BDSM and Kink: Essential Insights for Providers

A patient comes into your office, or a client climbs up on your massage table, with visible bruising on their arms and legs. How do you respond? Do you immediately screen for domestic violence? Are you prepared to ask open-ended questions that will allow them to disclose abuse, self-harm, combat sports, or participation on BDSM (bondage, discipline, domination, submission, sadism, masochism) with equal understanding and safety for their vulnerability?

Lilithfoxx, queer sexologist, AASECT-certified Sexuality Educator, and relationship & intimacy coach, tells me, ““Most of all, I wish providers knew that kink isn’t rare. Studies consistently show that a significant percentage of adults have engaged in or fantasized about BDSM practices.” That percentage is even higher among LGBTQ+ people, yet many healthcare professionals lack the training to respond competently. The gap between prevalence and provider education creates real barriers to care—particularly for queer and trans patients who already face disproportionate healthcare avoidance.

“When professionals dismiss or stigmatize it,” Lilithfoxx says, “they’re dismissing a huge part of their patient population. Creating a culturally competent practice means including kink in intake forms, using neutral language, and being curious rather than critical.”

So what is BDSM and why does it matter in inclusive health and wellness spaces?

In Hurts So Good: The Science and Culture of Pain on Purpose, researcher and journalist Leigh Cowart writes that "at its core, masochism is about choosing pain on purpose, for a reason. And often, in my experience, that reason is to feel bad to feel better." Cowart explores various forms of deliberate pain—from freezing cold winter ocean plunges to last-person-standing multi-day ultramarathons to hottest-of-the-hot chile pepper eating contests—demonstrating that consensual pain-seeking exists across contexts far beyond sexuality.

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