HIV COUNSELOR PERSPECTIVES Volume 10 Number 4 July 2001 DIVERSE SEXUAL PRACTICES There are many different ways of having sex, and different people have their own preferences for sexual activities. Although some sexual activities pose a high risk for HIV infection because they involve potential contact with bodily fluids such as blood, other activities may place participants at risk because of the particular dynamics of the situation. It is important for HIV test counselors to have a basic understanding about the varieties of sexual expression and to be comfortable discussing diverse sexual practices with clients. This issue of PERSPECTIVES provides an overview of a variety of sexual activities and a discussion of the related HIV risks and safety measures. between consenting adults. Sadism compensate for pain, sometimes caus- Research Update and masochism usually refer to the ing intoxication.2 association between sexual arousal Research suggests that S/M is a rel- There are a variety of ways to and physical or psychological pain.1 atively common behavior in the express and fulfill sexual desires, and Sadists enjoy administering pain, and United States. In 1953, the ground- many people engage in an array of masochists enjoy receiving pain. In breaking Kinsey study of sexuality sexual activities that may not be addition, S/M often involves evok- concluded that about 11 percent of the widely familiar. Some people engage ing feelings of helplessness, sub- U.S. population engaged in S/M activ- in role playing that may involve servience, humiliation, and degra- ities such as bondage or whipping.3 psychological dominance and sub- dation. Unlike most other types of mission, physical bondage, and the sexual activities, S/M does not nec- Popularity of S/M infliction of pain. Sexual activities essarily involve genital stimulation A study of 178 men who practiced may also involve bodily manipula- or penetration, partly because arousal S/M behaviors found that 48 to 80 tion, the use of “sex toys” and other and orgasm can be achieved in other percent reported engaging in and devices for sexual stimulation, feces ways. “S/M” is also commonly used enjoying spanking, bondage, humil- and urine, temperature and electri- as a general term for a broad range iation, whipping, and the use of dil- cal stimulation, sex with multiple of alternative sexual practices that dos. About 40 percent reported partners, or any combination of these may not involve the infliction of pain. engaging in behaviors that cause pain or other elements that arouse the The pain associated with S/M can participants and enhance their sex- be pleasurable because pain is expe- ual experience. rienced on a continuum, and sexual Inside PERSPECTIVES arousal increases tolerance for pain.2 1 Research Update Sadomasochism As a result, stimulation that usually 5 Implications for Counseling Sadomasochism (S/M or S&M) is causes pain may be pleasurable in a a widely used term that encompasses sexual context. In fact, the physio- 7 Case Study activities involving dominance, sub- logical response to pain is similar to 8 Test Yourself mission, bondage, and inflicting or that of orgasm.3 The brain produces 8 Using PERSPECTIVES receiving pain during erotic play natural opiates called endorphins that 2 PERSPECTIVES: DIVERSE SEXUAL PRACTICES but are relatively safe, including the are often difficult or impossible to con- use of ice, hot wax, biting, and slap- duct once play begins. According to some ping. Burning, branding, tattooing, Points that are typically covered estimates, 25 percent of all and piercing were considerably less when negotiating an S/M scene popular: between 7 percent and 15 include who will be involved, the adults in the United States percent reported ever engaging in location, how long it will last, who have at least experimented these behaviors.1 will assume which role, what will In a study of 34 women who happen in case of emergency, what with bondage. engaged in S/M activities, partici- are the bottom’s physical and emo- pants tended to be better educated tional limits, if the bottom has any ties up, handcuffs, or otherwise and less often married than the gen- dangerous medical conditions such restrains the bottom and then pro- eral population. Participants reported as heart problems or joint injuries, ceeds to tease, seduce, frustrate, and first being attracted to S/M as young and if oral, vaginal, or anal sex are ultimately satisfy the bottom.2 Accord- adults, and 87 percent were com- mutually acceptable.7 The negotia- ing to some estimates, 25 percent of fortable with their desire to engage tions should also cover history of sex- all adults in the United States have at in S/M. Sixty-eight percent identi- ually transmitted diseases (STDs), least experimented with bondage.7 fied as heterosexual, 20 percent as HIV status, and condom use. In an analysis of 514 messages sent bisexual, and 12 percent as lesbian. A common precaution is to agree to an international computerized dis- Twelve percent reported preferring on a code word or safe word that cussion group on sexual bondage, the the dominant role during erotic play, either person can use to stop the most frequent experience was play- 47 percent preferred the submissive scene, even if it involves enacting a ful use of bondage to explore new role, and 41 percent were “versatile,” fantasy about resisting and pleading areas of sexual pleasure. The study meaning they had no preference the other partner to stop.8 One exam- also found that a preference for the between dominant and submissive ple of a safe code is agreeing that the dominant role was expressed in 71 roles. Oral sex, spanking, and word “yellow” signals a partner to percent of the messages by hetero- bondage were the most commonly slow down or that shouting “red” sexual men, 11 percent by heterosex- favored activities, while behaviors will stop a scene completely.6,9 ual women, and 12 percent by gay involving exposure to urine and feces S/M play can be especially risky men. Preference for the submissive were least favored.4 when combined with alcohol or other role was expressed in 29 percent of In a national survey of 272 men drugs. Many S/M activities involve the messages by heterosexual men, 89 who engaged in S/M, 79 percent felt specialized skills, such as complex percent by heterosexual women, and satisfied with their S/M interests, 16 bondage setups, which may be com- 88 percent by gay men.10 percent reported occasional feelings promised by substance use. Sub- In a study of S/M preferences of shame, and 7 percent reported feel- stances that make the submissive part- among 272 men, the dominant role ing “dirty” or “perverted.”5 ner insensitive to pain or that impair was preferred by 33 percent of het- the dominant partner’s judgment and erosexual men, 21 percent of gay men, Trust and Communication coordination may increase risk of and 20 percent of bisexual men; the Trust and communication are injury and non-consensual acts.2,6 submissive role was preferred by essential for safe and responsible S/M 32 percent of heterosexual men, 38 play, especially if blood, burning, D&S and B&D percent of gay men, and 48 percent bruising, scarring, or exchange of bod- Dominance and submission (D&S) of bisexual men. The study also found ily fluids are involved. A misconcep- is an erotic power game in which both that 35 percent of heterosexual men, tion about S/M behavior is that harm partners consent to a role of con- 41 percent of gay men, and 32 per- is inflicted on partners against their trolling or being controlled.2 In dom- cent of bisexual men were versatile.5 will. Like any other form of healthy inance and submission role-playing Safety precautions during sexual sexuality, S/M play occurs between “scenes,” the “top” is the dominant bondage help minimize the risk of two consenting adults who negotiate or controlling partner, and the “bot- injury and infection. One potential the limits of their encounter. tom” is the submissive or obedient hazard is being tied up too tightly, Because of personal tastes, some partner. Examples of dominance and which may cut off circulation to hands, S/M activities are enjoyable for some submission scenarios include assum- feet, breasts, or genital areas. Padded, people but not for others. To ensure ing the roles of a master and a slave, wide leather cuffs can protect bound the pleasure of an encounter, partners a prison guard and an inmate, and joints from injury and are typically communicate with each other prior a teacher and a student. loose enough that they do not restrict to engaging in the S/M activity.6 As Bondage and discipline (B&D) is a circulation. Any bondage that con- in other sexual situations, negotiations type of role play in which the top stricts the neck is dangerous because PERSPECTIVES: DIVERSE SEXUAL PRACTICES 3 even light pressure on the throat can Penetration and Sex Toys that will be cut and to wear latex cause loss of consciousness.8 Just as it is important to practice gloves to avoid contact with blood.2 Some people engage in genital safer sex when penile penetration During play piercing, the top part- bondage to stimulate the penis or cli- occurs, precautions during other pen- ner typically pinches and lifts a bit toris. For example, ropes can be tied etrative activities reduce the risk of of skin (often around the nipple) and around a woman’s midsection and transmitting HIV and other infections. slides the sterile needle through. Each between her legs in such a way that “Fisting” is the practice of insert- needle may not cause much pain, but the labia—the folds of skin that cover ing the entire hand into the vagina it stimulates the nerve endings and the clitoris—are pulled back, expos- or anus.