SM vs. Abuse - Leather Leadership Conference Statement
This brochure is intended to help law enforcement and social services professionals understand the difference between abusive relationships vs. consensual sadomasochism (SM).
Law Enforcement Field Guide to SM
The purpose of this brochure is to provide law enforcement with a basic level of understanding about adults whose sexuality and lovemaking includes consensual sadomasochistic (SM) activities, and to provide information to assist you when you encounter an SM event.
Every year, NCSF helps hundreds of people, events, groups and businesses that are being persecuted for their association with the BDSM, swing and polyamory communities.
NCSF is here to help you -- the SM, swing, and polyamory communities. If you have a problem with discrimination, persecution, or harassment because of your sexual expression, please contact NCSF for assistance.
The following are statements from events, businesses and individuals NCSF has helped.
The National Coalition for Sexual Freedom (NCSF) is a national advocacy organization promoting tolerance of consenting adults who practice safe, sane and consensual alternative forms of sexual expression. NCSF represents the millions of Americans who suffer discrimination and persecution because of their normal interests in some form of alternative sexual expression.
Some Quick Facts:
What is SM?
Overview of S/M as a sexual orientation, contrast between SM & domestic violence & more
SM vs. Abuse
Guidelines for distinguishing between safe, sane & consensual SM & abuse
Interview Contact List
Individuals from the SM-Leather-Fetish community available for interviews
What is the Lifestyle?
Overview of demographics of swingers, and social and sexual attitudes
What is Polyamory?
Overview of demographics of polyamory, benefits and types of relationships.
In 2003, National Coalition for Sexual Freedom (NCSF) once again took the lead in defending the rights of individuals and groups in the SM-leather-fetish, swing and polyamory communities. NCSF's coalition of 38 educational and social groups is committed to creating a political, legal, and social environment in the United States that advances equal rights of consenting adults who practice forms of alternative sexual expression.
Leigha Fleming directs NCSF's Incident Response team. In total during 2003, NCSF responded to more than 500 cases, with more than 1,300 contacts between NCSF and individuals, groups, attorneys, prosecutors, and businesses that requested assistance. Some incidents required only one or two phone calls, but many evolved into much larger projects such as the attacks by religious political groups against SM conferences.
In 42% of the incidents, NCSF assisted individuals. The largest category of incidents involved parents who were engaged in child custody and divorce cases. Parents continue to experience difficulties gaining child custody due to their interest in SM, swing or poly activities. NCSF worked with a number of attorneys representing parents accused of being unfit because of their alternative lifestyle interests. In many cases, because of information we were able to provide, the courts decided that alternative sexual expression alone was not cause to impugn a parent's ability to be a good parent.
We also helped families dealing with child protective services because of their alternative lifestyle interests.
NCSF saw a sharp rise in the number of requests for help from individuals experiencing employment discrimination because of their involvement in alternative lifestyles in 2003. Individuals also consulted with NCSF on a variety of other issues, including: the legality of obscene materials, guidelines for posting sexually frank information on websites, the law regarding private parties, criminal cases, dealing with law enforcement and dealing with personal media exposure.
In 2003, NCSF also opposed zoning and other local regulatory measures against those who practice some form of alternative sexual expression. NCSF assisted the swing communities in Illinois and North Carolina by working with them to fight back against punitive zoning restrictions. In addition, we extended our outreach to the polyamory community in 2003 by working with individuals impacted by discrimination against their relationship style.
Opposition to SM events based on religious concerns continued in 2003. The host hotel for My Vicious Valentine (February 14-16) received calls from Concerned Women for America at the end of January. The CWA attack against My Vicious Valentine fizzled out, in large part due to the extensive education about SM events that NCSF did for local authorities in 2002. Only one reporter called NCSF from the hotline number posted on MVV's website.
The Tribal Fire conference (April 4-6) in Oklahoma was again targeted by religious groups who took out ads in the local papers denouncing SM practices and threatening to picket the event. Tribal Fire's organizers met with the police detective and the hotel to ensure the event would go on as planned. However four Mennonites held a prayer vigil in the hotel lobby for 72 hours. NCSF staff members attended Tribal Fire and spoke out about the importance of standing up for our rights.
When Concerned Women for America attacked International Mr. Leather (May 30-June 1) they quoted the Illinois State Health Department as saying there is a higher rate of STDs in homosexual men. CWA proclaimed that IML was therefore a danger to employees and guests at the host hotel. Susan Wright contacted the Illinois State Health Department, and the AIDS/Infectious Diseases department declared they would speak to any media outlet to debunk the CWA's absurd claims. IML was held as planned.
The Black Rose conference (November 11-14) was forced to move from Ocean City, Maryland, back to their former host hotel in New Carrollton, Maryland when two churches in Ocean City led a grass-roots movement to prevent the event from taking place in their rural resort town. There was a great deal of initial confusion regarding Black Rose's media response, and as a result, there were many misrepresentations and prejudicial and inaccurate descriptions included in the articles in the Maryland Coast Dispatch and the Daily Times of Salisbury which inflamed the situation. NCSF attempted to mediate the situation by providing accurate and unbiased information on SM/leather/fetish to the local media.
Fetish in the Fall (November 20-23) scheduled to take place in Kenner, Louisiana (part of metropolitan New Orleans) was moved after it was attacked by the Kenner police chief. Police Chief Nick Congemi urged hotel managers to decline any request to hold the event in any Kenner hotel. In his letter and press release to the media, Chief Congemi stated that "allowing the event to take place would seriously jeopardize the family atmosphere for which Kenner is noted." Congemi had already announced his run for mayor of Kenner (election held in March, 2004). For many years prior to this, Congemi had allowed his police officers to work as off-duty security for the adult swing conference in Kenner, N'awlins in November, produced by the same company that produced Fetish in the Fall. NCSF was called in immediately and was able to generate positive media coverage of this incident.
NCSF also opposed zoning and other local regulatory measures against those who practice some form of alternative sexual expression. NCSF assisted the swing communities in North Carolina and Illinois by holding open-forum discussions about how to affect zoning regulations and current litigation against lifestyle clubs. NCSF also worked with the Gay and Lesbian Activist Alliance (GLAA) to lobby against the Washington DC's Alcoholic Beverage Control regulation 905, which has been used to prohibit SM play in local establishments with liquor licenses even when liquor isn't being sold or consumed. In response to an Action Alert created and distributed in conjunction with D.C. Sexual Minority Advocates (DCSMA), NCSF received over 130 cc'ed letters from community members stating they were concerned that this regulation will prevent SM community spaces from existing in Washington D.C.
The Labyrinth in Denver, a community SM space, was shut down by a restraining order because of zoning violations. The undercover investigation took many months. The Denver community organized an ad hoc group called COSMA (Colorado SM Advocates) to fight for their right to have an SM club. NCSF conducted multiple interviews with the Denver Post, Rocky Mountain News, Lakewood Sentinel, Channel 7, ABC affiliate, and KHOW 630 AM radio during this incident.
NCSF gave 67 media interviews in 2003, with Susan Wright, Spokesperson, giving 49 interviews and Sue Gould, Swing Spokesperson, giving 18 interviews. Clubs and businesses regularly contact NCSF to receive media training for incidents or prior to holding an event.
NCSF began working with John Cloud, a reporter with Time Magazine in November 2003 on an article about the SM community, its history and practices. NCSF assisted in locating appropriate people in the SM community to be interviewed. Several SM conferences considered allowing the reporter into their event, but concerns over privacy prevented that. The positive article was published in January 2004.
In Indianapolis, a female professional dominant gave an interview with the local newspaper and Channel 6 News in May. This caused serious problems for her because she was located near a church-school and ran a home-based business (a D/s and role-play salon) with no business license or permits. The media and police received an anonymous tip about her illegal business operation. NCSF encouraged her to seek proper zoning, educated her about dealing with the media, and responded to media inquiries for her.
In March, NCSF was contacted by concerned community members about the Black Party's promo image, which showed a young man with a black eye and split lip. NCSF protested to the producers of the Black Party in NYC that this image doesn't portray SM but rather shows abuse. The NYC Anti-Violence Project, the National Coalition against Violence and other groups joined in this effort, writing to the producers protesting this image.
In one media incident, a nonprofit club in Muncie, Indiana, was threatened with closure along with a nearby strip bar until the media was educated about safe, sane and consensual SM. NCSF also gave media assistance to a swing club in Connecticut which was closed because of zoning issues.
Another media incident involved Nerve.com when they published a series of articles in June entitled "Letters from Leather Camp." The Nerve reporter infiltrated a private event, Leather Retreat. Leather Retreat didn't have a clause in their release form preventing reporters from writing for a commercial media outlet. Susan Wright negotiated with Michael Martin, Editor-in-Chief at Nerve.com, and sent out Nerve's statement and apology in NCSF's Media Update covering the articles. The comments section of Nerve.com was reinstated so SM community members could respond to the articles, and the articles themselves were purged of their most reprehensible comments.
Job discrimination continues to be a problem for individuals. NCSF helped more than a twenty people draft and file formal complaints with their employers regarding employment discrimination claims. One West Virginia woman lost her job because she belonged to a leather club. One Texas woman was sexually harassed by her supervisor when he found her website on the internet. She was initially terminated from her job when she complained about the harassment. NCSF worked with her and her husband to draft a formal grievance and helped her find a sympathetic attorney. She was rehired.
A number of discrimination complaints continue to be made regarding Paypal and E-bay regarding their policies for dealing with adult oriented vendors. Paypal and E-bay are deleting accounts that sell adult oriented merchandise. NCSF has contacted the parent company, E- bay, regarding their discriminatory practices. These companies continue their "no-adult content" policy in large part out of fears of prosecution for obscenity.
NCSF was contacted by individuals, attorneys and prosecutors on a variety of criminal cases, including: several cases of false rape, three different cases involving death of a participant, and two murder investigations. NCSF also made referrals to resources and the appropriate authorities in several domestic violence incidents. In three cases, NCSF was able to help the victim obtain protective orders and find appropriate counseling.
NCSF is here to help you -- the SM, swing and polyamory communities. If you have a problem with discrimination, persecution, or harassment because of your sexual expression, please call NCSF for assistance. If you are contacted by the media, please call NCSF immediately so we can assist in educating the reporter about SM, swing or polyamory.
And please support NCSF in our effort to change the political, legal, and social environment in the United States. We are a volunteer organization committed to making a difference. Join NCSF as a member or please hold a fund-raiser and donate to NCSF!
In 2002, National Coalition for Sexual Freedom (NCSF) once again took the lead in defending the rights of individuals and groups in the SM-leather-fetish, swing and polyamory communities. NCSF's coalition of 29 educational and social groups is committed to creating a political, legal, and social environment in the United States that advances equal rights of consenting adults who practice forms of alternative sexual expression.
NCSF's Incident Response team is directed by Leigha Fleming, who instituted new methods for tabulating responses in 2002. In total, nearly 600 contacts were made between NCSF and individuals, groups, attorneys, prosecutors, and businesses who requested assistance. Each incident sometimes required only one or two phone calls, but many evolved into much larger projects such as the series of attacks by religious political extremists against SM conferences in the midwest.
In 41% of the incidents, NCSF assisted individuals. The largest category of incidents involved parents who were engaged in child custody and divorce cases. Parents continue to experience difficulties gaining child custody due to their interest in SM, swing or poly activities. NCSF worked with a number of attorneys representing parents accused of being unfit because of their alternative lifestyle interests. In many cases, because of information we were able to provide, the courts decided that alternative sexual expression alone was not cause to impugn a parent's ability to be a good parent. Individuals also consulted with NCSF on a variety of other issues, including: the legality of obscene materials, guidelines for posting sexually frank information on websites, the law regarding private parties, and dealing with personal media exposure.
In 2002, NCSF also opposed zoning and other local regulatory measures against those who practice some form of alternative sexual expression. NCSF assisted the swing communities in Florida and Phoenix by holding open-forum discussions about how to affect zoning regulations and current litigation against lifestyle clubs. NCSF also worked with the Gay and Lesbian Activist Alliance (GLAA) to lobby against the Washington DC's Alcoholic Beverage Control regulation 905, which has been used to prohibit SM play in local establishments with liquor licenses even when liquor isn't being sold or consumed.
From February to May 2002, five SM conventions were targeted by Concerned Women for America, American Family Association, and the American Decency Association. NCSF worked with each event to counter sensationalized attacks in the media as well as resisting action by local authorities who attempted to shut down these SM conferences. The attacks took place in the midwest: My Vicious Valentine and International Mr. Leather in Chicago, Bound by Desire in Michigan, Tribal Fire in Oklahoma, and Beat Me in St. Louis in Missouri.
In April, Missouri State Senator John Loudon introduced a resolution to prohibit SM conferences from being held in that state. NCSF educated the Missouri State Attorney General about the educational benefits of SM conferences, and the state health department sent an observer who confirmed that all activities were safe, sane and consensual. Beat Me in St. Louis was held exactly as planned.
With two of these SM conferences, the host hotels canceled their contracts. However both conferences were able to re-locate to new host hotels. Cendant Corporation, the world's largest hotel franchiser with more than 6,400 hotels, bowed to pressure from religious political extremist groups and threatened its franchisees with reprisal if they booked "controversial" guests or groups that "national interest groups find offensive." NCSF conducted a successful media and write-in campaign that convinced Cendant Corporation to clarify its position, honoring the right of hotel franchisees to host the events of their choice.
In 2002, there were several police raids against alternative sexual expression clubs, including a raid that resulted in the closure of Behind the Scenes, an SM club in Philadelphia, PA. In July, a raid against Club Zinc, a swing club in Atlanta, GA, resulted in the arrest of patrons who consulted with NCSF. Another lifestyle club in Connecticut was raided and closed in June because they were improperly located in a residential neighborhood. In Phoenix, AZ, NCSF worked with several swing clubs that continue to be threatened with closure because of overly-restrictive zoning laws.
Spokesperson Susan Wright gave 81 interviews with the media in 2002 including print, radio and television interviews on national shows such as The O'Reilly Factor. Incidents such as the CWA attacks against SM conferences required extensive media contacts. In addition, the trial and conviction of serial killer John Robinson in Kansas City necessitated media work because Robinson met several of his victims in SM chat rooms. The witness who reported Robinson's theft of her toys to the police, resulting in Robinson's arrest, consulted with NCSF prior to her appearance in the trial.
The SM community rallied when Jack McGeorge's participation as a UN Weapons Inspector in Iraq was questioned by the Washington Post in a series of SM-negative articles. It was suggested that McGeorge should be dismissed from the UN weapons team because, among other things, McGeorge is a former Chairman of NCSF. Community members sent dozens of "Letters to the Editor" to the Washington Post, NY Daily News, CNN, and Fox News protesting the attacks against McGeorge, who received support from Hans Blix and remained on duty as a Weapons Inspector.
Clubs regularly contact NCSF to receive media training for incidents or events. In one media incident, a nonprofit club in Muncie, Indiana, was threatened with closure along with a nearby strip bar until the media was educated about safe, sane and consensual SM. NCSF also gave media assistance to a swing club in Connecticut which was closed because of zoning issues.
Job discrimination continues to be a problem for individuals. NCSF helped more than a dozen people draft and file formal complaints with their employers regarding employment discrimination claims. One Tennessee man lost his job because he belonged to a leather club. NCSF referred a Texas man to the EEOC because of racial discrimination. A California woman contacted NCSF when a job offer was withdrawn when her personal website was discovered. Another woman was dismissed from a private Catholic university because of her private sexual expression.
Discrimination complaints were also made about two Internet companies in 2002. In July, E-bay pulled all of its SM-related material for sale, while Match.com deleted a therapist's ad because it mentioned their poly therapy practice.
NCSF was contacted by individuals, attorneys and prosecutors on a variety of criminal cases, including: an exhibitionist arrested for public exposure, prostitution and obscenity charges against a pro-domme, and one individual cited for carrying SM toys in their car. NCSF also made referrals to resources and the appropriate authorities in several domestic violence incidents. In one case, a protective order was obtained.
In September, NCSF assisted in a behavioral forensic investigation concerning the alleged kidnapping of a Vancouver, Washington, man who was involved in master/slave relationship. NCSF worked with both prosecution and defense. The result was the dismissal of the unfounded charges of kidnapping and assault.
NCSF is here to help you -- the SM, swing and polyamory communities. If you have a problem with discrimination, persecution, or harassment because of your sexual expression, please call NCSF for assistance. You can visit our website on www.ncsfreedom.org or call our office at 410-539-4824.
And please support NCSF in our effort to change the political, legal, and social environment in the United States. We are a grassroots, volunteer organization committed to making a difference. Join NCSF as a member or please hold a fund-raiser and donate to NCSF!
Millions of adults engage in SM, swing, and polyamory activities. Many experience discrimination and persecution due to negative stereotypes that are encouraged by the media and religious political extremists. NCSF's 1998 Violence & Discrimination Survey found that 30 percent of the respondents experienced discrimination, while 36 percent suffered violence or harassment.
Behaviors involving the consensual exchange of power, and intense erotic stimulation and/or mental and emotional discipline to produce sexual arousal and satisfaction. Over 12 percent of adults have engaged in SM practices (also known as BDSM, leather or D/s).*
Social and sexual interaction with someone other than your significant other, with each couple honestly defining the limits of their activities for themselves. 2 percent of adults have tried swinging (also known as the Lifestyle).**
Committed, loving relationships that involve more than two adults consensually exploring love and sex outside of traditional monogamy. Four percent of adults have engaged in sex with another person and their spouse.**
* Janus, S., and Janus, C. The Janus Report on Sexual Behavior, 1993.
** Reinisch, J. Kinsey New Report on Sex, 1990.
The following Principles and Guidelines are intended to help law enforcement and social services professionals understand the difference between abusive relationships vs. consensual sadomasochism (SM). SM includes a broad and complex group of behaviors between consenting adults involving the consensual exchange of power, and the giving and receiving of intense erotic sensation and/or mental discipline.
SM includes: "intimate activities within the scope of informed consent that is freely given."
Abuse is: "Physical, sexual or emotional acts inflicted on a person without their informed and freely given consent."
The SM-Leather-Fetish communities recognize the phrase "Safe, Sane, Consensual" as the best brief summary of principles guiding SM practices:
Safe is being knowledgeable about the techniques and safety concerns involved in what you are doing, and acting in accordance with that knowledge.
Sane is knowing the difference between fantasy and reality, and acting in accordance with that knowledge.
Consensual is respecting the limits imposed by each participant at all times. One of the recognized ways to maintain limits is through a "safeword" which ensures that each participant can end his/her participation with a word or gesture.
Informed consent must be judged by balancing the following criteria for each encounter at the time the acts occurred:
Whether an individual's role is top/dominant or bottom/submissive, they could be suffering abuse if they answer no to any of the following questions:
These guidelines were created by activists and leaders at the Leather Leadership Conference in 1998.
17th Annual Symposium
in San Diego, California on Aug 27, 1999
I. Who we are... why we are doing this
Introductions of Dr. Ruth W., neurologist, and Susan Wright, Policy Director of NCSF
We are presenting on "SM Issues for Healthcare Providers" because the same issues which may lead to inadequate health care for patients with non-mainstream sexual orientations or gender identity affect those who participate in sexual minority practices.
There are many questions related to physical or psychological health which patients may feel unable to ask because of fear of discrimination or of breach of confidentiality. As health care providers, we have a responsibility to be able to address these concerns without passing judgment.
An understanding of the basic principles of SM play enables us to fulfill this responsibility. In addition, it is important that we be able to identify when someone is in an abusive, non-consensual situation, and to provide them with appropriate support. This workshop will address the physical and psychological aspects of SM practices and provide an understanding of common scenarios.
II. Examples of questions Doctors may get
A 50 y/o man defers consulting his family physician about lower abdominal cramping associated with bowel movements because he is afraid the doctor will be able to tell he is into anal sex play and enemas, and that this may be related to his problem.
A 30 y/o woman gets a vaginal tear from fisting, which is continuing to bleed, but doesn't want to consult her doctor or got to the ER.
A 45 y/o man is left in bondage by a professional dominatrix for too long and develops numbness and weakness of both arms which does not resolve after a couple of days.
A 25 y/o woman newly diagnosed with MS is scared to explore her new interest in SM with her girlfriend, because she doesn't know how to ask her neurologist about what might be safe or dangerous for her to do.
The same issues which may lead to inadequate healthcare for patients with non-mainstream sexual orientation or gender identity affect those who participate in sexual minority practices. This includes gays, lesbians, bisexuals, folks who enjoy SM, who have body modifications such as piercings, tattoos, who crossdress, who are sex workers, who have multiple partners, who are transgendered or engage in fetish behavior.
There are many questions related to physical or psychological health which patients may feel unable to ask because fear of discrimination or of breach of confidentiality. Simple problems fester or become chronic. Patients are afraid to tell their doctors about their alternative sexual expression - even doctors they know are kink-friendly.
We are all unused to discussing sexuality in a neutral atmosphere and we are not given training to do it. In the LGBT community we are at an advantage, because sexuality is often more to the forefront than in the heterosexual community, but this certainly doesn't make us immune to being judgmental about practices outside our realm of experience. But precisely because of this reason I would argue that we have more of a responsibility to address issues related to alternative sexual practices.
Everyone deserves adequate health care, whether they are kinky or straight. As a prerequisite to good health care, the patient must trust their physician.
As healthcare providers we have a responsibility to be able to address these concerns without passing judgment. An understanding of the basic principles of SM play enables us fulfill this responsibility. In addition it is important that we be able to identify when someone is in an abusive situation and to provide them with appropriate support.
III. What is SM?
SM includes a broad and complex group of behaviors between consenting adults that involves the consensual exchange of power. This includes the giving and receiving of intense erotic sensation and/or mental discipline and power games.
SM activity is often called "playing" or having a "scene" because that is the way the SM-Leather-Fetish community approaches our form of sexual expression. Our equipment is often referred to as "toys". Like any other kind of game, we have rules we play by.
Individuals negotiate their limits prior to having a scene. Negotiation is ongoing; before, during and after the scene (what's known as "aftercare") to make sure the bottom is fine with what occurred. In our community, it's considered polite to check in with a bottom the day after the scene (or to request that they call you). This is usually more for the psychological issues that may have arisen rather than physical concerns.
SM does not feel like what it looks like. SM rests on a firm foundation of ongoing communication because most of what's going on is in the participants head. I'll use the term top and bottom, but it's also called dominant and submissive, or master and slave. SM is sometimes called D/S or BDSM or the practitioner may not identify or label their activities at all.
Contrary to popular stereotypes, the bottom is in control of the scene and can stop the activity at any time. Often people use a predetermined "safeword". This is a word or gesture that will stop the scene. At community events, the established safeword is "safeword," but individuals often have their own personal safeword, or some simply use "no" to mean "no." Sometimes people who are very submissive have trouble saying no, so a word like "red" is easy for them to say. Or some bottoms like to resist and say no, when they really mean yes, so they choose to have a safeword.
This community-wide standard was codified more than ten years ago in the creed: "safe, sane, consensual."
1. Safe is being knowledgeable about the techniques and safety concerns involved in what you are doing, and acting in accordance with that knowledge.
This includes protection against HIV, STDs, and hepatitis. It also includes notifying your partner of any physical condition that may impact on the scene, like asthma, bad back, epilepsy, etc. It also includes psychological safety, such as you were abused as a child and don't like a particular part of your body touched.
The community concerns itself with safety issues by supporting hundreds of educational and social organizations that teach people the proper way to use their equipment. Such as: how to tie wrists without putting pressure on the insides; how to properly clean equipment; which areas on the body are unsafe to stimulate, such as the face, joints, spine, bottoms of the feet.
2. Sane is knowing the difference between fantasy and reality, and acting in accordance with that knowledge.
Since physical acts has so much power, there are many fantasies that can be acted out by only hinting at the physical conditions someone fantasizes about. That's why our language is so symbolic: dungeon, slave, words of humiliation, or affectionate ownership. You may have to break through the fantasy to make sure your patient likes and wants what is happening.
Sane includes being of clear mind, and the community strongly recommends that mind-altering substances should be avoided during a scene, including alcohol, illegal drugs, and prescription drugs that impair judgment.
3. Consensual is respecting the limits imposed by each participant at all times. One of the recognized ways to maintain limits is through the "safeword" I mentioned. If it's nonconsensual, then it's abuse or assault. SM must be consensual.
To determine if informed consent has been reached, you can ask the following questions:
a) Was informed consent expressly denied or withdrawn? (similar to rape standards, if one of the participants withdraws consent during the activity, that must be respected)
b) Were there factors that negated the informed consent? (alcohol impairment, drug use, underage participants)
c) What is the relationship of the participants? (first encounter or long-term partner?)
d) What was the nature of the activity? (did it cause permanent harm, was it unsafe, was it enjoyable?)
e) What was the intent of the accused abuser? (to cause pleasure, to gain dominance, to gain control, to hurt?)
IV. SM vs Abuse
The community standard of safe, sane and consensual emerged from the growing national concern with domestic violence. SM is not domestic violence, but increasingly as SM gains wider mainstream acceptance, there are abusers who take advantage of men and women who enjoy SM. This makes it difficult for you, as a doctor who is required to report abuse.
If there are physical signs, you can usually judge by the marks:
1. SM rarely results in facial marks or marks that are received on the forearms (defensive marks).
2. There is usually an even pattern of marks if it is SM, indicating the bottom held quite still during the stimulation.
3. The marks are often quite well-defined when inflicted by a toy like cane or whip, whereas in abuse there are blotches of soft-tissue bruising, randomly distributed.
4. The common areas for SM stimulation is on the buttocks, thighs, back, breasts, or the genitals. The fleshy parts of the body can be stimulated intensely and pleasurably.
Questions to ask to determine if it is abuse. Whether an individual's role is top/dominant or bottom/submissive, they could be suffering abuse if they answer no to any of the following questions:
1. Are your needs and limits respected?
2. Is your relationship built on honesty, trust, and respect?
3. Are you able to express feelings of guilt or jealousy or unhappiness?
4. Can you function in everyday life?
5. Can you refuse to do illegal activities?
6. Can you insist on safe sex practices?
7. Can you choose to interact freely with others outside of your relationship?
8. Can you leave the situation without fearing that you will be harmed, or fearing the other participant(s) will harm themselves?
9. Can you choose to exercise self-determination with money, employment, and life decisions?
10. Do you feel free to discuss your practices and feelings with anyone you choose?
V. Intersections of SM and Healthcare
The role of Health Care Providers is to educate the patient to understand the medical problem. Give the patient the info to help determine what is safe, and what to do if there is a problem. If they don't know already, they should know to educate play partner(s).
1. When SM causes health problem (least common). An accurate report of activity is essential and requires trust from patient:
a) Fainting or dizziness
b) Bondage-related - causing nerve damage, joint strain, numbness
c) problems releasing retained rectal objects
2. When the patient wants advice on what is safe (pretty common). Much of this we can figure out from common medical knowledge (eg how long can vascular supply be cut off), but you may need expert advice on this from scene-friendly physicians:
a) extreme bondage (breast, genital)
c) breath control
d) anal play
e) nipple piercing and breast-feeding
3. When health problem inhibits a patient from full expression of sexuality. This is more straightforward, and involves educating patient about their disease:
a) MS: fatigue, overheating, numbness, coordination, sexual dysfunction,
b) CAD: HTN level of exertion,
c) Diabetes: avoiding hypoglycemia,
d) Asthma: need quick-release restraints, no chest or breath restraint,
e) Epilepsy: awareness of aura, what to do if seizure occurs,
f) LBP, arthritis: avoid putting strain upon joints (shouldn't do this anyway).
VI. Talking to your Patients about SM
1. Who is involved in SM?
You have patients involved in SM practice and you don't know it. One out of every ten Americans engages in diverse sexual behavior, yet the stigma against these millions of people means that these people aren't talking about their sexuality as it impacts on their health concerns.
How does a patient come out about SM activities to a healthcare provider? It may be that the provider simply notices piercings or marks or shaved skin. Don't ignore these signs--ask questions to ensure it is consensual SM. That will encourage your patient in turn to ask their health care questions. As you ask questions, never assume you know the kinky activity by a person's appearance.
As an added bonus, Doctors can benefit from being kink-aware because the SM community constantly talks to each other. They belong to support groups, women's groups, special interest groups, and word gets around. You could find you're getting many referrals if it's known that you don't pass judgment on their lifestyle.
2. Don't discriminate against SM practitioners.
It is imperative for you to be nonjudgmental. As a prerequisite to good health care, the patient must trust their physician. To create that trust, the HCP must be receptive. Patients are often inhibited from going to HCP in the first place because of embarrassment/fear of being judged or discriminated against. Many practitioners don't even tell their therapists much less their doctors.
You must be aware that there is REAL discrimination and persecution going on against SM practitioners. The analysis of the NCSF Violence and Discrimination Survey indicates that 1/3 of the respondents have suffered discrimination because of their SM practice, and another 1/3 have suffered attacks and harassment because of their SM practice. People lose their kids, their jobs, their spouses, and even suffer estrangement from family members because of the stigma. NCSF has received complaints from people who have been lectured by their doctors to stop what they are doing, or they were made to feel like they were wrong.
Just because you treat and understand a kinky patient, that's not the end of the road. Often you have to make referrals, and you will have to educate other HCP. This includes making them comfortable enough and knowledgeable enough to give quality medical care to the patient.
3. How do you talk about SM with your patient?
You as the Health Care Provider may be embarrassed about expression of sexuality in patient. Most of us are uncomfortable with discussing sexuality. Medical school doesn't address this issue, and our society is taught to treat sexuality as a joke or something to be avoided.
4 out of 5 of the people who participate in the organized SM community are closeted at work or with their friends and family. Some don't even tell their primary partner about the SM activities they engage in. This can cause problems for the doctor when the patient hems and haws and doesn't ask their real question until your hand is on the door knob. It can take up extra time you don't have. So be sensitive to hints and tentative probes - it may be up to you to help them discuss their activities and how it might be adversely affecting their health.
Remember that your patients have had no experience talking about this in the way that you require. They may provide too much information about their personal desires and explain their sexual encounters in ways that are embarrassing to you. They aren't trying to shock you - they are simply sharing in the way they've learned through SM support and educational groups. You can gently help them stay on track by asking questions and keeping the dialogue moving.
We are here because we want to be able to address these needs of our patients, as they can have deep impact upon level of healthcare sought and given. Patients have a right to this. If we don't feel comfortable we should refer to someone else, and not at patient's emotional expense. As LGBT Health Care Providers, I feel we are better equipped to deal with these issues because our sexuality is a more prominent factor in our identity, and we should have more empathy for those who feel marginalized because of sexual practices.
We don't have all the info about what the patients' needs are, and they may not tell, or even anticipate all of their activities, and they don't have the medical information to make decisions about safety.
How we can appear non-judgmental:
a) Ask about sexual partners/activities when taking medical history
b) Be very careful about judgmental language and use open ended questions.
c) Ask patient to define terms used rather than making assumptions.
The NCSF Incident Reporting & Response (IRR) program provides assistance to individuals and groups within the alternative sexual expression communities who become victimized because of SM, leather, fetish, or swing practices.