masochism

BDSM
context

P value

0.60
0.70
0.85
0.20
1.05
0.75
29.47

0.14
0.14
0.09
0.14
0.36
0.32
29.41

1.841
1.450
2.060
1.000
1.897
1.604
0.045

0.066
0.147
0.039
0.317
0.058
0.109
0.964

Table 7 Comparison of mens levels of distress in sexual

dysfunction in BDSM and non-BDSM contexts (n = 44)

Frequency (%)
2 (2.9)
57 (83.8)
3 (4.4)
3 (4.4)
1 (1.5)
2 (2.9)
68 (100)

NonBDSM
context

BDSM = Bondage and Discipline, Domination and Submission, Sadism and

Masochism; GMSEX = Global Measure of Sexual Satisfaction

Table 4 Scenarios where BDSM practices take place

Car
Home
Hotel
BDSM club
Workplace
Irregular
Total

Women
Most
frequently
practiced

Low desire
Difficulties to feel aroused
Maintenance of arousal
Premature orgasm
Inhibition of orgasm
Anorgasmia
GMSEX

NonBDSM
context

BDSM
context

P value

0.87
1.02
1.11
0.65
0.70
0.33
26.515

0.17
0.23
0.26
0.83
0.22
0.20
28.70

2.489
2.825
2.910
1.078
2.503
1.342
1.400

0.013
0.005
0.004
0.281
0.012
0.180
0.162

BDSM = Bondage and Discipline, Domination and Submission, Sadism and

Masochism; GMSEX = Global Measure of Sexual Satisfaction

J Sex Med 2015;12:10521061

1058
Discussion

The current study aimed to describe a BDSM

community sample. We examined sociodemographic variables, BDSM play activities, and
distress-associated sexual functioning problems in
both BDSM and non-BDSM settings.
Our sample consisted of highly educated people
from urban backgrounds. Most were involved in
committed, monogamous relationships. These
data are consistent with other ndings [33]. The
sample characteristics may reect our use of the
Internet for data collection because the Internet is
used by a higher percentage of people in the more
highly educated sociodemographic strata. In addition, the fora where the study was advertised consisted of people who participated in BDSM parties
that occurred in non-virtual contexts; this context
represented a place where privileged classes are
less exposed to public scrutiny because such events
protect attendees from societal discrimination and
serve as a form of privilege [34].
Several of the participants had different partners for non-BDSM and BDSM activity. On the
one hand, this nding highlights the exclusive
dyadic relationships that integrate BDSM activities and social events into participants sexual life.
This integration suggests that BDSM does not
occur solely among people who only have episodic
sexual encounters; on the other hand, it indicates
that consensual or nonconsensual non-monogamy
can be a coping strategy for addressing an interest
in BDSM activities.
One important result of our study is the elapsed
time between the participants awareness of an
interest in/preference for BDSM and their rst
BDSM experience. On average, the participants in
our study became aware of their BDSM interests
in adulthood, which suggests that such preferences
form after the rst sexual experience. The time
between interest and practice is 6 years on average,
which indicates that people delay acting on their
BDSM interests. This delay may be related to
internalized stigma, a lack of information or a lack
of access to the existing BDSM community, and
the resulting difculty of meeting like-minded
partners.
In the current study, we used Santtila et al.s [14]
four main categories of BDSM activities as a framework for classifying most of the diverse practices
that the female and male participants reported. As
Table 5 shows, the classications allowed us to
understand that the participants favored practices
were not always the ones they practiced most freJ Sex Med 2015;12:10521061

Pascoal et al.
quently. Thus, it is only sometimes possible for
participants to translate their most desired practices
into real-life practices. This disconnect may arise
from a lack of resources and implements or a lack of
adaptation or complementarity between the participants desires and preferences. Furthermore,
our results support previous research and highlight
the fact that both straight men and women prefer
humiliation practices, which may create negotiation problems among practitioners. These practices give rise to separate subgroups within the
BDSM community, such as FemDom, where
self-identication as a top or bottom is often linked
to gendered and essentialist discourses. In this
context, consensual non-monogamy may help to
overcome this conict by allowing two people to be
in a sustained relationship without necessarily
engaging in BDSM practices in the context of that
relationship, even when both are BDSM practitioners. In contrast, BDSM practitioners may also feel
pressured to be coupled with a person who has
matching interests, thus narrowing the pool of
available and eligible partners.
The nding that most BDSM sexual activities
occur at home can be interpreted in several ways.
First, it indicates an integration of BDSM practices into the domesticity of participants sexual
lives. Thus, BDSM practices become normalized
sexual habits rather than something that occurs
elsewhere, outside of a private and comfortable
space. Second, according to the participants, this
nding suggests a need for space and time to set
the stage for the practices and instruments
involved in BDSM practices.
Regarding distress in sexual functioning, the
women were equally distressed with their sexual
functioning, other than maintaining arousal, in
both contexts. This nding may be interpreted in
light of cognitive models of sexual dysfunction that
highlight the role of cognitive distraction in
explaining arousal problems. For women, performance and body appearance concerns are related to
sexual dysfunction [35]. Because BDSM sexual
activity does not focus entirely on appearance as the
source of arousal nor does it focus almost exclusively on genital stimulation, women may be less
anxious about their sexualized bodies, body parts
[36], and sexual performance because they are
focusing on other aspects (e.g., roleplaying) and
therefore experience less distress about maintaining arousal in BDSM contexts. Regarding sexual
functioning distress in men, it is interesting that the
men reported low distress related to sexual desire,
obtaining and maintaining arousal, and orgasm

Sexual Distress in BDSM and Non-BDSM

inhibition in BDSM contexts compared with nonBDSM contexts, while the amount of distress
regarding premature orgasm or anorgasmia did not
signicantly differ across BDSM and non-BDSM
contexts.
Premature orgasm and anorgasmia were the
only sexual problems that were equally distressing
in both contexts (BDSM and non-BDSM) for the
men. Because BDSM is globally considered a
nongenitally focused expression of sexual activity,
we would expect that premature orgasm would not
be distressful in BDSM contexts. However, premature orgasm might be distressful in BDSM contexts
because of the difculty men have with arousal after
orgasm during the refractory period [37], or
because it might interrupt or disturb the scene
being played out. Some BDSM behaviors may in
fact be compensatory or therapeutic strategies for
the distress experienced in non-BDSM sex [38];
however, these strategies may not sufce for
orgasm control.
There are several ways through which BDSM
practices can divert distress away from concerns
about sexual functioning, namely an emphasis on
practices that require a good display of nongenital
technical skills (e.g., ogging, bondage, needle
play) and that produce sexual responses on their
partners, or contexts where coitus is not even an
option, and/or where typical anxiogenic markers
of sexual function (such as not having an erection)
are positively valued and even fundamental to the
role play (e.g., male chastity belts, Cock and
Ball Torture [CBT], cock humiliation, forced
orgasm). Thus, the relationship between the
nongenital and genital aspects of sexual experience
should be considered as a source of potential disruption in a BDSM context. Because sexual functioning is an important predictor of sexual
satisfaction, we expected that people who report
lower levels of sexual functioning distress in
BDSM contexts would be more satised in those
contexts compared with non-BDSM contexts.
However, in our sample, the female and male participants were equally sexually satised during
BDSM and non-BDSM activities. These results
appear to be consistent with literature that indicates that sexual satisfaction is a dimension that
goes beyond the experience of sexual function [39].
However, to better interpret these results, we need
to better understand sexual satisfaction across
these two contexts.
The current study has several implications for
sex therapy and research. First and foremost, clinicians should be aware of the existence of non-

1059
pathological sexual activities beyond genital
sexuality and what these entail for clients who are
members of a marginalized sexual minority. Thus,
clinicians should not assume that a clients sexuality is by default non-BDSM oriented; rather, clinicians should ask clients about both BDSM and
non-BDSM sexual practices and whether these
practices are related to their motivations to seek
clinical treatment.
Another important implication is the dissonance
between the participants favorite and most frequent practices. It is important to address issues
related to the difculties BDSM practitioners face
when trying to perform their favorite sexual activities (e.g., noncompatible partners) and how these
difculties affect their sexuality, intimate relationships, and negotiations with partners. There is little
research on the development of BDSM preferences
and identities. The 5-year average hiatus between
becoming interested in BDSM and acting upon
that interest appears to support the need for more
research to address sexual development issues,
social and internalized stigmatization, partner concordance, and sexual identity and repertoire.
Additionally, when clients present to a clinical
setting with complaints about sexual functionrelated distress, the clinician should consider the
ways in which genital primacy is present outside of
BDSM-related practices, whether it distresses the
client, and whether BDSM practices that shift the
focus away from the genital dimensions of sex
could be utilized to help the client overcome a
mechanistic view of sexuality based on normative
views of how sex should be performed and governed by efciency and bodily prowess.
The present study also suggests areas for future
research. Given the range of stimulation activities
and differences coupled with the genital decentralization that occurs in BDSM practices, there is a
need to better understand whether the classical
model of sexual response should be expanded to
include other types of sexual responses while
providing a broader understanding of the sexual
response cycle. An important direction for future
research is clarifying the intersection between specic BDSM and non-BDSM sexual behaviors,
sexual function, and sexual distress. Another avenue
for research addresses the intersection and importance of BDSM and non-monogamous practices
and/or identities. The importance and mode of
such simultaneous relationships (whether they are
realized through cheating or through open relationships, polyamory, and other consensual nonmonogamies) [19] should help contextualize the
J Sex Med 2015;12:10521061

1060
ways in which different expressions of distress can
change according to partner(s) and to the practices
engaged in with each partner.

Pascoal et al.
ing distress that BDSM practitioners experience.
Finally, non-monogamous behaviors and other
factors might help explain differences in reports of
sexual distress.

Limitations

The current study has several limitations that

cannot be overlooked and should be considered
when interpreting results. First, the current sample
is not representative of the Portuguese BDSM
community; only 13% of the BDSM practitioners
included on the newsgroups and listservs where the
study was advertised responded to requests to participate in this study. Our participants were practitioners who are actively involved in online fora and
BDSM parties; thus, they constituted a small and
nonrepresentative convenience sample. Not only is
our sample small, it has a strong gender imbalance;
this imbalance is consistent with other studies, but
it limits further data analyses. Additionally, we do
not know whether the participants reported sexual
functioning distress referred to their corresponding sexual behaviors. Furthermore, the distinction
between BDSM and non-BDSM may not apply to
BDSM practitioners for whom the boundaries
between BDSM and non-BDSM contexts are not
clear. These two limitations could be overcome in
future research that could help improve our knowledge of BDSM- and non-BDSM-related sexual
functioning distress. An additional limitation is that
sexual functioning distress has a low degree of
variability in each dimension. Moreover, our
sample had low levels of distress. To improve variability, future studies should employ more diverse
methods to recruit participants.
Conclusion

Overall, this study found that BDSM practitioners

become interested in BDSM in their early twenties
but do not act on their interest until their late
twenties and that BDSM activity occurs mostly at
home. The participants reported that both BDSM
and non-BDSM sexual activities are similarly satisfying. In contrast to the dominating pathologizing
view of BDSM, most of the participants do not
exclusively engage in BDSM sexual practices.
Further, Alison et al.s categories of sexual activity
could be used to classify the BDSM practitioners
responses to open-ended questions. Overall,
BDSM activities were associated with lower sexual
functioning distress in most genitally centered categories compared with non-BDSM contexts for the
men, but not for the women. This nding supports
a gender-specic approach to the sexual functionJ Sex Med 2015;12:10521061

Acknowledgments

The authors would like to acknowldege the BDSM

community and Nuno Monteiro Pereira, MD, PhD for
their support.
Corresponding Author: Patrcia Monteiro Pascoal,
PhD, Faculdade de Psicologia, Alameda da
Universidade, Lisboa 1649-013, Portugal. Tel: + 35121-794-36-00; Fax: + 351-21-793-34-08; E-mail:
pmpascoal@psicologia.ulisboa.pt
Conict of Interest: The authors report no conicts of
interest.
Statement of Authorship

Category 1
(a) Conception and Design
Patrcia Monteiro Pascoal; Rui Henriques
(b) Acquisition of Data
Patrcia Monteiro Pascoal
(c) Analysis and Interpretation of Data
Patrcia Monteiro Pascoal; Rui Henriques; Daniel
Cardoso

Category 2
(a) Drafting the Article
Patrcia Monteiro Pascoal; Daniel Cardoso
(b) Revising It for Intellectual Content
Patrcia Monteiro Pascoal; Daniel Cardoso; Rui
Henriques

Category 3
(a) Final Approval of the Completed Article
Patrcia Monteiro Pascoal; Daniel Cardoso; Rui
Henriques
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