Top Tips on Exploring Kink and Fetish Freely and Safely

Practices labelled ‘kinky’ and fetishes constitute an integral part of the diversity of human sexual self-expression. Long since marginalised and treated like diseases, nowadays, such sexual interests are treated with more nuance and legitimacy due to advances in scientific research. From a diagnostic perspective, the question is no longer about moral norms, but instead about consent, safety and the eventual distress associated with such practices (APA, 2013 ; First, 2014).

Kink is an umbrella term whose origins stem from sex communities. It is used to categorise sexual practices or dynamics viewed as atypical compared to more dominant norms. It’s not a medical term, nor does it have any connotation with sickness (Moser & Kleinplatz, 2005). It encompasses BDSM practices, but also role playing, relationship scenarios and consensual power dynamics.

BDSM is an acronym to mean bondage, discipline, domination, submission, sadism and masochism. Amongst other things one may find, physical and sensory impairment (handcuffs, blindfolds etc.), the administration of pain ( nipple clamps , spanking etc.), and humiliation (verbal humiliation, ball-gags etc.). BDSM can be practiced with or without sexual intercourse taking place (Connolly, 2006 ; Ambler et al., 2017). Above all, BDSM is about eroticising power dynamics and relational asymmetry. No practice is spontaneous; scenes are chosen between partners, according to their respective interests.

Indeed, the conscious use of psychological domination and submission, physical bondage, pain, and/or similar experiences are practised in a safe, legal, and consensual manner so that participants may experience erotic excitement and/or personal growth (Wiseman, 1998). Let’s not forget that from the moment that the consent and safety of a person is no longer respected and ensured, we’re no longer talking about BDSM, but instead sexual violence.

Fetishism refers to sexual arousal primarily centred on an inanimate object, a non-genital part of the body, or a material (leather, latex etc.) (Scorolli et al., 2007). This focus may be exclusive or not, stable or fluctuating. Fetishisms aren’t necessarily problematic, and they only become a clinical issue when accompanied by stress or a change in behaviour (APA, 2013).

A study from Scorolli et al. (2007), based on the analysis of online forums, shows that the most frequent paraphilic interests concern:

• Body parts, specifically the feet
• Objects that are associated with the body, such as shoes or underwear

These preferences are often part of a sensory continuum centred on textures, shapes and smells, rather than a radical departure from so-called ‘classical’ sexuality.

A significant proportion of adults report at least one paraphiliacal interest or behaviour during their lifetime (Bauserman, 1997 ; Ahlers et al., 2011 ; Holvoet et al., 2017). In one study from Quebec, 23.6% of people report having had an experience linked to fetishism (Joyal et al., 2014). In the Czech Republic, 31.3% of men and 13.6% of women had at least one paraphiliacal interest, including fetishism (Bártová, 2021).

What’s more, 46.8% of Belgian people have already practiced some form of BDSM, and amongst them, 12.5% practice it regularly. Interest in BDSM and fetishism is much higher in men than in women (Holvoet et al., 2017). All of this data confirms that fetishism and kinks are common variations of human sexuality.

One common belief is that kinks and fetishes are linked to trauma, in particular sexual trauma, experienced during childhood. A qualitative study done on 260 participants who practice BDSM showed that less than 19% mention any form of traumatism in where their desires originated. 72% of participants attribute their practices to their identity (personality, personal taste, exploring different roles), 38% to their environment (general life experience) and 22.7% to biological and genetic factors (Hughes & Hammack, 2022).

A multifactorial study is therefore appropriate. This needs to incorporate:

• Learning and conditioning mechanisms
• Individual differences in the experiencing arousal and sexual inhibition
• Sociocultural, relational and identity-related factors (Brown et al., 2020).
  

This form of intentional communication favours an atmosphere of trust, mutual responsibility and emotional intimacy. What’s more, the conscious way in which people deal with power dynamics suggests recognition of agency, where each person is entitled to withdraw consent at any moment, reinforcing autonomy and the feeling of subjective control (Weiss, 2011).

Those whose practices BDSM do not present more psychological troubles than the general population, and may even report higher indicators of well-being (Wismeijer & van Assen, 2013). An experimental study brought to light the fact that consensual BDSM scenes can induce states of flow accompanied by a temporary reduction in stress and negative attitudes (Ambler et al., 2017). According to Csikszentmihalyi (1991), flow is a state of modified consciousness achieved during ideal conditions, often associated with extreme concentration, a floating feeling and the impression of being perfectly connected to a situation. These results suggest that BDSM practices can play a beneficial, regulatory role in an individual.

A paraphilia refers to an intense and persistent sexual interest in atypical objects, situations, people or dynamics. It is not a diagnosis in itself.

Nevertheless, a paraphilic disorder can be diagnosed when it:

• Causes significant suffering
• Alters social, professional or relational functioning
• Poses a threat to others, specifically in the case of a lack of consent (APA, 2013).

This distinction aims to avoid pathologising consensual sexual practices amongst adults, all whilst preserving a clear framework for identifying dangerous situations, or ones that cause suffering (APA, 2013 ; First, 2014 ; Moser & Kleinplatz, 2005). For example, in one German study 62.4% of men reported having at least one paraphilia, but only 1.7% of them experienced significant stress because of it (Ahlers et al., 2011). The clinical issue, therefore, lies in evaluating the space that these interests take up in a person’s life, rather than evaluating the interest in itself (First, 2014). From the moment a paraphilia becomes dangerous to oneself or another person, it’s important to seek professional help. It is also essential to note that a paraphilia can be fantasised about without being acted upon.

When a person seeks help for distress related to their kinks or fetishes, treatment is mainly based on a psychotherapeutic approach, most often cognitive-behavioural therapy, tailored to the issues presented (Hallberg et al., 2020). Therapeutic support aims to provide a safe and non-judgmental environment, allowing the person to explore their sexual interests, practices and the meanings they attribute to them.

It may be worthwhile to explore relationship and communication patterns, reflect on the conditions that promote consensual, safe and respectful practices, promote individual autonomy, and strengthen assertiveness skills. Therapeutic objectives may also include improving interpersonal communication, strengthening negotiation skills, ensuring consent, regulating emotions related to intimate experiences, and resolving intrapsychic conflicts related to the integration of kinks or fetishism into personal, relational, and identity life (Andrieu, Lahuerta & Luy, 2019).

Pharmacological treatments are reserved for severe forms of paraphilic disorders, particularly in cases where there is a risk to others (e.g. non-consensual sexual exhibitionism), and are also combined with psychotherapeutic follow-up (Assumpção et al., 2014).

A neutral and informed ‘kink-aware’ approach is recommended in order to avoid stigmatisation and promote therapeutic alliance (Sprott et al., 2017). It is essential for professionals to stay informed about advances in research and update their perceptions so as not to reproduce moral judgements under the guise of medical discourse (Moser & Kleinplatz, 2006; Wismeijer & van Assen, 2013). Ethical guidelines for healthcare professionals are available to improve the reception and care of patients who practise BDSM (Moser & Kleinplatz, 2006).

Stigmatisation remains one of the main sources of suffering for people with atypical sexual interests. Fear of medical judgement often leads to the concealment of distress or even a refusal to seek treatment (Waldura et al., 2016). Minority stress models help us understand the psychological impact of this marginalisation, which can contribute to anxiety, shame and isolation (Williams & Sprott, 2022).

It may be helpful for individuals wishing to learn about or engage in these practices to contact BDSM schools. Similarly, it is entirely legitimate to ask healthcare professionals, before any consultation, whether they consider themselves competent to welcome and support patients who practise BDSM.

Kinks and fetishisms make up part of the normal diversity of human sexuality. Kinky practices and BDSM require high-quality, constant communication to clarify desires, limits, roles and consent procedures before, during and after scenes, contributing to safety, trust and positive experiences.

The contemporary medical position is based on a clear distinction between sexual diversity and clinical disorder, in cases of distress, coercion and/or danger. In therapeutic support, the main challenge is to provide a space where these practices can be discussed, to reduce stigma and to support individuals' autonomy in developing a consensual and fulfilling sexuality.